This week Prof Mark Whiteley and his colleague, Prof Deen Jameel, gave a talk at the Royal Society of medicine to the Independent Doctors Federation. The talk was 50 minutes in length followed by questions which ended up taking another 30 minutes.
Prof Whiteley explained that traditionally, patients, nurses and doctors have been taught that “varicose veins always come back”.
However, after over two decades of research as both lecturer and then consultant, Prof Mark Whiteley has developed The Whiteley Protocol® which markedly reduces the risk of varicose veins coming back after treatment.
Mark explained that the major reasons for varicose veins appearing to come back after treatment are:
Mark has written a book which will shortly become available called “why varicose veins come back – and how to stop them” where these factors are fully explored as well as others that are essential for patients to know before they choose to get their veins treated.
Many vein clinics and vein practices still have the same doctor who consults the patient and does the surgery also does the duplex scan. This often results in varicose veins being missed particularly perforating veins and pelvic veins.
There is a huge amount of research showing that you need to be constantly performing a task to be expert at it. This has been backed up by research presented at the venous conference in 2014 showing doctors doing their own limited scans miss at least 30% of the causes of varicose veins. In addition, even the National Institutes of Health and clinical excellence (NICE) recommend that patients having varicose vein surgery should be investigated and treated by teams – not doctors doing their own scans (nice.org.uk/guidance/cg168/chapter/1-recommendations#referral-to-a-vascular-service-2).
At The Whiteley Clinic, scans all performed by expert vascular technologists trained in The Whiteley Protocol® and performing venous duplex scan is consistently through the working day. These typically take 30 to 40 minutes which is the sort of time required to be able to see all of the veins in the legs that can be causing a problem.
Over the last decade and a half, The Whiteley Clinic has been at the forefront of research showing that pelvic varicose veins can cause a host of problems including leg varicose veins.
Unfortunately, despite this, most doctors still do not check for pelvic varicose veins meaning that one in seven women with varicose veins (rising to one in five if they have had children) do not get their pelvic varicose veins investigated or treated giving them a very high chance of recurrence.
The research showing this was published in 2014 and presented the American venous Forum (https://thewhiteleyclinic.co.uk/research/published-research/varicose-veins-come-back-dont-check-pelvic-veins/).
Most doctors ignore incompetent perforating veins as part of varicose vein treatments. This is because there was some incorrect research published in the 1990s suggesting these incompetent perforating veins disappeared if varicose veins were stripped.
Prize-winning research from The Whiteley Clinic show that this was wrong and that stripping the veins did not cause the incompetent perforating veins to close (http://www.ncbi.nlm.nih.gov/pubmed/17701962). Indeed, when they were checked a year after stripping, the vast majority was still open and feeding blood into recurrent varicose veins.
The arguments as to why incompetent perforating veins need to be treated have been published internationally and are based on research from The Whiteley Clinic (https://thewhiteleyclinic.co.uk/research/published-research/incompetent-perforator-veins-recurrent-varicose-veins-trlop/).
Although we have now known for many years that varicose veins grow back again after stripping, most people still think that laser, radiofrequency or foam sclerotherapy do not cause this problem (https://thewhiteleyclinic.co.uk/research/published-research/varicose-veins-come-back-stripping-5-8-year-results/).
This is true, provided they are used by experts who understand the techniques.
Different sizes and different positions of veins, needed different techniques. Many clinics only offer one or two different techniques and this can mean that some of the veins might not have the optimal treatment.
An example of how treatments recommended by companies might not be optimal without doctors do their own research was shown by one of our prize-winning papers of radiofrequency treatments (https://thewhiteleyclinic.co.uk/research/published-research/research-radiofrequency-ablation-rfa-rfitt-effect-of-leed-on-varicose-veins/).
The Whiteley Protocol® is a constantly updated research protocol that optimises exactly the right treatment combination, tailored for each individual patient and their unique varicose vein pattern.