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How Does The Whiteley Protocol® Reduce Recurrent Varicose Veins?

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We know that recurrent varicose veins occur because of one of the following:

  • The wrong veins were treated
  • The right veins were treated but with the wrong techniques
  • New varicose veins formed due to more valves failing

The Whiteley Protocol® is the result of research started by Mark Whiteley at the end of the 1990s to understand why veins recur (come back after surgery) and how best to try to prevent this.

As each cause of recurrent varicose veins has been identified, The Whiteley Protocol® has been developed to take this into account.


The Wrong Veins Were Treated

The Whiteley Protocol® starts off with ensuring that each patient with venous problems (such as recurrent varicose veins) gets a full duplex ultrasound scan performed by a The Whiteley Clinic trained vascular scientist.

Quick scans performed at other clinics tend to only check the major veins in the legs. Duplex ultrasound scans performed at the The Whiteley Clinic follow The Whiteley Protocol® and ensure that all of the veins in the legs are checked for problems.

This takes around 10 to 20 minutes per leg, using a high resolution modern duplex ultrasound scan machine operated by a highly trained vascular scientist trained in The Whiteley Protocol®. Therefore a proper venous duplex ultrasound scan costs money to perform.

Offering a duplex scan for free or offering it cheaply (which many vein clinics do) means that corners are being cut elsewhere. It might be that the scan is performed quickly, that a cheap scan machine is being used or the person doing the scan is not highly skilled. Whichever reason (or combination of reasons), it is highly unlikely that such a scan will be as thorough as a properly conducted duplex ultrasound scan performed at the The Whiteley Clinic.

By ensuring that every one of our vascular scientists has been fully trained in The Whiteley Protocol® and that they all scan using the same technique and routine, we can be certain that we rarely (if ever) miss an underlying vein that is causing the venous problem or varicose veins. This is particularly true as we developed the technique to scan paelvic veins using transvaginal duplex ultrasound scanning (see: http://www.ncbi.nlm.nih.gov/pubmed/25324278).

Our audited results support this in the only recurrences we see after treatment at the The Whiteley Clinic are ‘de novo’ veins or natural disease progression. It is exceptionally rare that we have ever seen anyone come back with recurrent varicose veins due to a vein that we have missed due to poor scanning and treatment.


The Right Veins Treated But With The Wrong Techniques

When Mark Whiteley performed the first endovenous thermal ablation in the UK in March 1999, it started a revolution of vein treatments.

The initial radiofrequency ablation treatment was quickly joined by endovenous laser and then ultrasound guided foam sclerotherapy.

Each of these basic mechanisms resulted in multiple companies producing different products within the same category.

Since 1999, the The Whiteley Clinic under the guidance of Prof Mark Whiteley, has performed clinical and laboratory-based research. In addition, audits are undertaken and both ensure that the treatments used at the The Whiteley Clinic are the best that are available.

By the early 2000’s, (before many people even thinking of treating varicose veins with these new endovenous techniques), Mark Whiteley and his team at the The Whiteley Clinic had already recognised that different veins needed different techniques. There could be no ‘one size fits all’ and so clinics only offering one technique, such as laser, would never get the best results for all of their patients.

Examples of the research studies can be seen as follows:

Using these results as well as many others from our audits, The Whiteley Protocol® recommends the right treatment technique for the right vein found on the duplex ultrasound scan.


New Varicose Veins Formed Due To More Valves Failing

The only factor in recurrent varicose veins that cannot be addressed by The Whiteley Protocol® is the continuation of the disease and more varicose veins forming due to more valves failing.

When patients are treated with The Whiteley Protocol®, all of the veins that are part of the varicose vein problem are treated with the correct sequence of techniques to get the best results.

The veins that have been treated are closed and the failure rates are virtually zero using The Whiteley Protocol®.

However, for each year following treatment somewhere between 3 and 4.5% of patients will develop new varicose veins because more valves have failed in previously normal veins. This is the ‘de novo’ rate of formation of new varicose veins – or more commonly called disease progression rate.

At the The Whiteley Clinic, we have performed several audits all of which show that recurrence rates after treatment with The Whiteley Protocol® are fairly constant at 3.3%. This is exactly within the “de novo” rate due to the formation of new varicose veins by disease progression. This both shows that we have successfully overcome the other two and more major causes of recurrent varicose veins by using The Whiteley Protocol® – and also that if other clinics or hospitals try really hard they may be able to equal these results but they will not be able to improve on them.


References

Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women. Whiteley M, Dos Santos S, Harrison C, Holdstock J, Lopez A. Phlebology. 2014 Oct 16. pii: 0268355514554638. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/25324278)
Pelvic vein embolisation in the management of varicose veins. Ratnam LA, Marsh P, Holdstock JM, Harrison CS, Hussain FF, Whiteley MS, Lopez A. Cardiovasc Intervent Radiol. 2008 Nov-Dec;31(6):1159-64. doi: 10.1007/s00270-008-9402-9. Epub 2008 Aug 28. (http://www.ncbi.nlm.nih.gov/pubmed/18756371)
Five-year results of incompetent perforator vein closure using TRans-Luminal Occlusion of Perforator. Bacon JL, Dinneen AJ, Marsh P, Holdstock JM, Price BA, Whiteley MS. Phlebology. 2009 Apr;24(2):74-8. doi: 10.1258/phleb.2008.008016. (http://www.ncbi.nlm.nih.gov/pubmed/19299275)
An in vitro study to optimise treatment of varicose veins with radiofrequency-induced thermo therapy. Badham GE, Strong SM, Whiteley MS. Phlebology. 2014 Sep 12. pii: 0268355514552005. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/25217038)
Endovenous surgery for recurrent varicose veins with a one-year follow up in a patient with Ehlers Danlos syndrome type IV. Whiteley MS, Holdstock JM. Phlebology. 2014 Apr 8. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/24714385)
The effects of environmental and compositional manipulations on the longevity of Tessari-made foam for sclerotherapy Patel SB, Ostler AE, Dos Santos SJ, Pirie TM, Whiteley MS. JVS Venous and Lymphatic Disorders Online: Sep, 2014 DOI: http://dx.doi.org/10.1016/j.jvsv.2014.07.010 (http://www.jvsvenous.org/article/S2213-333X(14)00163-2/abstract)
Modified Tessari Tourbillon technique for making foam sclerotherapy with silicone-free syringes. Whiteley MS, Patel SB. Phlebology. 2014 Oct 6. pii: 0268355514554476. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/25288590)