International Training Centre for EVLT

Next week in Barcelona, AngioDynamics is to announce that The Whiteley Clinic has been selected to be the international training centre for EVLT (EndoVenous Laser Therapy).

EVLT was the first endovenous laser system for the treatment of varicose veins and this is now owned by AngioDynamics.

AngioDynamics is fast becoming one of the most influential companies supplying equipment for varicose vein and other endovenous treatments. Their "NeverTouch" endovenous laser system, commonly called the "Gold Tip" laser or more correctly the VenaCure-EVLT, has been featured in the national news and has been increasing in popularity recently.

In addition, AngioDynamics also supplies a product for sclerotherapy and has other developments on the way to improve venous surgery and phlebology.

As part of their aim to improve the training of doctors performing endovenous laser treatment of veins, AngioDynamics are developing four training centres for EVLT in Europe - The Whiteley Clinic in the UK, and three other centres in the Netherlands, Germany and France.

The Whiteley Clinic has a very long history of training doctors, nurses and other healthcare professionals in endovenous techniques and the modern approach to venous surgery, having started running VNUS courses in 1999.

In 2009 The Whiteley Clinic developed a training arm, The Clinical Exchange (www.theclinicalexchange.com), to satisfy an increasing demand for training in different aspects of venous diagnosis and surgery including courses for:

microsclerotherapy and thread vein treatments
endovenous laser ablation
radiofrequency ablation of varicose veins
TRLOP closure of perforators
foam sclerotherapy
ambulatory phlebectomies

In addition The Clinical Exchange runs courses on laser sweat ablation and a pre medical taster course for students considering medical school.

The Clinical Exchange has a teaching room seating up to 48 people with live HD video links to the operating theatre and diagnostic duplex ultrasound room in The Whiteley Clinic. Delegates attending The Clinical Exchange can observe live cases and be in direct contact with the surgeon, vascular technologist and team throughout the procedures, enabling to ask questions as they occur.

With their reputation and history of excellent training in venous subjects, The Whiteley Clinic was selected by AngioDynamics as the lead centre of the four European training centres and is thus both the UK training centre and the International Training Centre for EVLT.

Vulval Varicose Veins on Embarrassing Bodies tonight

Mark Whiteley of The Whiteley Clinic has been asked to supply photos and facts about varicose veins of the Vulva for the TV Program "Embarrassing Bodies" to be screened tonight.

This very common, but much under recognised, problem has been treated successfully by The Whiteley Clinic since 2000. We have treated more patients with this condition than any other clinic in the world, and the veins are classified by The Whiteley Clinic Vulval Varicose Vein grading system:

	Description	Frequency seen at present
Grade 0	Normal – no varicosities nor venous reflux in vulva	Usual
Grade 1	No visible varicosities in vulva, but ultrasound proven reflux in vulval veins usually with para-vulval varicose veins seen on inner thigh	Common – 1 in 7 females presenting with leg varicose veins (1 in 5 of those post vaginal delivery)
Grade 2	Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins.	Uncommon
Grade 3	Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area	Very uncommon
Grade 4	Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing	Rare

see:

www.vulval-varicose-veins.co.uk

Mark Whiteley in the Telegraph.co.uk

Today (Sunday 27th May, 2012) the lovely Kate Shapland mentioned Mark Whiteley in her blog on The Telegraph.co.uk under the title:

"WHERE TO GO FOR VEIN REMOVAL"

Kate is specialist journalist who runs a blog called "The Leg Room"

http://fashion.telegraph.co.uk/beauty/news-features/TMG9290946/Beauty-Notebook-Super-skin.html

"Pioneering research means Whiteley is still leading the way"

For full article, see Surrey Advertiser 25th May 2012
Business News Extra - page 4

This week, Mark Whiteley and his research fellows at The Whiteley Clinic were featured in The Surrey Advertiser.

The article outlined the research and development that The Whiteley Clinic has supported over the last 10 years, in the areas of Varicose Veins treatments, Leg Ulcer Treatments and the development of Laser Sweat Ablation.

Students (ether students wanting a career in medicine or medical students who want to progress their careers) who would like to get involved in the research, are invited to contact The Whiteley Clinic on info@thewhiteleyclinic.co.uk.

Why is anyone still having vein stripping?

A 40 year old lady came to The Whiteley Clinic this week with recurrent varicose veins. She had been to a "vein expert" elsewhere, who had recommended vein stripping under a General Anaesthetic in 2003.

