PATIENT INFORMATION Varicose & Thread Vein Treatments Please use this space to make a note of any questions you wish to ask: Varicose & Thread Vein Treatments The Spencer Private Hospital, Ramsgate Road, Margate, Kent, CT9 4BG Appointments and General Enquiries: 01843 234 247 Introduction Our Consultant Team What are Varicose Veins Why should Varicose Veins be treated? Where does the blood go if my Varicose Veins are removed? Diagnosis and Investigation Conventional Treatments Support Stockings Surgery Endovenous Treatments EVLA (Endovenous Laser Ablation) Foam Sclerotherapy What are Thread Veins? Microsclerotherapy Treatment for Thread Veins What Should You Do Next? Insured Patients Self Paying Patients 4 4 5 7 7 8 9 9 9 10 10 11 12 13 14 15 15 Introduction If you suffer from the embarrassment of unsightly varicose or thread veins or any of their complications - discomfort, discolouration or ulceration, Spencer Private Hospitals are pleased to offer the latest treatments at a time to suit you. NHS treatment for varicose veins is now severely restricted, and is simply not available at all for “cosmetic” conditions such as thread veins. Spencer Private Hospitals are committed to providing a personalised service for the diagnosis and treatment of venous problems and provides diagnostic techniques and precision treatments producing excellent surgical and cosmetic results. Our Consultant Team Mr George Tsavellas Ms FRCS, Consultant Surgeon • • • Qualified at Charing Cross & Westminster Medical School, London. Consultant Laparoscopic Surgeon in East Kent since 2004. Specialist in minimally invasive procedures including keyhole surgery for varicose veins. Mr Giorgio Giancola MB BCh, FRCR, Consultant Interventional Radiologist • • • 4 Consultant Radiologist at East Kent NHS Trust since 1991. Specialist interest in interventional general and vascular radiology including Doppler ultrasound, for venous problems. Expert in pre-surgical venous mapping. What are Varicose Veins? Varicose veins are abnormally swollen, twisted, blue veins that protrude from the surface of the skin. The role of normal veins is to carry blood back from the leg to the heart. Some lie just beneath the skin (‘superficial veins’) and some lie deep in the leg beneath the muscles (‘deep veins’). Varicose veins arise from the superficial veins. The leg muscles squeeze the deep veins during walking, pumping blood out of the leg. All of these veins contain one-way valves to ensure that the blood flows towards the heart. Weakness of the vein wall allows valves in the superficial veins to stretch so that they do not close properly. Blood then flows back down into the leg along these veins. The veins and their branches enlarge and can be seen on the surface as varicose veins. Raised pressure in these veins encourages the development of spider veins and discoloured areas which look like bruises. The damaged valves cannot be mended and the best way to cure the problem is to take out the affected veins. All varicose veins are removed leaving only the normal vessels so that venous blood can no longer flow the wrong way, back down into the leg. It is therefore perfectly safe and often beneficial to remove varicose veins. The removal of varicose veins does not affect blood flow because other veins and especially the deep veins take over this job. 5 Varicose veins are usually obvious due to their visibility, especially on standing. They are enlarged, often bulging beneath the skin. Early symptoms include discomfort, aching, heaviness, fatigue, burning, throbbing and cramps. They may be associated with areas of thread veins on the skin. If left untreated, irritation of the skin around the ankles with swelling of the feet (worse at the end of the day) and discolouration may occur. Normal, healthy valve (left) Re fluxing valve (right) Finally, eczema, phlebitis (inflammation of the vein) and ulceration may occur. Large varicose veins can also be easily damaged by a minor injury resulting in profuse bleeding. Many people, however, only suffer the cosmetic embarrassment of visible veins. Varicose veins often run in families and may affect up to 30% of the adult population in western countries. Men and women develop varicose veins to an equal extent, but women more frequently seek treatment. The problem may arise at any time of life, but is more common with increasing age. Prolonged standing, excess weight, hormonal medications and pregnancy worsen varicose veins. 6 Why Should Varivose Veins Be Treated? Varicose veins do not get better by themselves; they get worse slowly and progressively. Early treatment often prevents the symptoms developing and, of course, removes the unsightly appearance. in fact, the earlier you receive specialist treatment the better the long term clinical and cosmetic results. The Spencer Private Hospital offers treatments that have been developed by world expert vein specialists and have gained approval from the National Institute for Clinical Excellence (NICE) and most major insurance companies. Treatment is designed for each patient based on the clinical history, examination and investigation with a vein scan. Where Does the Blood Go If My Varicose Veins Are Removed? When functioning normally, the entire system of superficial veins only return less than 10% of the blood flow from the legs. However, varicose veins are not normal veins. They are diseased vessels that allow venous blood to move back down the leg — in the wrong direction. This interferes with normal circulation and forces normal veins to work harder. Eliminating the diseased veins is good for your circulation and reduces the workload for normal veins. When varicose veins are eliminated, patients often notice that their legs feel better and less tired. 