Recurrent varicose veins and brown stains at ankle

This lady had severe left leg recurrent varicose veins. Over time, these had caused brown stains (skin damage called “Haemosiderin”) at her ankle. She came to The Whiteley Clinic where she is undergoing treatment using The Whiteley Protocol. Massive improvements can be seen even after stage I of the treatment.

Before and after varicose veins with brown stains skin damage – haemosiderin – CEAP C4

Recurrent varicose veins

This lady had previously gone to a vascular surgeon to have her veins treated. She had undergone a vein stripping operation. Not surprisingly the veins returned within a few years.

She underwent a venous duplex ultrasound scan performed by one the specialist Clinical Vascular Scientists at The Whiteley Clinic. They identified the underlying problems.

• 1] The previous stripping had missed a bit of vein in the mid thigh which was still open.
• 2] The vein was re-growing in the groin and upper thigh – a process called neovascularisation in the groin and strip tract revascularisation in the thigh
• 3] The previous surgeon had not treated her incompetent perforating veins – one in the thigh and three in the lower leg feeding directly into the area of skin damage

We have published research from The Whiteley Clinic showing why stripping does not work in the majority of people. Fortunately, more and more surgeons are now following us and are moving to endovenous treatments such as laser, radiofrequency, clarivein and glue.

We have also published our rationale as to why we treat incompetent perforators. Unfortunately, most doctors still do not look for these nor treat them. There is increasingly good evidence indicating that leaving these incompetent perforating veins and treated is a major reason why varicose veins come back again in the future.

It is for this reason that we invented the TRLOP operation to close incompetent perforators under local anaesthetic in 2001. TRLOP is part of stage I treatment of varicose veins under The Whiteley Protocol.

Brown stains and skin damage at the ankle (haemosiderin)

In the past patients have been told that varicose veins are “only cosmetic”. This is shown to be wrong in a large number of cases varicose veins that are left untreated.

Patients who do not get their varicose veins treated run the risk of leg aching, ankle swelling, skin damage (venous eczema, red stains or brown stains) which can then go on to venous leg ulcers. This progressive deterioration when varicose veins are left untreated forms the basis of the CEAP scoring system. Varicose veins are classed as C2 but when skin damage occurs, this becomes C4.

If this patient had left her veins and treated, the skin damage would slowly have worsened with a high chance that the skin would break down, causing a venous leg ulcer which is classed as C6.

Fortunately, having come to The Whiteley Clinic and had a full assessment under The Whiteley Protocol, all of the underlying problems that had either been a result of her previous surgery or missed by her previous surgeon were identified. Using The Whiteley Protocol, an individual treatment plan was tailored for her.

Even after stage I of the three-stage plan, her varicose veins had all disappeared, her symptoms of aching legs had disappeared, and the brown skin damage was seen to be improving. If she decides to go no further than stage I of The Whiteley Protocol, then she will get a good result compared to her previous surgery. However if she continues to stage II and then stage III, her risks of ever getting varicose veins back in this leg drop to the lowest possible recurrence rates as proven by The Whiteley Clinic audits, and she will get the best possible cosmetic result.