Patient had stripping of right Great Saphenous Vein 3 times
since 2003 by a "vein expert" in London

She had her vein stripped in 2003. Not surprisingly this vein came back again as they usually do after vein stripping.

Unfortunately she has gone back to the same "vein expert" twice since - and had further vein stripping under general anaesthetic twice since!!!

When examined at The Whiteley Clinic, she was found to had strip tract re-vascularisation - re-growth of the vein due to the stripping process.


Duplex ultrasound report showing that Great Saphenous Veins
has grown back - Strip Tract Revascularisation 

This sort of problem is found regularly after vein stripping procedures.

Since we brought endovenous surgery into the UK in 1999, we have not seen a single case of revascularisation in any of our patients following endovenous techniques.

This patient will be treated by 2 sessions of endovenous surgery to her leg, both under local anaesthetic. She will be able to walk home afterwards - true walk-in walk-out surgery.

If she had had this in the first place, it is unlikely she would have need the subsequent 2 operations that she had, nor what we need to do now.

For more information, see http://www.veinstripping.co.uk/

"Superglue" to treat Varicose Veins?

A "superglue" to stick varicose veins together needing virtually no anaesthetic at all, has been developed by Sapheon, a company in the United States.

The product, called "venaseal", is based upon a product that is already used successfully to close other blood vessels elsewhere in the body, such as arteries in the brain.

Only tiny amounts of the "venaseal" who are needed to treat the great saphenous vein, the commonest cause of varicose veins. The great saphenous vein runs between groin and ankle. To successfully treat varicose veins, surgeons usually need to treat the section of this vein that runs between groin and the knee.

Traditionally, this sort of surgery has been done under general anaesthetic using a "stripping" technique (www.veinstripping.co.uk). However over the last 10 years or so, general anaesthetic and stripping has been completely replaced by local anaesthetic endovenous laser ablation (EVLA) or radiofrequency ablation (RFA) in good vein practices.

However these ablation techniques use heat to destroy the vein and so require a lot of local anaesthetic to be injected through the skin and around the vein - a process called tumescence. Unfortunately the injection of tumescence can be very uncomfortable and even painful in some people.

Therefore over the last few years there has been a search for a way to close veins without using heat and thus not needing tumescent anaesthesia to be injected.

Several techniques have been suggested, some of which have been featured before in this blog or on The Whiteley Clinic websites, along with reasons why we do not support them.

Many doctors have started using ultrasound guided foam sclerotherapy which, although very useful in the small veins, has a very poor success rate in the larger veins such as the great saphenous vein. Therefore foam sclerotherapy is a great adjunct to treatments of the great saphenous vein, but it is not a good treatment by itself.

In contrast to this, "venaseal" is looking very promising. The glue is injected under ultrasound control through a single needle access point - the only area that needs any local anaesthetic for the procedure. The early data seems to suggest that the glue sticks the vein together and causes such an intense reaction, the vein appears to be completely destroyed.

If this proves to be the case, it could well be an improvment on endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) which both produce excellent results when used by experts in the correct manner.

In view of this exciting development, The Whiteley Clinic has decided to join the multicentre international trial of "venaseal".

Any patients who are interested in either having "venaseal" treatment at The Whiteley Clinic or being included in the study, are invited to contact us on info@thewhiteleyclinic.co.uk.

Ask an Expert on The College of Phlebology

Since the launch of The College of Phlebology (www.CollegeofPhlebology.com) last month, the "Ask and Expert" section has yielded some of the most useful tips for those people treating veins:

Examples of recently asked and answered questions by Members are:

Q - How far down the calf are you comfortable using laser for gsv or ssv, with regard to nerve damage risk?

Q - Is there any rationale for superiority of applying tumescent from proximal to distal rather than starting at the level of the sheath?

Q - I take it that you still aim for LEED of 60-90 j/cm even with 1470nm laser + radial fiber, and 10W, rather than 5-6W and 30-50 j/cm?

Q - for superficial truncal veins and accessory truncal veins, what depth from skin is your cutoff for avoiding laser for fear of producing a hard pigmented cord?

These questions and more are answered - and any member can pose any questions on vein treatments to the experts on the Advisory Board.

Curing leg ulcers

 First - an e-mail that arrived today:

"Hey Mark,
I saw one of your patients daughter in clinic yesterday .... I referred her to you she had terrible trouble with her leg ulcers, her daughter was so happy and singing your praises and mine for referring, she is off the morphine and walking around, her district nurses cant believe it, just thought I would let you know."

