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New Microwave Varicose Veins Treatment

by – February 18, 2019

A new microwave varicose veins treatment is now available in the UK. The first case took place on Friday 15th February at The Whiteley Clinic in Guildford.

Prof Mark Whiteley (consultant venous surgeon) and Miss Judy Holdstock (chief vascular technologist) performed the case. The patient was a 43-year-old teacher from Farnborough, Mr Richard Sutton.

Richard Sutton – first microwave varicose veins case in the UK

Mr Richard Sutton – First case of endovenous microwave varicose veins treatment in UK – 15 Feb 2019 – The Whiteley Clinic

Mr Richard Sutton – First case of endovenous microwave varicose veins treatment in the UK – 15 Feb 2019 – The Whiteley Clinic

Mr Sutton had been suffering from left-sided recurrent varicose veins. He had gone to another varicose vein unit for his previous varicose vein surgery. Unfortunately, they had only treated his great saphenous vein.

This was inadequate treatment. They had missed the major cause of his varicose veins. This was the second vein from the groin, the anterior accessory saphenous vein.

Therefore despite having had endovenous laser treatment before, his varicose veins had not gone. Over the last couple of years, he had severe itching and swelling of his ankle (CEAP C3).

Having varicose veins that are causing symptoms and ankle swelling means that he was eligible for treatment under NICE clinical guidelines CG 168.

Mr Sutton came to The Whiteley Clinic to find out why the previous surgery had not worked. Under The Whiteley Protocol, Judy Holdstock performed a venous duplex ultrasound scan.

The scan showed successful treatment of the great saphenous vein. However, he had a massively dilated and incompetent anterior accessory saphenous vein (12 mm diameter). He also had two very large incompetent perforator veins in the lower leg. All of these veins were causing his severe varicose veins in the thigh and calf.

The new endovenous microwave treatment was presented to Mr Sutton. He knew that he would be the first in the UK having microwave varicose veins treatment using the ECO system.

Research from The Whiteley Clinic showed that it would be effective. Richard Sutton gave his consent to the procedure.

The microwave varicose vein treatment (ECO system)

Recurrent varicose veins – pre-op photos before endovenous microwave treatment – First case in UK – Richard Sutton on 15th February 2019 at The Whiteley Clinic

Recurrent varicose veins – pre-op photos before endovenous microwave treatment – First case in UK – Richard Sutton on 15th February 2019 at The Whiteley Clinic

The procedure was a walk in, walk out case under local anaesthetic. This is “ambulatory surgery”. The whole procedure took 45 minutes. He was ready to leave The Whiteley Clinic one hour after treatment.

The anterior accessory saphenous vein was found with duplex ultrasound. Prof Whiteley inserted the microwave catheter into the vein. Duplex ultrasound guided the catheter inside the vein. He placed local anaesthetic around the catheter and vein. The microwave permanently destroys the vein. This stops blood falling the wrong way down it.

Both large incompetent perforator veins were then closed using the TRLOP technique. Mark Whiteley and Judy Holdstock invented TRLOP in 2001. Mark put the microwave catheter into the veins. Duplex ultrasound guided the placement. Turing the microwave on closed these veins permanently. This prevented the blood from squirting out into the varicose veins.

Finally, Prof Whiteley removed the large surface varicose veins by phlebectomies. This is necessary to stop any phlebitis in the redundant varicose veins.

The wounds were too small for stitches. The nurses put plasters on all wounds. Mr Sutton was discharged home wearing a bandage and stocking. He was told to remove this bandage in 24 hours and stocking in three days. Little plasters on the wounds are removed after three days.

Advantages of endovenous microwave varicose veins treatment

First microwave varicose veins treatment in UK on Richard Sutton by Mark Whiteley and Judy Holdstock – 15 February 2019

First microwave varicose veins treatment in the UK on Richard Sutton by Mark Whiteley and Judy Holdstock – 15 February 2019

Endovenous microwave varicose veins treatment is the latest treatment for leg varicose veins. It uses heat to permanently destroy refluxing veins.

Closing these veins forces venous blood to flow the right way again. Hence patients improve. This is fully explained in the book “Understanding Venous Reflux: the Cause of Varicose Veins and Venous Leg Ulcers“.

The National Institute of Health and Care Excellence (NICE) recommends “endothermal ablation” to treat varicose veins.

The two commonest types of “endothermal ablation” are radiofrequency ablation and endovenous laser ablation. Both heat the vein wall to permanently close the diseased vein. They work provided the right settings are used.

However, radiofrequency ablation requires contact with the vein wall. This isn’t necessary for Endovenous laser. However, laser does require some strict laser protection. Everyone in the room has to wear laser protection glasses. The clinic needs a laser protection officer. Strict laser regulations apply to the operating theatre.

Endovenous microwave varicose veins treatment is a form of “endothermal ablation”. Hence it should be as effective as both radiofrequency ablation and endovenous laser ablation. However, the microwave does not require contact with the vein wall. This is an advantage over radiofrequency ablation. It also does not require laser protection nor strict laser regulations. This is an advantage over the endovenous laser.

As such, endovenous microwave varicose veins treatment may well become a new gold standard of “endothermal ablation” of varicose veins. Further studies will tell.

Richard Sutton immediately after endovenous microwave varicose veins treatment at The Whiteley Clinic – The first case in UK 15 February 2019

Richard Sutton immediately after endovenous microwave varicose veins treatment at The Whiteley Clinic – The first case in UK 15 February 2019

20 years experience of endovenous varicose vein surgery

Prof Mark Whiteley and Judy Holdstock performed the first endovenous surgery in the UK in March 1999. Their first case used radiofrequency ablation, a product called VNUS Closure. At the time few people took notice. The first newspaper report on their work appeared in 2000.

By 2001, other doctors were just starting to use these techniques.

Almost exactly 20 years after that first case, February 2019, Mark Whiteley and Judy Holdstock performed this first endovenous microwave varicose vein treatment.

This microwave method of treating varicose veins is one of a series of new technologies for veins.

Mark, Judy and their team at The Whiteley Clinic will continue to be at the forefront of the research and development into these new techniques.

This ensures that we will offer the latest and best vein treatments to our patients at The Whiteley Clinic.

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