The system of management described here has been developed by surgeons at The Middlesex Hospital in London. This is the result of extensive research over the last 10 years and inclusion of the best techniques from Europe and the United States. The excellence of this method has been confirmed in treating thousands of patients with venous diseases. The main principles include using special tests to measure blood flow in the veins to find out exactly where the problem arises. State of the art ultrasound equipment shows colour images of the troublesome veins. Surgical treatment is employed only when essential to cure varicose veins. Special instruments developed in Switzerland are used to ensure that no unsightly scars are left on the leg. Smaller varicose veins and thread veins are removed by injection treatment or PhotoDerm (high intensity light treatment). Treatment is designed for each patient based on the results of the vein tests. Everyone is different, so individual tailoring of treatment is essential. 
 

Frequently asked questions

 This page has be prepared to provide information and answer your questions about a variety of circulatory problems, ranging from cosmetic blemishes through to more serious underlying circulatory problems. This guide is not intended to replace a formal consultation with a vascular specialist who will be in a better position to answer your questions fully. 
 

VARICOSE VEINS

What are varicose veins? 

Arteries take blood from the heart to the extremities. Veins, which contain one way valves, channel the blood back to the heart. When there is an obstruction, or when prolonged pressure is placed on the veins the valves stretch and no longer close properly. This allows blood to fall back down the vein. The veins in the legs closest to the skin enlarge resulting in what are commonly called Varicose Veins. These can range from minor dilatations to a large bunch of grape-like structures in the calf. They may be associated with discolouration of the skin and ulceration near the ankle. 

What are the symptoms?

Varicose veins may cause feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramps in the legs. These symptoms are often accompanied by swelling, which frequently appears after long hours of standing. 

A Venous Assessment.

What investigations can be performed? 

Vein disorders are not always visible and diagnostic techniques are important in determining the cause and severity of the problem. A formal venous assessment involves a clinical examination and a non-invasive ultrasound scan. This looks at the blood flow through the legs, checking to see where the problem with the veins has arisen. Locating the problem areas with ultrasound allows all troublesome veins to be treated reducing the chance of further varicose veins. 

When to consult your doctor? 

Varicose veins is a slow progressive condition which will get worse with time and may eventually lead to quite marked skin changes. The earlier these are treated the better the long term and cosmetic outcome. Your General Practitioner will refer you to a surgeon with a special interest in veins. 

What treatments are available? 

Venous assessment will determine which treatment is suitable for you. Early varicose veins can be treated successfully by injections. This involves injecting a substance into the veins so that the vein walls stick together. You will be asked to wear a tight elastic compression bandage for one day until the vein treatment is complete. Large varicose veins are best treated by surgery. The operation involves making a cut into the skin overlying the place where the varicose veins arise and tying off the main feeding vein. The varicose veins are then removed using a new accurate technique of inverting them and removing them from within the vein. This results in less bruising and pain. Small varicose veins in the leg are removed through tiny incisions, using special small instruments. This normally requires one or two nights' stay in hospital. 
 

DERMAL FLARES

What are dermal flares? 

Dermal flares, sometimes known as spider veins, are very fine dilated veins situated just beneath the surface of the skin. 

What causes them? 

In some patients they are related to varicose veins even if none are visible on the surface of the leg.. In other people they occur without any other problem with the veins. 

Can they be painful? 

Yes, dermal flares can be associated with pain, which is often cyclical in women and related to periods. 

Can they be treated? 

Yes, although it is important to exclude an underlying cause by doing a venous assessment. Treating the surface veins in the presence of large varicose veins results in them returning quite quickly. The underlying cause should be treated first to ensure the best result. 

What treatments are available? 

There are several forms of treatment which include electrolysis, PhotoDerm (high intensity light) and microsclerotherapy. 

Which form of treatment is best? 

Depending on the result of your venous assessment you will be advised which treatment will work best. The most common form of treatment is microsclerotherapy, with the PhotoDerm being reserved for specific problems, in particular when small vessels run together. 

What is microsclerotherapy? 

Microsclerotherapy involves injections with a very fine, almost invisible, needle. Through this an injection of fluid is introduced which sticks the walls of the vein together so that the blood cannot return. The fluid does not enter your circulation but remains in the surface veins. The vein walls that have been damaged by the injection are slowly removed by the body's natural defence mechanisms over a period of three months. There is an instant result in many patients but others may take up to three months for the veins to clear. In some patients the blood slowly leaks back and the veins reappear. These may require further treatment. 