Leg ulcers are a horrible - you might not want to look at these pictures. However, in the UK about 500,000 people and in the USA some 2.5 million people regularly get these. They are often painful and always ruin peoples lives.



Day 1 - Patient has been told by a teaching hospital she will take 2 years to heal!!!
She is on morphine, dressings and compression bandaging. She underwent The Whiteley Protocol
having a scan to show the venous reflux and local anaesthetic endovenous surgery 

Leg ulcers are usually venous leg ulcers (cause by venous reflux) and they are almost always treated by nurses using dressings and compression bandages. 

Day 4 - 4 days after Whiteley Protocol treatment - ulcer left open to the air.
Nurses not allowed ot put dressings on ulcer 

Over the last few years, The Whiteley Clinic has been one of the new wave of vein clinics around the world that have introduced local anaesthetic endovenous surgery. We have spent years researching and understanding venous reflux and venous disease (see the book - "Understanding Venous Reflux - The cause of varicose veins and venous leg ulcers).

Day 8 - Scabs are allowed to form as they are nature's dressing - and allow health skin to form underneath.

We have developed The Whiteley Protocol - a system where we can assess all venous reflux (from Thread veins, through varicose veins, the venous eczema and leg ulcers).

Day 14 - Scabs about to fall off and no pain killers needed now.
Patient is up and walkiong about, pain free for the first time in months



By understanding the underlying problem with the venous reflux, we find that we are able to cure over 60% of people with leg ulcers. We cure them by fixing the reflux using our local anaesthetic endovenous methods and then allowing the ulcer to heal by exposure to the air (and NOT allowing dressings and bandages which now are not needed). 

Day 19 - Paitient well on way to healing, walking without aid and on no pain-killers
No comperession bandaging nor dressings have been used since.

Unfortunately, most people with leg ulcers never get a chance to be investigated and cured - and most doctors and nurses never tell their patients that local anaesthetic surgery might be able to cure their leg ulcers and stop them needing dressings and bandaging.

Look out for the Whiteley Clinic research into leg ulcers that is shortly to be published.

For more information see www.legulcers.co.uk

 

Pelvic cause of varicose veins - a problem often missed



Para-vulval veins - a sign of pelvic venous reflux. All of this lady's varicose veins came form her pelvis.
Traditional varicose veins surgery of the leg veins would not cure her.

This 38 year old lady, who has had 2 children, found her varicose veins on both side were getting worse.

A previous treatment of foam sclerotherapy to leg veins had not improved them - and in fact they had continued to deteriorate.

On examination, she had these large varicose veins at the top to the leg, on the inside of the thigh.

These veins are called para-vulval veins, as they emerge onto the leg next to the vulva. There is also a varicose vein coming onto the leg from the anal area.

This is a classic presentation of Pelvic Vein Reflux - www.vulval-varicose-veins.co.uk.

When this lady had her duplex ultrasound scan by the specialist vascular technologists at The Whiteley Clinic, it was found that her Great Saphenous Veins and Small Saphenous Veins on each side were perfectly normal.

If this patient had gone to a normal "vein specialist" it is likely she would have been offered stripping, endovenous laser or radiofrequency ablation - all of which would fail in her case.

What she needs is pelvic veins embolisation and then the legs can be treated successfully after the pelvic problem has been fixed.

www.vulval-varicose-veins.co.uk

For professionals, this and other complex problems will be discussed with members on www.collegeofphlebology.com

College of Phlebology - CollegeofPhlebology.com



The College of Phlebology - The Internet resource for excellence in Veins

The Whiteley Clinic is proud to be Gold Members of The College of Phlebology.

The College of Phlebology is an internet based college, that has something for everyone.

For patients / the public, the College of Phlebology website provides:

• information about veins and vein conditions
• the latest vein treatments
• a search facility to find your local vein expert

For doctors and nurses who treat veins - from thread veins, to varicose veins and leg ulcers:

• training videos
• news items about vein treatments
• forums to "ask an expert"
• use of MCPhleb if you treat thread veins
• use of FCPhleb if you operate on varicose veins and leg ulcers

Launched only a month ago, The College of Phlebology is rapidly growing as a resource for information and education for those interested in veins and vein conditions.

www.CollegeofPhlebology.com

Book ranked 3rd in class on Amazon

Understanding venous reflux - proving popular with varicose veins and ulcer patients

On today's rankings, "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers" was ranked 3rd best selling book on Amazon.co.uk in the class: "surgery > vascular".

