Huge varicose veins can look awful. It has often been said that varicose veins are “only cosmetic”. However, research has shown that about 1 in 20 patient with varicose veins deteriorate every year. Deterioration of varicose veins is described by the CEAP scoring system.
Varicose veins can deteriorate in different ways:
The skin changes around the ankle might be venous eczema, or are often brown skin changes. The name of these brown stains is “haemosiderin”. This is always a sign of severe venous disease.
This gentleman was 61 years old when he came to the The Whiteley Clinic. He had massive visible varicose veins of his right leg. You can see these in the photographs. He had left these alone for years. Not surprisingly, the varicose veins worsened over time. The varicose veins had got bigger over the years. They had also spread more extensively on the leg. In addition, they had started causing ankle swelling and skin discolouration.
This skin discolouration comes from constant inflammation at the ankle. This inflammation results from venous blood falling the wrong way down the varicose veins. If you want to know more, you can read “Understanding venous reflux – the cause of varicose veins and venous leg ulcers“.
Worried about the risk of venous leg ulcers, he came to The Whiteley Clinic. He chose us because we specialise in venous disease.
He underwent venous duplex ultrasonography. This was performed by one of our specialist venous vascular technologists, trained in the Whiteley Protocol. The scan showed that he had an incompetent great saphenous vein. Incompetence means that the valves inside the vein have stopped working. When the patient stands up, the blood falls the wrong way down the vein. This is called “venous reflux“.
The patient also had multiple incompetent perforator veins. These are short veins that “perforate” the muscle. They should take blood into the deep veins from the surface. When incompetent, they allow blood to shoot out in the wrong direction. This can cause varicose veins and skin inflammation.
The great saphenous vein and incompetent perforating veins cannot be seen from the surface, and can only be seen on venous duplex ultrasound scan.
In this case, the great saphenous vein measured 17 mm in diameter. Many surgeons have said is too big for the new endovenous treatments. However, a recent publication from the The Whiteley Clinic has shown how we can treat such big veins.
In this research paper, we have described how to identify big veins using the “smile sign”. Our research showed that very large veins can be treated. Also, we show a multi-pass technique. We perform this under local anaesthetic. Patients can walk home an hour after treatment. No stitches were needed because the wounds are so small.
The picture shows the excellent result after only four weeks. He has only undergone stage I of the Whiteley Protocol. Four weeks after this, stage 2 will be started. Completion of the Whiteley Protocol will result in him having the lowest possible chance of recurrence. It will also give him an excellent cosmetic result.
If you wish to enquire more about your own vein problems, please contact us.