7 Diagnosis & Investigation Laparoscopy or keyhole Careful clinical examination of the Deg veins is necessary before treatment starts. An ultrasound scan is used to assess the veins which cannot be seen through the skin. This painless investigation allows accurate diagnosis and mapping of your leg veins so that a tailored treatment of your veins can be offered and provided. All patients seen for a new consultation at The Spencer Private Hospital therefore undergo a Doppler ultrasound of the leg veins. Colour duplex ultrasound imaging provides a moving picture of the blood vessels in the leg. A blood flow ‘map’ is added which shows the direction of blood flow in veins. Knowing where the problem has arisen enables the specialist to plan accurate treatment therefore reducing the risk of recurrence. Following your consultation and scan the specialist will discuss his recommendations with you. 8 Conventional Treatments Support Stockings Compression graduated stockings can be prescribed to slow down the progression of leg varicose veins. This is done for symptomatic relief, but they must be worn every day for the rest of your life to be effective. Stockings may help vein symptoms so long as they are worn, but they will not cure the problem. Pain medication may help keep you more comfortable. Conventional Surgery Surgical treatment of varicose veins is the oldest and most established method of treatment. Surgery involves a general anaesthetic and may require a night in hospital. Usually the surgeon will make a small incision in the groin and then a further incision just below the knee. The main varicose vein will then be stripped out between these incisions. At the same time, the surgeon may make several smaller stab incisions around the lower leg and calf to remove the unsightly smaller vein branches - a procedure known as multiple avulsions or phlebectomies. Following surgery your leg will be heavily bandaged and you are likely to require some time away from work to recover. The discomfort and bruising from the surgery will take several weeks to subside. *Up to 30% of patients will suffer from recurrent varicose veins in the years following surgery. Surgery for varicose veins is still performed for some patients and your surgeon will advise you if this is the best treatment for you. * As per current NICE Guidelines. 9 Endovenous Treatments EVLA (Endovenous Laser Ablation Endovenous laser ablation (EVLA) is often an effective alternative to the surgical stripping of veins. It is carried out either on an outpatient basis under local anaesthetic or daycase basis under general anaesthesia depending on the extent of the varicose veins present. Under ultrasound guidance, a thin fibreoptic probe is inserted through a tiny entry point, usually near the knee. Laser energy is delivered in short pulses to seal the faulty vein so that blood cannot flow through it. The lasering is not usually painful but there is some discomfort from the local anaesthetic injections. The procedure takes about 50 minutes per leg. You may require some additional treatment for management of any residual smaller varicosities in the lower leg — either through tiny incisions or foam injections. These treatments can be undertaken at the same time or later, depending on the pattern of veins and type of anaesthetic used. After treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg. Walking immediately after the procedure is encouraged. EVLA has a very good safety record with significant complications being rare. It is over 95% successful at obliterating the cause of the varicosities and 90% of patients are happy with the results. Recurrence of varicosities after EVLA is uncommon; this occurs in less than 10% of cases. Side-effects from EVLA are minor but do expect bruising, with some discomfort most apparent at 5 days and a tight feeling as the vein contracts. Serious complications are rare but could theoretically include DVT (deep vein thrombosis), skin burns, nerve damage causing patches of skin numbness, leg swelling and arterial damage. 10 You will have to wear compression stockings for two weeks after the treatment and we advise that you do not fry for at least three weeks but otherwise you can get on with your life as normal with minimal time off work. Foam Sclerotherapy Liquid sclerotherapy (injection treatment) has been used for decades to treat varicose veins with variable results. It is still the treatment of choice for thread veins but for larger veins the results of just injecting liquids are not good. Foam sclerotherapy is a simple 15 ly into the correct place by ultrasound guidance. These two simple modifications have revolutionised injection therapy and mean that some patients can be effectively treated by injections alone. Some doctors even use foam as a substitute for major surgical stripping but we believe that EVLA is more effective and durable for larger veins and reserve foam injections for those varicosities that persist after EVLA. Foam sclerotherapy is virtually painless just involving one or two small needle punctures into the affected veins. 