It was also ranked 23rd under "medical research".

The book was written as a simple explanation as to how varicose veins and leg ulcers develop from the failure of the valves n the legs - by taking the reader through a step by step account of how the circulation works.

Research from the publishing company has shown that over 75% of the books have been bought by people who have varicose veins or leg ulcers - or friends or relatives of someone who has - and only 25% by healthcare professionals.

The aim of the book is to help anyone to understand how leg veins work - and what goes wrong with them.

The next book in the series - due out this summer - then outlines how these problems are best treated, and explains why some of the older techniques (and a few of the new ones) don't work effectively.

Why Thread Veins need Duplex before Treatment

This lady in her 50s, came to have her thread veins treated at The Whiteley Clinic this week.

Apparently "simple" Thread Veins of the Leg 

She had been to one General Practitioner who had told her that they were cosmetic veins only and did not need treatment. This general practitioner had then given her "cream" telling her the veins with disappear.

Of course they did not, has thread veins of the legs cannot be treated successfully with cream of any sort.

More importantly, no doctor can ever pass judgement on veins without a duplex ultrasound scan showing exactly what is going on in the veins, deeper in the leg.

Apparently "simple" thread veins of the leg on standing

Fortunately, she saw a second general practitioner who is aware that almost 90% of people with "simple" thread veins have underlying venous reflux - or "hidden varicose veins".

Therefore she was referred for a full assessment to The Whiteley Clinic.

Although no varicose veins are visible on standing, a full venous duplex ultrasound scan was performed which is shown below.

Duplex ultrasound scan - X shows venous reflux 

The venous duplex ultrasound scan shows that the great saphenous vein (GSV) has venous reflux from the upper thigh all the way to the ankle. The patch of thread veins is coming straight off one of the branches (or tributaries) from this.

Therefore blood refluxing or "falling" down the great saphenous vein (GSV) is impacting directly onto the thread veins.

If this patient had gone to a cosmetic practice or beauty clinic which did not have a minimum of hand held Doppler but preferably colour flow duplex ultrasound, it is likely that she would have been offered treatment for the thread veins.

Treating these thread veins without treating the underlying cause first is highly likely to cause a disaster, with the patch of thread veins becoming either larger and more difficult to treat (telangetic matting) or brown staining with a progression to more thread veins in the future.
The thread vein course run by The Whiteley Clinic at The Clinical Exchange teaches all delegates why it is essential to perform Doppler examination as a minimum, and how to perform it correctly.
For anyone who has read "Understanding Venous Reflux - the cause of varicose veins and venous leg ulcers" you will be able to see that this patient has phase 1 passive reflux. As such a hand held Doppler at the groin alone would not have been enough to diagnose her.
This patient needs endovenous laser ablation or radiofrequency ablation of her great saphenous vein before her thread veins can be successfully treated.
For more discussion about this and similar cases, please see www.collegeofphlebology.com.
For information about thread vein courses please see www.theclinicalexchange.com

Varicose veins of abdomen and leg ulcer

This patient presented to The Whiteley Clinic this week. He is in his 60s and has a leg ulcer of the right ankle.

Leg ulcer of right leg (covered by clear dressing)

As a child, he had been given injections penicillin into his thighs at age 3 weeks. As he grew up, his legs swelled regularly and he had "fragile veins".

Examining his abdomen when standing, he showed varicose veins of his right lower abdomen running from groin to flank.

Varicose veins of patients left lower abdomen groin up to the flank

This is a rare pattern of varicose veins seen when the veins deep in the pelvis have been blocked for a very long time.

For more pictures and discussion about this case, see: www.CollegeofPhlebology.com

Whiteley Clinic - 9th Fastest Growing UK Health Company

The Whiteley Clinic - 9th Fastest Growing UK Health Company

This month, the Plimsoll "UK Private Hospitals and Clinics Industry - Individual Company Analysis" was published.

The Plimsoll analysis compared the 261 UK Private Hospitals, Clinics and Health Companies.

We are delighted that The Whiteley Clinic came out as 9th fastest growing of these UK companies - and was listed as 22nd best trading partner.

