Vein Talk

By: Mr Ian Franklin
Created on 28th November 2011

Mr Ian Franklin is a consultant vascular surgeon at Cadogan Clinic. He pioneered the introduction of the VNUS Closure treatment for varicose veins to the NHS, carrying out over 1,000 procedures, and has lectured around the world on the subject of vein treatment. Here, he shares some of his insights

Vein problems can have an enormous impact on sufferers’ lives, and can cause a whole string of problems. Of course sometimes it’s just cosmetic, but even that can have a huge effect on someone’s quality of life – it’s amazing the lengths people will go to in order to hide their veins, whether they be tiny thread veins or big, bumpy varicose veins.

So I feel the cosmetic angle is not to be underrated, but there is also a medical implication with varicose veins – symptoms such as aching, congestion, itching, swelling; all of these can be down to vein problems. And there is no need for people to suffer this, as all these things can be cured by treating the underlying veins.

In the same vein

People tend to think of thread veins and varicose veins as different problems, with one being cosmetic and the other medical. In fact, the two often coexist and it tends to come on very insidiously: you get a little thread vein, which gradually gets worse over time and by the time you come in for treatment you will usually have a mixture of thread veins and varicose veins.

One of the key things with vein treatment is that you have to treat them in the right sequence. You can’t treat the thread veins before you treat the varicose veins. It’s like redecorating your house – you have to start with the hidden works, the plumbing and the wiring, then you do the plastering, then the woodwork and then the final thing is the painting and the wallpapering. If you try to do it the other way around, it won’t work.

It’s the same with veins: you need to treat the underlying problem first, then the bumpy varicose veins and finally the thread veins.

A lifetime commitment

Unfortunately, there are no lifestyle measures a person can take to stop themselves from having vein problems, as it is largely genetically determined. If you catch them early, they may be easier to treat in that they are less extensive and so you will only need one treatment session rather than a more prolonged series of treatments, but it is important to realise that there is no one-off cure for veins.

A good analogy is that it’s a bit like owning a car; if you’ve just taken your car for a service, that doesn’t mean it’s never going to go wrong again, you just wait a sensible amount of time before taking it again.

If you have a vein coming and you go for treatment early, it doesn’t prevent you from needing further treatment in future. So I wouldn’t necessarily advocate early treatment to avoid problems later. I would advise people to come in for treatment when it’s starting to have a negative impact on their life.

Tackling the problem

Vein treatment technology has improved hugely over the past couple of decades. Initially there was stripping, then along came this endovenous treatment, whereby you could insert a very fine catheter into the vein and destroy it using heat. Laser works in a similar way to that, it delivers heat using a laser fibre.

The problem with laser is it’s quite crude, you can’t monitor the temperature at the tip of the fibre. So when I first encountered the VNUS Closure technique I was very excited – it’s a radiofrequency machine and the beauty of it is that it’s completely automatic. The temperature is very tightly regulated, and it’s just enough to shut down the vein, without causing damage to the surrounding structures.

VNUS Closure is a very accurate, standardised way of closing a vein. It’s also very quick and pretty painless – it can all be done under a local anaesthetic and the patient essentially walks into the clinic and walks out again straight after the procedure.

That treats the underlying problem. Next, you have to treat the bumpy, varicose veins. That’s usually done either by injection or phlebectomy – which is where the surgeon makes tiny microincisions under local anaesthetic and gently removes the vein through those incisions, which then heal up without leaving a significant scar.

Thread bare

Once the underlying problem and the varicose veins have been treated, chances are you’ll still be left with a few thread veins here and there. Again, this is something you will have to keep an eye on for life – it’s a bit like having Botox for wrinkles. If you have one session of Botox, you’re not going to look 17 again, you’ll look a little bit younger, but you have to keep topping up over time.

With thread veins, the treated veins will disappear, but you may well get more in time. Usually the best way to treat them is to do micro-injections using tiny needles. They’re easy to treat, and the treatments are easy to top-up, but there is no one-off cure.

But I must stress, there is very little point in doing this unless you have first treated the underlying problem. People often come to see me, very disappointed, after having spent enormous amounts of money on laser treatments and injections and it hasn’t worked, and when you scan them there’s a big faulty valve underlying it.

A word of advice

Finally, if you are considering vein treatment, the most important thing is to go to a practitioner who is qualified and experienced in dealing with veins. Otherwise, they won’t be able to deal with the underlying problem and you will be no better off than when you started, and considerably out of pocket! The good news is that vein problems are easily treatable, so long as you go to the right place.

CS&AG