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Treatment

The treatment of venous disorders of the legs depends upon its severity and will depend upon the results your doctor's examination and investigations. the investigation of venous problems is becoming more sophisticated with the advent of better imaging with Duplex Doppler scanning and your doctor or specialist may wish to get this and other tests done prior to making recommendations.

Deep Veins

Thrombosis is normally treated conservatively with drugs which although they don't necessarily dissolve the clot, prevent it propagating thereby becoming dangerous. the aims of the treatment is to prevent the clot getting worse and thereby stop a large clot flying off up into the lung arteries with sometimes fatal results.

Superficial Veins

Small varicose veins can be satisfactorily treated with sclerosant injections providing there is no significant reflux from the major saphenous tributaries. If however, this is present injections tend to provide only temporary relief.
 

The standard treatment for varicose veins, the result of long and/or short saphenous vein reflux is surgery. This usually comprises of a small incision in the groin or in the case of the short saphenous vein, behind the knee and the tributaries running into the main saphenous trunk are identified, divided and tied off. The main trunk is then itself ligated flush where it joins the deep system. The long saphenous vein will usually be removed by the insertion of an instrument called a stripper into it down as far as the middle of the calf. Any other varicosities can then be removed through tiny stab incisions so small, they do not require stitches. The results of carefully done, thorough surgery are good. Elastic stockings are worn for a  couple of weeks after the operation and any bruising will normally have resolved by six weeks. Normal showers can be taken throughout the recovery period. 
 

In 1999 we introduced a new technique to the UK called VNUS CLOSURE. This was the first of a new wave of treatments in Varicose Vein surgery - Keyhole or Pinhole varicose vein surgery. With VNUS Closure, the main saphenous vein is destroyed using radio frequency waves via a thin catheter introduced through a tiny stab incision just below the knee. The vein is heated to 85 ºC which denatures the protein in the wall of the vein and guarantees that it cannot merely thrombose and open up again. The walls of the vein are thereby fused together. This spares the need for the groin incision. The technique is very new and innovative. At the Whiteley Clinic we have the world's largest experience of this technique and have developed many new ways of using this technique to treat veins previously not able to be treated by VNUS.

 

Over the last decade, since we introduced this technique, we have developed our techniques further. We now perform EVLA (Endo venous Laser Ablation) under local anaesthetic, which uses the same principle of killing the vein using heat - but uses laser rather than radiofrequency electric current.

 

We also use the new RFiTT device as well as foam sclerotherapy and TRLOP which we invented here at The Whiteley Clinic.

 

Ulcers

Assuming that the cause of the leg ulcer is due to venous insufficiency, the mainstay of treatment is by providing enough compression bandage support to overcome the inadequate calf muscle pump and prevent blood refluxing into the leg. This with the addition of medicated dressings results in the healing of the majority of venous ulcers. However, it is essential that thorough investigation of the reflux be undertaken so that any superficial venous reflux can be treated as outlined above. Deep venous reflux can sometimes be treated surgically but it is a matter for fine judgment and case selection. Support hosiery is normally therefore recommended for this small group of patients. Perforator veins, if causing significant reflux into the ankle area, can be interrupted surgically by the use of a keyhole technique by placing a telescope beneath the deep fascia of the calf (the deep fascia is a strong sheet of sinew that lies beneath the fat under the skin. It provides the familiar shape of the calf and ankle). The perforators can be seen coursing across the space between the superficial fat outside the fascia and the deep veins inside the muscle.