Mr Whiteley is an internationally respected and well-renowned vascular expert, specialising in the surgical and non-surgical treatment of varicose veins and venous conditions. As the founder of The Whiteley Clinic (www.thewhiteleyclinic.co.uk) his aim was to bring the very best treatments for varicose veins and vein problems, such as varicose and thread veins, to the UK public. Here he shares his knowledge:
What exactly are varicose veins?
In the simplest form, varicose veins are the swollen veins that can be seen bulging on some people's legs when they stand up. Approximately one in five adults (20%) have these. However much more worrying are "hidden varicose veins" or medically venous reflux (or venous incompetence). These are the same problem, veins that are not working in the legs, but without any bulging veins showing on the surface to warn you that things are going wrong. "Hidden varicose veins" effect another one in five adults (20%) meaning that almost 2 in every 5 adults (40%) suffer from visible varicose veins or "hidden varicose veins".
Why do we get them?
We get varicose veins and "hidden varicose veins" when the valves stop working in our legs and blood therefore falls down the veins the wrong way. The cause of the valves not working seems to be a familial cause - in other words you get this problem from your parents.
How do you know when you have them? What signs do you need to look out for?
If you are lucky and have varicose veins, you know you have them because you see bulging veins when you stand up.
If you are less lucky and have "hidden varicose veins", then you might have any of the following: thread veins of the legs, tired and aching legs especially in the heat after standing, swelling of the ankles, venous eczema (itchy skin) of the lower leg in particular around the ankles, red stains around the ankles, Brown stains around the ankles or even skin breakdown and leg ulceration.
If you have any of these conditions you should have a venous duplex ultrasound scan. Although an expert can diagnose varicose veins without an ultrasound scan, it is impossible to see the "hidden varicose veins" that underlie these unless there has been a venous duplex ultrasound scan performed.
Is there any way to prevent them, or reduce their size?
Unfortunately not. Although exercise is very good for the vascular system generally, it does not prevent varicose veins or "hidden varicose veins". As you get these from your parents, you cannot prevent them. Support stockings can improve the symptoms whilst they are being worn but have no effect as soon as they are removed. Therefore they are only useful for symptom relief and never cure the problem.
What are common myths about varicose veins that you would like to dispel?
The commonest myths that are wrong is that:
- they are caused by pregnancy - this has been shown to be incorrect. Pregnancy makes them worse but only if you have them already even if they are hidden before pregnancy
- they are caused by being overweight - weight has no influence at all on the development of varicose veins
- varicose veins are cosmetic only - in fact the cause of varicose veins (the valves not working) only ever deteriorates and worsens and if left untreated frequently goes on to cause worse problems. Nobody should ever except they have "only cosmetic varicose veins" unless a venous expert has seen them with a venous duplex ultrasound scan performed by a trained specialist technologist who performs venous scans regularly
- varicose veins always come back after treatment - with the new endovenous techniques (I first performed this in the UK in 1999) varicose veins should not come back again after treatment. Only three in one hundred people per year will develop new varicose veins after treatment. However after stripping or inadequate treatment by those not specialising in varicose veins, recurrence rates are far higher and hence the myth.
How can you treat varicose veins?
The treatment varies between patients. As with many medical conditions, we have now discovered that varicose veins and "hidden varicose veins" have many different forms and so there is not one treatment that adequately treat everybody. As such, at my clinic we have developed the Whiteley protocol which we use to tailor the correct treatment process for each individual patient depending on the results of the scan. It is only by doing this that we obtain the excellent results with low recurrence rates that we do. All varicose vein treatments should now be performed under local anaesthetic as walk-in walkout procedures.
Is there any health risk if you don’t treat varicose veins?
In a proportion of patients the varicose veins will worsen causing clots in the veins (phlebitis), bleeding, skin damage and leg ulceration. Not all varicose veins will cause these complications. A venous duplex ultrasound scan will enable a venous expert to predict which patients have veins that are most at risk of deteriorating and those that can be safely left for the time being and monitored for signs of further deterioration. Any clots, bleeding, ankle swelling, itching, skin discolouration means that treatment is essential to prevent further deterioration and complications.
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