11 Serious complications with foam sclerotherapy are rare but it is possible for any of the following to happen: allergic reactions, deep vein thrombosis (DVT), temporary eye sight disturbances, ulceration of skin. The most common problem with foam sclerotherapy is staining of the skin which can take several weeks or longer, to go. Of larger veins are treated some patients experience an uncomfortable swelling but this can usually be relieved by aspirating through a needle. After treatment you will have to wear compression stockings for two weeks. You may need more than one sclerotherapy session to achieve the desired result. In summary, foam sclerotherapy is a very useful addition to our armoury for use against varicose veins - and is particularly useful in complex veins through scar tissue, in recurrent varicose veins or in hard skin around ulcers at the ankles - but it isn’t as good as EVLA or surgery for large truncal veins. What Are Thread Veins? Thread veins can occur on the legs, face, cheeks or nose. They are commonly known as spider veins or broken veins, are very common and can be very unsightly. In addition, in the legs they can cause aching, tired legs, itching and burning discomfort. Symptoms are often worse in warm weather. The veins can vary from fine red marks to larger purple or deep blue veins. They can cause significant cosmetic embarrassment and many women will not wear skirts in the summer months. 12 The reason why people develop thread veins on the legs is not fully understood but important associations are heredity, pregnancy and hormonal factors. They may also become more obvious after mid-life because the skin has become thinner and some of the under skin layers are absorbed during later life with the veins becoming more obviously exposed. There are many different types of thread vein and they are very often associated with underlying (visible or hidden) varicose veins and superficial venous reflux. In order to get the best results from treatment it is very important to have a proper assessment of the whole vein system in the leg to see if there is any connection between the superficial thread veins and the deeper veins. The importance of this is that if there is a connection which is not treated then back flow and high pressure will work against the treatment, making it less effective. Recent research has shown that nearly all thread veins have a “feeder” vein nearby that also needs treatment. These veins are called reticular veins. Combination treatments for thread veins including treatment of varicose veins may therefore be required. For best results, a full venous assessment is recommended, and this is beyond the scope of most cosmetic nurse practitioners or beauty therapists performing thread vein treatments Microsclerotherapy Treatment for Thread Veins After treating any underlying varicose veins or superficial venous reflux, an injection technique called “Microsclerotherapy” is used to treat the thread veins directly. A non¬toxic chemical is injected through a very fine needle directly into the vein. This irritates the lining of the vein causing the walls to stick together and prevent blood flowing through the vessel. 13 The treatment takes about 30 minutes and you will experience only minimal discomfort. The walls of the thread vein or spider vein that have been damaged by the injection are slowly removed by the body’s natural defence mechanisms over a period of months. Once the vein has been injected it can take between two weeks to six months for it to completely disappear. On rare occasions it can take up to a year. Compression stockings are worn for 2 weeks to reduce the amount of bruising and discolouration. Normal activities can be resumed immediately. The number of treatments necessary will vary according to the patient and the extent of the condition. To allow the outcome of previous microsclerotherapy sessions to become clearly visible, there must be six weeks between treatments. Patients find that over time a few more thread veins may appear and it is common to require an annual or bi-annual ‘tidy-up’ visit. What Should You Do Next? Once you have decided to seek advice, it is essential to have a formal consultation with our specialist Mr Tsavellas, who will be in a position to answer all your questions. A referral letter from your GP is essential if you have insurance and a good idea even if you do not. It is good practice to make sure your GP knows of any planned treatment. For further information or to arrange a consultation, please call Kerry Goulding at The Spencer Private Hospital on 01843 234 247 or email [email protected] 14 Insured Patients The excellent quality of care provided by The Spencer Private Hospital is recognised by all the major private health insurance companies such as BUPA, WPA, AXA-PPP, Standard Life and AVIVA. Depending on your level of cover, the fees for varicose vein treatments are usually fully reimbursed. You are strongly advised to check with your insurance company before undergoing any treatment to check your level of cover and to be issued with an authorisation number. Please ensure that you have been referred to Mr Tsavellas by your family doctor and when informing your insurance company please quote Mr Tsavellas’ GMC number 3433119. Self-Paying Patients The Spencer Private Hospital can arrange payment options to enable you to spread the cost of your treatment and competitive fixed price packages are available. Please ask for details. 15 Margate The Spencer Private Hospital, Ramsgate Road, Margate, Kent, CT9 4BG Appointments and General Enquiries 01843 234 247 Ashford The Spencer Wing, William Harvey Hospital, Kennington Road, Ashford, Kent, TN24 0LZ Appointments and General Enquiries 01233 616 201 www.spencerprivatehospitals.co.uk East Kent Medical Services Ltd Registered in England & Wales No 03130118 Registered Office The Spencer Private Hospital, Ramsgate Road, Margate, Kent CT9 4BG