20 years of endovenous varicose veins treatment – Mark Whiteley and Judy Holdstock 20 years after their first case in the UK
Today is the 20 Years Anniversary of the first endovenous varicose veins surgery in the UK.
On 12th March 1999, Mark Whiteley and Judy Holdstock performed the first “keyhole” varicose veins treatment in the UK.
For the first case, they used VNUS Closure. This was a radiofrequency device.
At that time, there was very little experience in the world how to use it.
Many of the early surgeons using radiofrequency were using a combination of open surgery and radiofrequency.
They were cutting open the groin to tie the great saphenous vein at the top. Following that, they were using VNUS Closure to ablate the rest of the vein instead of stripping it out.
Mark and Judy turned this around. Using ultrasound, they put the radiofrequency catheter into the great saphenous vein below the knee.
Then they passed the catheter up the vein to the groin. Using ultrasound, the catheter was positioned precisely at the top of the vein.
For the first case, a combination of sedation and a light general anaesthetic was used. However, it was 2005 before they turned to local anaesthetic only.
The early reaction to the first endovenous varicose veins treatment was not good. When Mark Whiteley presented the first case at the Venous Forum in Leeds in April 1999, there was wide scepticism.
Several surgeons went on record saying that it wouldn’t work. However, Mark and his team have recently published their 15 years results showing the excellent long term results of endovenous varicose veins treatment.
In addition, endovenous varicose veins treatment has now become the first line recommended treatment for varicose veins.
The modern endovenous varicose veins treatment is very different from the early VNUS Closure. The original VNUS Catheter had external electrodes passing radiofrequency electric current into the vein wall. It took 20-40 minutes to close each vein.
New endovenous techniques are much faster. There are several different radiofrequency methods available. However, Mark has found laser is more versatile and easier to use in complex cases.
In addition, there are new techniques that do not even use heat to ablate the varicose vein. Cyanoacrylate glue can stick the vein shut permanently and Clarivein (MOCA – Mechanochemical Ablation) uses a rotating wire and sclerotherapy to ablate the vein.
In February 2019, Mark and Judy did the first Microwave Varicose Veins Treatment in the UK. In fact, it appears to be the first case outside of China.
The microwave closes the vein in a very similar way to the laser. However, there is no need for eye-protection and special laser regulations.
Therefore, 20 years after introducing endovenous varicose veins treatment with radiofrequency, Mark and Judy have now introduced endovenous microwave ablation (EMWA).
This will now become one of the varicose vein techniques available under The Whiteley Protocol.
Most people do not take venous disease seriously. Patients expect varicose veins to keep returning after treatment. Patients with venous leg ulcers are not offered curative surgery and remain stuck in compression. Women with pelvic congestion syndrome are not referred for embolisation but are told that they have “endometriosis” or that there is nothing that can be done.
This is because we do not have vein specialists called “phlebologists” in the UK. Most doctors who treat varicose veins are not vein specialists. Even “vascular” surgeons specialise in arteries, not veins.
Therefore Mark Whiteley had set up the “College of Phlebology“. This College aims to train interested doctors and nurses to become vein specialists.
In this way, the next 20 years should see better treatments and outcomes for patients with venous disease.
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