  

Early venous eczema from Varicose Veins

Many people are put off from have their varicose veins treated by doctors, nurses or even just "friends" who erroneously tell them that "Varicose Veins" are just cosmetic".

Varicose veins which have been left for years starting to damage the skin
as evidenced by the onset of Venous Eczema

Unfortunately for the patients who listen, varicose veins are usually the sign that the major truncal veins in the legs have lost their valves, and that the blood is falling back down the veins rather than being pumped up to the heart.

This falling blood (called "venous reflux") impacts on the skin capillaries, and over years causes damage and inflammation.

This patient had left her varicose veins for years, and over the last 12 months, started to notice her ankle was swelling by the end of the day.

Over the last 3 months, an itchy red patch has appeared just below the varicose veins - that she finds she scratches when asleep preventing it from healing.

This is early venous eczema - and the only cure for it is to have the varicose veins scanned and treated effectively - stopping the venous reflux and making the blood pump the right way up the leg veins.

For more information see: http://www.venouseczema.co.uk/ and http://www.venouseczema.com/micro/conditions/venous-eczema/what-is-it/

Perfecting results of varicose vein surgery with RFiTT

George Badham - Whiteley Clinic Summer Research fellow in 2010
Results of RFiTT presented at The Venous Forum April 2012

The RFiTT procedure for treating varicose veins was introduced over 5 years ago as a new technique for "keyhole" varicose vein surgery.

The Whiteley Clinic initally would not use the device as the initial results were disappointing compared to the near perfect results that we expect by treating patients by The Whiteley Protocol(TM).

In Summer 2010, George Badham, a Whiteley Clinic summer research fellow and Cardiff Medical student, preformed a prize winning research study to show how the recommended treatment technique was sub-optimal and he showed how to modify this to optimise the procedure (The Whiteley Clinic Method).

George used a model to perform his research - but of course this doesn't necessarily mean that the optimised technique would work in patients.

Therefore George has analysed one year of patients treated with his optimsed technique - "The Whiteley Clinic Method" - and is presenting his research as a poster at The Venous Forum this week in the Royal Society of Medicine in London.

In this work, George Badham has shown that using his modification to the technique, we have managed to get 100% closure of the treated Great Saphenous Vein at one year - perfect results!

We would recommend that anyone using RFiTT in the treatment of Varicose Veins should use The Whiteley Clinic Method as described by George Badham, to ensure that they get optimal results for their patients.  

Reducing costs of endovenous surgery

Maria Boland - Whiteley Clinic summer research fellow 2009 

This week, Maria Boland will be presenting her research about endovenous surgery at The Royal Society of Medicine in London, at the Venous Forum meeting.

Maria, a medical student and summer research fellow at The Whiteley Clinic in 2009, has assisted in a project analysing how endovenous surgery under local anaesthetic has changed in The Whiteley Clinic since 2005.

Her research has monitored how since endovenous surgery started being performed under local anaesthetic, the amount of work that can be done in local anaesthetic session has increased. This has been due to a combination of new procedures and improved techniques.

As one of the world's leading vein clinics, The Whiteley Clinic experience has shown that they can keep the same excellent high standards of treatment, with excellent patient satisfaction scores and yet have:

• Reduced the number of endovenous devices used per patient
• Increased the amount of work that can be done per local anaesthetic session
• Decreased the number of sessions needed to treat patients

These changes have meant that The Whiteley Clinic is able to reduce the costs of endovenous surgery without any decrease at all on the quality of their work.

Maria's Poster will be on display at The Venous Forum this week at The Royal Society of Medicine and will be called:

"5 year audit of number of visits and endovenous devices required for walk-in walk-out endovenous surgery for varicose veins under local anaesthesia"

M.Z. Boland, B.A. Price, M.S. Whiteley

Warning - Varicose veins coming from Pelvic Veins

This lady, who presented to The Whiteley Clinic with varicose veins, typifies a problem that we are seeing very commonly.

Although her varicose veins appear to be in the legs, when she was scanned by the expert Vascular Technologists at The Whiteley Clinic, it was found that all of her underlying leg veins were normal - and all of the visible varicose veins come from "hidden varicose veins" in the pelvis.

Left leg varicose veins - however scan showed the underlying causes was from Pelvic Veins only. Surgery to the leg varicose veins (Stripping, Laser, Radiofrequency, etc) would NOT have worked

Had this lady gone to a normal varicose vein clinic or seen a normal varicose vein surgeon, she would have more than likely had her normal leg veins treated (by stripping, laser, radiofrequency or foam sclerotherapy).

