On 23rd November, there was a meeting in Madrid. It was on the advances in the treatment of varicose veins and pelvic congestion. Prof Mark Whiteley from Whiteley Clinics was a guest speaker.
Mark gave four of the nine lectures and performed two of the seven live cases.
Mark’s first talk was on the investigation and treatment of pelvic congestion syndrome. Pelvic congestion syndrome is still regarded by many doctors as a problem caused by the compression of veins in the pelvis. They also tend to only look at the two ovarian veins. They tend to ignore the two internal iliac veins.
Prize-winning research from the Whiteley Clinics has shown that this is wrong. Judy Holdstock, Angie White and David Beckett performed a prize-winning study into this. In the study, they showed that most pelvic congestion syndrome is actually just “varicose veins” of the pelvis. It turns out that using MRI, CT scanning and Venography can overdiagnose the problem in many patients.
This is very important. The treatment of pelvic congestion syndrome is different depending on the cause. Most patients with pelvic congestion syndrome can be treated at the Whiteley Clinics. We use coil embolisation under local anaesthetic.
Compression needs a stent. This can be a much more involved procedure, with more uncertainty as to the long-term outcome. Therefore, this is very good news for patients with pelvic congestion syndrome.
The second talk by Mark Whiteley examined the use of glue for varicose veins. Cyanoacrylate glue (superglue) is being used to treat varicose veins successfully. Using superglue, the operations can be quicker and require fewer injections. Also, using glue reduces the risk of nerve damage.
However, glue is more expensive than other techniques. Also, it might be less successful in big veins. Finally, some patients can react to the glue. Fortunately, this appears to be mild in the majority of cases.
The use of glue is an exciting prospect in the treatment of varicose veins. Further research and development will show exactly which patients get the most benefit.
Prof Whiteley’s third talk explained that varicose veins, skin changes around the ankle and also venous leg ulcers commonly have incompetent perforating veins under them. Increasing amounts of research show that it is necessary to treat these incompetent perforating veins.
In 2001, Prof Mark Whiteley and Judy Holdstock invented TRLOP. This stands for TRansLuminal Occlusion of Perforators. We perform TRLOP under local anaesthetic.
Our published results of TRLOP are very good. An ultrasound guides the procedure. However, we use a variety of devices including laser, radiofrequency and even glue.
His final lecture explained how we can now see the effect of sclerotherapy on the vein wall. The Whiteley Clinics research department has developed techniques to show how sclerotherapy, glue, MOCA (Clarivein), endovenous laser and radiofrequency ablation affect the vein wall.
By understanding how these techniques work, we can improve how we use them. We have already shown this approach improves the success rate of varicose vein surgery. This is one of the reasons for our very high success rate at Whiteley Clinics.
Mark Whiteley and vascular technologist Eluned “Lyn” Davies performed a live case of TRLOP closure and foam sclerotherapy. The patient had a venous leg ulcer.
Following this treatment, the ulcer should now heal. These procedures are all performed under local anaesthetic alone. We do not need sedation or general anaesthetic. The patient was able to walk home an hour after treatment.
Finally, Mark Whiteley and Vicki Smith treated a patient with extensive thread veins (C1 veins). They injected the veins with micro-sclerotherapy. This procedure is highly effective when performed correctly.
However, the patient needs to wear compression stockings for 2 to 3 weeks for the best result.