How often do I need to have this done? 

A session usually last 20 or 30 minutes and the number of injections will depend on the extent of your veins. The sessions usually take place at intervals of 2-3 weeks and the number you require depends on the response of your veins to treatment. Your consultant vascular surgeon will indicate the number of sessions that may be needed. 

Do they return? 

In patients where the flares are due to untreated venous disease there is a high incidence of recurrence. If this has been treated, further flares may appear over a period of years. It may be necessary to undergo further sessions of injections in the future. The frequency is extremely variable and is related to the severity of the initial flares. It is possible to repeat the treatments as often as necessary to obtain a good result. 

Will all the flares disappear? 

The treatment is highly successful, and in the majority of patients an excellent result is achieved. There are some patients who obtain a considerable improvement but never achieve a perfect result. Occasionally there are some patients who fail to get appreciable improvement. The majority of patients, however, are very satisfied with the results. 

How safe is the treatment? 

We have treated an excess of ten thousand patients without a problem. You should expect some bruising for a couple of weeks after each treatment but you will be asked to wear a bandage for 24 hours which helps to reduce the amount of bruising. It is possible to get a blister at the site of injection but this usually clears with no complication. The treatment is not associated with long term staining of the skin. 

Who does the treatment? 

The treatments are all carried out by properly trained nurses under the supervision of experienced medical practitioners who are ultimately responsible for the treatments. 
 

PHOTODERM TREATMENT

What is PhotoDerm?

PhotoDerm is an intense pulsed white light used for treating small thread veins on the face and legs. The light heats the blood in the veins and damages the vessel walls. This causes them to collapse and dissolve. The vessel then fades and slowly disappears over several months. The treatment is applied by placing a rectangular light guide on the skin over the vein. PhotoDerm can be adjusted specifically to treat different lesions and patient skin types. There is little or no pain and minimal side effects on surrounding skin.

How many treatments will I require?

The number of sessions will vary according to the size of the area treated. The first session is to assess your skin’s reaction and to find the right settings. Generally face lesions require a further three treatments and legs require between five and six treatments carried out at two weekly intervals.

What are the side effects?

Most side effects are short term. Immediate side effects include some reddening of the skin and local swelling which goes away within two - four days. Occasionally there can be some bruising which will disappear over a week or two. Any change in skin colour will disappear within six months.

Who should not be treated with PhotoDerm?

PhotoDerm can be used for almost everyone, but is not effective in dark skinned people.

Will they come back?

Patients who have a tendency to develop spider veins may develop new veins. The vessels which have been removed will not return, however, new vessels may appear. It is best to avoid sunlight and to wear an effective sun block to prevent new veins appearing on the face. 
 

SWOLLEN LEGS 

Many patients complain of swelling of their legs. Sometimes this involves just the ankles and sometimes it extends to include the whole leg. 

I have swollen ankles at the end of the day, is this serious? 

Most people who stand a lot will develop swelling of the ankles as the day progresses. If your job involves standing then simple support stockings may help you. It is important to wear well- fitting shoes without a high heel. 

Can varicose veins cause swelling of the legs? 

Yes, people with varicose veins may have an inefficient circulation. Normally when you walk the blood is pumped back towards the heart but with varicose veins this mechanism is damaged which may result in swelling. 

Will surgical treatment of varicose veins help to reduce swelling? 

Varicose vein surgery may help and a Venous Assessment of your legs using non-invasive scans will determine whether or not you will benefit from surgery. 

What is lymphoedema? 

Lymphoedema is a condition which causes swelling of the legs. Arteries supply the leg with blood and veins take the blood from the leg back to the heart. There is also the lymphatic system which clears fluid from the limbs. If the lymphatic system becomes blocked or if you have a poorly developed system you are at risk of developing swelling. 

What can be done about lymphoedema? 

In most cases lymphoedema can be treated by the use of elastic compression stockings or the use of an intermittent pneumatic compression pump. 

Can lymphoedema be treated surgically? 

The surgical treatment of this condition is usually reserved for very severe cases. Nearly all the surgical procedures are associated with quite extensive scarring and is not generally recommended for early lymphoedema. 

If I have lymphoedema how can I prevent it from getting worse? 

In patients with poor lymphatic systems it is important to take great care of your feet. Good hygiene prevents infection between the toes which could overwhelm the lymphatics and make the condition worse. It is important that any infection, including athlete's foot, is treated early.