Varicose Veins and Venous Eczema CEAP C4 – Whiteley Protocol

This 60-year-old man had varicose veins and venous eczema. The venous eczema was due to severe venous reflux in the underlying veins.

Varicose veins and venous skin damage at ankle (CEAP C4) – 6 weeks after only Stage 1 of The Whiteley Protocol

A high-resolution duplex ultrasound scan was performed by a The Whiteley Clinic trained Clinical Vascular Scientist. This showed that the varicose veins were due to valve failure in both truncal veins and incompetent perforating veins.

As such he was treated under local anaesthetic using The Whiteley Protocol. The truncal veins were closed with a 1470 nm endovenous laser. The incompetent perforators were closed with the TRLOP technique. The large varicose veins were removed by ambulatory phlebectomy.

Varicose veins and venous skin damage at ankle (CEAP C4) – 6 weeks after only Stage 1 of The Whiteley Protocol – From medial side

Six weeks after this Stage I treatment he is already significantly improved. The leg aching is gone and ankle swelling much reduced. His risk of leg ulceration has dramatically reduced.

In 2 more weeks he will go on to Stage II of The Whiteley Protocol which will improve him further. This will also reduce the risk of varicose veins coming back again.

TRLOP closure of Incompetent Perforating Veins

Although many doctors and clinics claim to perform endovenous laser for varicose veins, most only treat the truncal veins. Incompetent perforating veins are usually ignored as they are difficult to diagnose and treat.

However there are very good arguments as to why they should be treated, as published by Mark Whiteley in peer-reviewed journals in Europe and the USA (see https://www.ncbi.nlm.nih.gov/pubmed/25132056).

In 2001, Mark Whiteley and Judy Holdstock invented the TRLOP technique to treat incompetent perforating veins. The have proven this technique to be very effective. Indeed some American surgeons have started using this technique although they have tried to rename it “PAPS”.

Regardless of name, it seems to make a big difference as to whether a patient gets their veins back again in the future or not.

As such, failure to look for incompetent perforating veins, or to use the TRLOP technique, would appear to put patients at a higher risk of recurrence in the future. Hence in the Whiteley Protocol, perforating veins are always checked and TRLOP is then recommended.