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No varicose veins are too big for laser treatment

by – November 1, 2018

International guidelines agree that patients with varicose veins should be having “endothermal ablation” as their treatment option. This means endovenous laser ablation  (EVLA) or radiofrequency ablation (RFA).

However, many patients are told that their veins are “too big” for endovenous surgery. Instead they are told to have stripping or foam sclerotherapy, which are not the recommended treatments for optimal results.

Research published from the The Whiteley Clinic has shown this to be incorrect. The vein specialists at the The Whiteley Clinic have been able to show that varicose veins of any size can be successfully treated with endovenous techniques under local anaesthetic. When the principles of the Whiteley Protocol are followed treatment is successful.

The Smile Sign

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No varicose veins are too big for endovenous surgery under local anaesthetic. The Multi-pass technique developed by The Whiteley Clinic

When a varicose vein is observed with ultrasound, it is usually circular. Whilst an endovenous laser or radiofrequency device is in the vein, and local anaesthetic is put around the vein, it usually contracts around the device. When it contracts, it surrounds the device. This is called “concentric contraction” and the vein is intact contact with the device.

This means that when the laser or radiofrequency is fired, all of the heat goes into the vein wall destroying it. Provided the right amount of heat energy has been used for that individual vein, as determined by the Whiteley Protocol, then it will be permanently ablated and the operation will be a success.

However, if the vein is too big, then the vein does not constrict around the device. Instead it flattens like an “smile”. This means that the endovenous device is only in one part of the vein, and cannot touch all of the vein wall at once. Hence firing the device will lead to only partial treatment of the vein and treatment failure.

Therefore it is very important to note the smile sign when assessing a vein for treatment.

The Whiteley Clinic “multi-pass” technique.

In order to be able to treat the whole of the vein wall when the vein has flattened, a multi-pass technique has been developed at the The Whiteley Clinic. Using ultrasound guidance, the laser is passed repeatedly through the smile sign segment at a set power and rate. This is to ensure complete ablation of the wall. The number of passes, the power and the rate of movement is tailored to each individual vein.  This applies in all of the Whiteley Protocol techniques.

When we reviewed our results, we had treated over 1900 veins as part of this study and every single vein had been successfully ablated.


Endovenous thermal ablation is what we recommend as the first option for the treatment of varicose veins. Some doctors tell patients their veins are unsuitable, often because they are “too big”. This research from The Whiteley Clinic shows that we can predict how a big vein will react when being treatment takes place under local anaesthetic. It also shows how we can modify the technique to ensure any vein can be treated successfully.

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