Using The Whiteley Protocol, our patients have a scan that identifies exactly where the vein come from - and we don't make any assumptions. Hence most of our scans take some 40 minutes or more (unlike most venous scans that are rattled off in 10 minutes or so - missing more difficult patterns like this).

Varicose veins down the backs of both legs - however scan showed the underlying causes was from Pelvic Veins only. Surgery to the leg varicose veins (Stripping, Laser, Radiofrequency etc) would NOT have worked.

The successful treatment of women with this sort of pelvic venous problem starts off by identifying it.

Pelvic vein problems almost always occur in women who have had at least on baby by normal vaginal delivery. Very occasionally the problem can be found in women who have had caesarian sections - and very rarely in women who have not had childbirth, or in men.

Visible veins on the upper inner thigh, next to the vulva, shows that pelvic veins are probably involved.

One of the "tell-tale" signs are women who have veins at the top and inner side of their thighs, next to their vulva (para-vulval veins) as above.

A pelvic duplex ultrasound scan performed by one of our experts then shows which veins are involved, directing treatment by X-ray, through a pin-hole only.

Once the pelvic veins are treated, the bulging veins on the legs can then be treated, knowing that the chance of them coming back again is minimal.

However, if a woman with this problem had undergone surgery using normal techniques (such as stripping, laser of radiofrequency) the veins would return very soon after treatment, as the underlying pelvic veins would have been missed. Unfortunaltely, this is what usually happens and is one of the reasons that so many women get their veins back again after treatment elsewhere.

For more information please see: www.vulval-varicose-veins.co.uk

New Clinical Grading for Varicose Veins of Vulva

Varicose veins of the vulva and vagina are thought to affect somewhere between 100,000 and 500,000 women in the UK, and countless more in the USA, Europe and the rest of the world.

The usual advice given to women with this problem is that "nothing can be done about it" or to wear tight supportive underwear.

However developments over the last decade at The Whiteley Clinic have shown that this condition can be treated with a combination of embolisation of the pelvic veins causing the problem and then foam sclerotherapy of the veins themselves.

In order to choose the right treatments, a grading system is needed to know how severe the veins are. The Whiteley Clinic grading system for varicose veins of the vulva has therefore was introduced in 2011 and has been recently published (2012).

	Description	Frequency seen at present
Grade 0	Normal – no varicosities nor venous reflux in vulva	Usual
Grade 1	No visible varicosities in vulva, but ultrasound proven reflux in vulval veins usually with para-vulval varicose veins seen on inner thigh	Common – 1 in 7 females presenting with leg varicose veins (1 in 5 of those post vaginal delivery)
Grade 2	Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins.	Uncommon
Grade 3	Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area	Very uncommon
Grade 4	Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing	Rare

If you want to see more about this scale, it was first published in:

The treatment of varicose veins of the vulva and vagina. by MS Whiteley
In: Greenhalgh RM (Ed.) Vascular and Endovascular Controversies Update. London Biba Publishing, 2012 p. 666-670


For more information about varicose veins of the vagina or vulva see: www.vulval-varicose-veins.co.uk

Barrie Price wins debate about perforator veins

Mr Barrie Price MS MD FRCS FCPhleb
Consultant Vein Surgeon and Fellow of The College of Phlebology
(www.collegeofphlebology.com)

On Tuesday this week, Mr Barrie Price of The Whiteley Cinic, won his debate at a major international medical conference.

The Charing Cross symposium is the biggest vascular conference in the UK - and one of the major Vascular events each year in the world.

The debate was between Professor Charles McCollum and Barrie Price. Professor McCollum was arguing for the popular assertion that below knee perforating veins do not need to be treated, and treating them is pointless.

Barrie Price spoke engagingly and brilliantly explaining his own experience, The Whiteley Clinic research and also the mechanism of action of perforators as outlined in The College of Phlebology book "Understanding Venous Reflux - The Cause of Varicose Veins and Venous Leg Ulcers".

The debate became quite heated as it became clear that Barrie Price's assertion that these perforating veins are very important in varicose veins, venous eczema and the formation of venous eczema - and that the treatment of these perforating veins is actually essential. Indeed the failure of most venous surgeons to do so is one of the major reasons that varicose veins keep coming back again and that patients with venous leg ulcers spend years in bandages rather than being cured by surgery.

