In 2000, Mark Whiteley and Judy Holdstock invented a way of closing perforating veins using a needle hole only and the VNUS Closure® catheter. Using the ultrasound to find the incompetent perforating vein, Mark Whiteley and Judy Holdstock would pass a needle into it. They would then pass the VNUS Closure® catheter into the incompetent perforating vein, closing it permanently with heat at 85 degrees centigrade. They called this technique TRLOP (TRansLuminal Occlusion of Perforators).
In 2004 VNUS manufactured the VNUS RFS® on the strength of their procedure, and by using this we have been able to close incompetent perforating veins under local anaesthetic.
In 2008 we moved over to using the RFiTT® device for TRLOP technique which has given us an improvement in our results both in terms of closing the incompetent perforating veins and the speed of procedure.
In 2004 Mr Mark Whiteley presented his TRLOP technique and four-year results in America. The following year, he went back to the same meeting in Miami to present a five-year results of TRLOP to find that one of the delegates from the previous year was presenting his one year results of “PAP”. It transpires that the PAP – or perforator ablation procedure – is in fact the TRLOP technique. The “inventor” of the PAP technique claimed that it could be used with laser and therefore was different from TRLOP.
However, as the TRLOP gains access into a perforator using ultrasound and then passes a heating element into the perforator to close it, it can be seen that PAP is a copy of the TRLOP procedure with no material difference from it.
The role of the incompetent perforating vein in the varicose vein surgery is one of the more complex issues and many surgeons treating varicose veins do not understand either their role or their treatment.
Unfortunately, as many surgeons don’t understand this, it is not surprising that some insurance companies also find it difficult to understand how essential it is to treat these veins.
Perforating veins should take blood from the superficial veins under the skin, in the through the muscle and into the deep veins to be pumped back to the heart. Normal people have about 150 of these perforating veins on each leg.
When these veins lose their valves, high-pressure blood from the deep veins can be squirted outwards into the surface veins, causing varicose veins, thread veins, venous eczema and itching as well as brown stains (haemosiderin) and possibly leg ulcers.
Some erroneous research suggested that these veins closed after standard varicose veins surgery and therefore could be safely ignored. This was shown to be wrong in prize-winning research from Whiteley Clinics in 2004 – which was also the subject of an M.D. thesis sponsored by Whiteley Clinics.
Mark Whiteley has also published research showing that 40% of patients with varicose veins have at least one incompetent perforator as do 63% of people with recurrent varicose veins. Not only this, but those with recurrent varicose veins, have more incompetent perforating veins per leg than those with primary varicose veins.
Therefore there is a very clear association between having incompetent perforating veins and getting your varicose veins back again after surgery.
This research is supported by many other surgeons who have shown similar trends in their own practices.
Some surgeons try to claim that incompetent perforating veins are just there to “allow blood back into the deep veins” from varicose veins higher up in the leg. However anyone with good enough Duplex Ultrasound will find a large number of patients with varicose veins and often skin damage who have incompetent perforating veins as the only cause – showing that incompetent perforating veins are a problem in their own right.
TRLOP technique invented by Mark Whiteley and Judy Holdstock of Whiteley Clinics to close incompetent perforating veins. All in all, the evidence shows very clearly that if incompetent perforating veins are present in patients with varicose veins or venous problems, they should be treated as part of the correction of the vein pump.
Before 1985, these veins were treated by cutting open the leg under general anaesthetic and tying the veins off (such as the Cockett and Lynton procedures). This wasn’t very successful and so in 1985, a German surgeon called Hauer invented SEPS (subfascial endoscopic perforating vein surgery). This has now been superseded by TRLOP.
(For research publication showing our excellent results see: http://www.ncbi.nlm.nih.gov/pubmed/19299275)