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Recurrent Varicose Veins Treatment

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Modern treatments for Recurrent Varicose Veins

Since Mark Whiteley performed the first endovenous varicose vein surgery in the UK in March 1999, the treatment of recurrent varicose veins has been made much more logical (see: http://www.telegraph.co.uk/news/uknews/1374873/New-varicose-vein-surgery-speeds-recovery.html). Mark and his team realised the potential for the new techniques in recurrent varicose vein surgery, producing one of the first reports of this in 2002 (see: http://www.ncbi.nlm.nih.gov/pubmed/12384651).

Using these new endovenous techniques, it is possible to treat any vein that can be seen with a duplex ultrasound scan, under local anaesthetic using The Whiteley Protocol®.

Therefore, the treatments for recurrent varicose veins are the same set of treatment options as for primary varicose veins, namely:

Although the devices themselves may be the same, the way that they are used can be substantially different in recurrent varicose veins compared to normal varicose veins. This is because after scar tissue has formed, the veins may be distorted and much more difficult to treat.

Using The Whiteley Protocol®, we have never found any recurrent varicose veins that cannot be treated successfully. In the past, patients have often been told that their varicose veins are too difficult or complex to treat and so the patient must just get used to wearing support stockings. Using The Whiteley Protocol®, this is never the case.


Treatments for Recurrent Varicose Veins in the past

In the past, recurrent varicose veins were very difficult to treat.

Doctors used to use a general anaesthetic open surgical technique. Through incisions made in the groin or behind the knee, veins were tied and/or stripped. We now know that this is not a good way to treat veins and Whiteley Clinics have not performed such archaic surgery since 1999. It is amazing that anyone still puts patients through this sort of procedure.

Additionally, doctors who tie and strip veins using open surgery still think that varicose veins come from either the great saphenous vein (GSV) or the small saphenous vein (SSV). This is why their incisions are either in the groin, to find the top of the great saphenous vein (GSV) or behind the knee for the top of the small saphenous vein (SSV).

However, back in 2001, research supervised by Mark Whiteley showed that varicose veins do not start from the top of the vein but rather with valves giving way lower down in the vein. With time, the problem ascends up the vein, with the top of the vein being affected last not first (see: http://phl.sagepub.com/content/17/1/29.abstract).

Therefore the old cutting and stripping operations are basically upside down.

In addition to this, further research from Mark Whiteley and Whiteley Clinics showed that recurrent varicose veins were also associated with incompetent perforating veins (see: http://www.ncbi.nlm.nih.gov/pubmed/11352523) and pelvic varicose veins (see: http://www.jvsvenous.org/article/S2213-333X(12)00035-2/abstract) and research from elsewhere had already shown that other veins such as the anterior accessory saphenous vein (AASV) were also involved (see: http://www.ncbi.nlm.nih.gov/pubmed/14629879).

Therefore, as the open surgical technique causes scars and veins to grow back again, and is usually aimed at the wrong veins, it is not surprising that recurrent varicose veins are common. It is even less surprising that when open surgery for recurrent varicose veins is repeated, the results are even less successful.


References

The Saphenofemoral Valve – A Gatekeeper Turned Into Rearguard Fassiadis N, Holdstock JM, Whiteley MS Phlebology 2002;17:29-31 (http://phl.sagepub.com/content/17/1/29.abstract)
Incompetent perforating veins are associated with recurrent varicose veins. Rutherford EE, Kianifard B, Cook SJ, Holdstock JM, Whiteley MS. Eur J Vasc Endovasc Surg. 2001 May;21(5):458-60. (http://www.ncbi.nlm.nih.gov/pubmed/11352523)
Pelvic Venous Reflux is a Major Contributory Cause of Recurrent Varicose Veins in more than a Quarter of Women Whiteley AM, Taylor DC, Whiteley MS. JVS Venous and Lymphatic Disorders. 2013 Jan;1(1):100-101. DOI: http://dx.doi.org/10.1016/j.jvsv.2012.10.007
(http://www.jvsvenous.org/article/S2213-333X(12)00035-2/abstract)
The lateral accessory saphenous vein – a common cause of recurrent varicose veins. Garner JP, Heppell PS, Leopold PW. Ann R Coll Surg Engl. 2003 Nov;85(6):389-92. (http://www.ncbi.nlm.nih.gov/pubmed/14629879)
New Varicose Vein Surgery Speeds Recovery The Telegraph 19 Nov 2000 (http://www.telegraph.co.uk/news/uknews/1374873/New-varicose-vein-surgery-speeds-recovery.html)
A novel approach to the treatment of recurrent varicose veins. Fassiadis N, Kianifard B, Holdstock JM, Whiteley MS. Int Angiol. 2002 Sep;21(3):275-6. (http://www.ncbi.nlm.nih.gov/pubmed/12384651)