When the audience was asked to vote, it came a a huge surprise to traditional vascular surgeons (who generally do not treat perforators) that 2/3rds of the audience voted for Barrie Price and his arguments.

This year, both Barrie Price and Mark Whiteley were invited to speak and write chapters in the Charing Cross book (see previous blog post). In addition, Judy Holdstock and Charmain Harrison from The Whiteley Clinic were asked to teach on The Office Based Vein Course at the same meeting.

3 Chapters in Charing Cross Vascular Text book

Mark Whiteley and Barrie Price from
The Whiteley Clinic wrote 3 of the chapters

The book "Vascular and Endovascular Controversies Update" has been released at the Charing Cross International meeting that is currently underway in London.

Mark Whiteley and Barrie Price of The Whiteley Clinic have written 3 of the chapters:

• Perforating Veins: I prefer radiofrequency and laser - pages 583-588
  M S Whiteley
• Debate: Treating calf perforators is pointless - Against the motion - pages 602 - 608
  B A Price
• The treatment of varicose veins of the vulva and vagina - pages 666 - 670
  M S Whiteley

In his chapter on varicose veins of the vulva and vagina, Mark Whiteley announces for the first time:

1. The observation that haemorrhoids (piles) arise from pelvic vein reflux, making them amenable to treatment by vein techniques
2. The Whiteley Clinic grading system for vulval venous reflux

Vaginal, vulval and perforator vein treatments

Surgeons Mark Whiteley and Barrie Price, and vascular technologists  Judy Holdstock and Charmaine Harrison - all from The Whiteley Clinic - will be teaching at the Charing Cross Office-Based Vein Practice course tomorrow.

Along with Dr Tony Lopez of The Imaging Clinic, Mark Whiteley and his team will be sharing their expertise in the diagnosis an treatment of:

• Varicose veins of the vagina
• Varicose veins of the vulva
• Incompetent perforating veins

Mark Whiteley and Barrie Price have also been invited to lecture on these subjects on Tuesday in the main Charing Cross meeting.

Mark Whiteley will be lecturing on:

• Perforating Veins - The place of radiofrequency and laser

and:

• Vulval disease treated by coil embolisation

Barrie Price will be heading the debate explaining the benefits of treating perforator vein reflux.

1 year of venous eczema being misdiagnosed as cellulitis

Venous Eczema of left ankle -
heading for venous leg ulcer.
Incorrectly treated as cellulitis
for a year

Venous Eczema of same left
ankle -
Incorrectly treated as cellulitis
for a year

This patient came to The Whiteley Clinic for a second opinion recently, unhappy that his "cellulitis" wasn't improving.

The man had had varicose veins for years, clearly seen in the photographs.

Last year, when his ankles started to swell and he started getting red patches around his ankles, especially on the left, he went to his family doctor who told him that he had "cellulitis" - and infection of the skin.

He was was treated over last summer and autumn with antibiotics - 8 weeks in total - and not surprisingly had no effect from these.

He was referred to a consultant dermatologist who gave him steroid cream - which once again made no difference (as we would expect).

Eventually the patient themselves heard about The Whiteley Clinic and referred himself.

Duplex ultrasound scanning at The Whiteley Clinic showed that he has venous reflux (varicose veins) causing swelling of the ankles (oedema) and skin damage. The veins will be easy to treat by The Whiteley Protocol under local anaesthetic.

When the ankles swell due to varicose veins or hidden varicose veins, or there is skin damage from this cause, then there is a high risk of the patient going on to develop venous leg ulcers.

Treatment with antibiotics or steroid creams do not change this. All such patients should be sent to a specialist vein clinic and have venous duplex ultrasound scan performed by a specialist.

Treatment of the underlying varicose veins (or hidden varicose veins) is performed under a local anaesthetic through tiny pin-holes and not only cures the venous eczema - but also stops any further deterioration, preventing leg ulcers.

For more information see: www.venouseczema.co.uk 



"Best for Legs" - Tatler Guide

See Tatler - Beauty and Cosmetic Surgery Guide 2012 - May 2012

I am absolutely thrilled to be included in the Tatler "Beauty and Cosmetic Surgery Guide - 2012".

This guide surveys the most sought out Doctors in the UK and is published in May.

This year's gide has just hit the shops and is included when you buy Tatler.

You can also buy Tatler and the Guides online at:

http://www.tatler.com/