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How to choose your varicose veins surgeon and treatment

by – September 9, 2019

How to choose your varicose veins surgeon and treatment

Most patients with varicose veins do not get a say in who they are referred to. They trust their Family Doctors or directed by their insurance companies.

Other patients more wisely do their own research, checking out websites and reviews. Unfortunately, many just choose the cheapest, not realising that there is a massive difference in outcomes between different doctors and clinics.

Until now, there has been no way for patients to tell who gets good results and who doesn’t.

Therefore they have to base their choice on whether the website looks nice, whether they think that cheap surgery is also “good surgery”, and of course reviews written by patients who have only just had the consultation and procedure, and do not know whether the varicose veins will come back in a few months’ time.

What are good and bad results in varicose veins surgery?

Obviously, there are some early indicators of bad varicose veins surgery.

  • Doctors can be rude, often hiding a lack of confidence and knowledge.
  • Doctors doing their own ultrasound scan rather than having a qualified vascular technologist doing it for them – despite NICE guidelines and research showing this is suboptimal.
  • Doctors who only have one or two methods to treat veins at their disposal, meaning that they have to ignore difficult veins such as incompetent perforating veins or incompetent pelvic veins. Not surprisingly, their patients often find that the varicose veins didn’t even disappear after treatment!

Many of the indicators of bad varicose veins surgery only appear after several months or even a year. It is these patients who have often written a good review saying how well they feel and how good their legs look, only to be disappointed when the varicose veins reappear.

The reason for this is that many of the techniques used in the way that some doctors use them cause temporary clots in the veins. These temporary clots block the veins making the patient think a good result has been achieved. However, as the clots dissolve over the next few months to year, the blood starts falling back down the varicose veins, causing them to reappear on the surface.

Unfortunately, by the time this happens, most patients have already given good reviews and they find that doctors don’t want to listen to their concerns. It is only at this point that many start looking for a vein specialist.

Doctors who work in teams with vascular technologists and nurses are more likely to find out what the underlying cause of a patient’s varicose veins is

Doctors who work in teams with vascular technologists and nurses are more likely to find out what the underlying cause of a patient’s varicose veins is

How to identify good varicose vein surgery.

Even today, there are some simple indicators to look for.

  • Doctors who work in teams with vascular technologists and nurses, as recommended by the NICE clinical guidelines, are more likely to find out what the underlying cause of a patient’s varicose veins is.
  • Doctors who have access to all the different sorts of endovenous treatments and can choose the right one for the right patient are more likely to get good results.
  • Obviously patient reviews help to some extent, although they must be taken in context.

However, what is currently missing, is a way for patients to know whether doctors get good results in the medium to long term. In addition, patients also need to know whether certain treatments that are offered give good results in the medium to long-term.

How to identify good medium to long-term results from varicose vein surgery.

Ever since the Bristol heart scandal in the 1990’s, doctors who lead the way in their professional area have been striving to identify the best way to measure the outcomes from doctors, clinics and hospitals performing procedures.

The best way is the formation of a “registry”.

A registry is a centralised database where every doctor working in a certain area, puts the clinical details of every patient they see.

The patient data is anonymised, and strict guidelines as to data protection are enforced, to satisfy all of the data protection guidelines.

Over weeks, months and years, this builds into a database of patients of all different ages, physical attributes, severity of varicose veins and venous disease. Doctors then put in what investigations and treatments they have performed as well as the results of any complications.

Over time, each doctor can then be compared with all of the other doctors, to ensure that they are getting satisfactory results and their patients are not being put at risk.

This is a value of a basic “registry”. It is for this reason that the College of Phlebology set up the International Venous Registry.

Patient-reported outcomes (PRO):

Of course, the worry is that doctors might say that they are getting good results when they are not. This can be deliberate if doctors want to appear better than they are or can be by accident if they merely forget to fill in complications or certain records.

In order to prevent this from happening, the College of Phlebology International Venous Registry also includes input from patients.

At regular times through the patient journey, patients receive emails from the registry, asking them about their current symptoms and quality-of-life.

As patients have different treatments and follow-ups, further email questionnaires can determine whether treatments have been excessively painful, have been successful, with the patients about publications or whether they have had good results.

Most importantly of all, long after a patient has been discharged by a Doctor, they will continue to get questionnaires checking that they have not had recurrence in the long-term. If they have, it then notes when the recurrence occurred, how bad it was and what surgery was needed to repair it.

How to choose your varicose veins surgeon and treatment:

The College of Phlebology Venous Registry icon

The CoP Venous Registry will develop into a complete database as to which doctors and treatments give acceptable or good results in the short, medium and long terms.

As a new registry, it doesn’t have the information in it at the moment to provide these results – yet! But doctors who believe that they have good results and are using the right techniques will want to join the registry so that their results will be available for patients as soon as possible.

Therefore, when choosing which doctor you should consent to allowing to treat your varicose veins, you should check that they are an active member of the CoP Venous Registry.

Such doctors will have an icon on their websites and maybe their literature (see icon) with an individual member number and a link to the College of Phlebology list of active members of the CoP Venous Registry.

The Whiteley Clinic is proud to support the College of Phlebology Venous Registry, and our consultants are amongst the first to sign up and use it.

The contents of this site are for informational purposes only and are meant to be discussed with your doctor or other qualified health care professional before being acted on. Always seek the advice of a doctor or other licensed health care professional regarding any questions you have about your medical condition(s) and treatment(s). This site and the information provided is not a substitute for medical advice.