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HIFU treatment of recurrent varicose veins

by – August 20, 2020

Recurrent varicose veins are a major problem. Previous prize-winning research from The Whiteley Clinic has shown varicose veins can grow back again after stripping.

HIFU treatment of recurrent varicose veins – the recurrent stump of the sapheno-femoral junction after a tie and strip on ultrasound

HIFU treatment of recurrent varicose veins – the recurrent stump of the sapheno-femoral junction after a tie and strip on ultrasound

In fact, our long-term study showed that over 80% of patients having varicose vein stripping grew their varicose veins back again after 5-8 years.

Fortunately, if the correct treatment for the size of vein is chosen, it is now almost impossible for the treated veins to grow back. This is one of the basic principles of The Whiteley Protocol.

Venous reflux causes varicose veins and venous leg ulcers.

In 1999, Mark Whiteley introduced endovenous surgery into the UK. Initially using radiofrequency, and then moving onto laser, he showed that heating the target vein to a precise level caused permanent closure of the vein. This closure stopped blood leaking or “refluxing” back down the veins.

As this venous reflux is the major cause of varicose veins and venous leg ulcers, it meant that both of these conditions could be treated effectively. It also meant that recurrence rates should drop if the correct procedures and settings are followed. These are all laid out in The Whiteley Protocol.

Unfortunately, there are a great number of patients who had tying and stripping of their varicose veins in the past. Unbelievably, some people still have this treatment!

When this happens, a large proportion of these patients will re-grow veins in the groin. An example of this can be seen in the first of the pictures in this post.

The saphenofemoral junction and tying varicose veins.

The junction of the “saphenous vein” and the deeper “femoral vein” is called the saphenofemoral junction. When the valve at this junction works, and blood can only flow up the leg from saphenous vein into femoral vein, then there is no problem.

When this valve gives way, and blood falls from the femoral vein refluxing down the now incompetent saphenous vein, this is called venous reflux. This backward flow of blood causes inflammation at the ankles leading to eczema, staining and leg ulcers. The body often reacts by making varicose veins. These dilated veins trap the falling blood, reducing the inflammation and damage at the ankles.

When this junction is tied at surgery, and the saphenous vein is stripped, you would think that the problem would have been solved.

Unfortunately, our prize-winning research has shown that in most cases the vein just grows back again and the tie dissolves. When the vein grows back again, it never goes a new valve and so it instantly becomes a recurrent varicose vein.

Open surgery for recurrent varicose veins

HIFU treatment of recurrent varicose veins – HIFU energy being aimed by ultrasound and on-screen guides

HIFU treatment of recurrent varicose veins – HIFU energy being aimed by ultrasound and on-screen guides

Those old style surgeons who have not kept up with the advances in phlebology over the last 20 years, will still perform surgery in the groin to treat recurrent varicose veins.

Under general anaesthetic (occasionally under spinal or local anaesthetic) the skin is cut and these veins are identified through scar tissue. Often this is performed by finding the artery first and working onto the vein.

The recurrent junction can be found and sutured.

This is complex surgery and often takes quite a long time to heal well. Moreover, it is just the same as tying the vein in the first place and not surprisingly the veins just grow back again. Hence it is pretty useless.

Endovenous surgery and the hedgehog technique.

If the veins are fairly straight, endovenous laser or radiofrequency can be used to close recurrent varicose veins. Many doctors try to use foam sclerotherapy in more complicated veins. However, if the veins have reattached at the saphenofemoral junction, foam sclerotherapy does not give good results as the refluxing blood stops the foam sclerotherapy working well and re-opens the vein.

Mr Barrie Price of The Whiteley Clinic published one of the many techniques that we use at The Whiteley Clinic called the “Hedgehog technique”.

When many recurrent varicose veins are arising from the recurrent saphenofemoral junction, each can be treated in turn using radiofrequency or laser. Because many entry points are needed, the entry cannulas (or tubes) that are put into each vein to guide the radiofrequency or laser, make the area look like an “hedgehog”.

The hedgehog technique has been very successful and is performed under local anaesthetic only.

HIFU treatment of recurrent varicose veins

HIFU treatment of recurrent varicose veins – after non-invasive treament the stump is completely closed

HIFU treatment of recurrent varicose veins – after non-invasive treament the stump is completely closed

Although the hedgehog technique is minimally invasive, it still does need multiple cannulas put into the target veins under local anaesthetic. The laser or radiofrequency is then passed down each cannula in turn and the vein destroyed with heat.

Today, we can do the same operation completely noninvasively.

As is shown in these pictures, we can identify the regrown saphenofemoral junction on ultrasound. We can then place the HIFU aiming guides directly on the part of the vein we wish to ablate (close).

Using just a little local anaesthetic for the tender scar tissue, several pulses can then be passed across the skin and focused onto the recurrent varicose veins. Working our way along the area of recurrent varicose veins, we can then completely seal the regrown junction.

This stops all of the reflux of blood from the femoral vein into the recurrent varicose veins through the saphenofemoral junction. Now that the reflux is stopped, foam sclerotherapy can be used in the future if needed to get rid of any other recurrent varicose veins further down the leg.

An additional advantage of the HIFU Echotherapy treatment is that the patient walked home directly after the treatment and did not even need to wear a stocking!

For more information about HIFU Echotherapy, please contact us.

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