Varicose vein operation that's tailor made for YOUR legs
00:21 GMT, 27 March 2012
Treatments for varicose veins can leave patients with pain and bruising afterwards.
A new combination of procedures avoids these side-effects, as Rebecca Sparkes, 33, a nurse from Eltham, London, had the treatment
'When my daughter Daisy was born seven years ago, the vein (on left thigh) got worse,' said Rebecca Sparkes
Around a month after my son Nathaniel was born nine years ago, I noticed a swollen purple vein standing up on my left thigh.
It would hurt when I stood for more than a couple of hours.
My GP confirmed it was a varicose vein, caused by faulty valves in the vein.
When these valves don’t work properly, the blood that’s meant to be pushed back to the heart pools in the veins instead. That’s what was causing the pain and the purple colour.
He said varicose veins can often start in pregnancy because of the extra weight of the baby and hormonal changes.
The NHS will treat you only if the veins start to cause real problems.
At that stage, mine wasn’t that bad and anyway, as a nurse, I’d seen patients after they’d had their veins ‘stripped’ on the NHS and knew it could be very painful and leave a scar.
I’d also heard that even the newer methods, such as laser treatment to close the vein down, can have side-effects such as bruising and swelling.
When my daughter Daisy was born seven years ago, the vein got worse.
My GP prescribed support stockings, but they looked and felt horrible, so I wore them for only a couple of days. I decided I’d just have to live with it.
Then, earlier this year at work, I got chatting to a surgeon who said a colleague of his was looking for volunteers for a new varicose vein treatment.
I saw the surgeon, Dr Florian Netzer, in March. He explained certain treatment methods worked better for one type or size of vein than another.
But most surgeons simply applied one method — lasering or stripping, for example — to all the varicose veins, and this was what caused problems such as pain, bruising or scarring.
Dr Netzer said he was testing out a tailor-made combination of five techniques, depending on which best suited each vein.
'When I took the bandages off two hours later, the vein had vanished,' said Rebecca
First, he took a scan which showed all the damaged veins in my leg as yellow on a screen — there was a varicose vein at the back of my left thigh which I didn’t even know I had.
Then I had the 45-minute treatment — Dr Netzer injected local anaesthetic into my left thigh, and I lay on my front while he treated the vein on the back of my leg.
He explained he was using a combination of hot steam injections and radiofrequency to heat up the vein so it collapsed.
Then I turned over on to my back, while Dr Netzer treated the other vein in the same leg. Once it was over, my legs were bandaged up and I went home.
When I took the bandages off two hours later, the vein had vanished and there was no bruising, swelling or any pain.
The day after surgery I did an eight-hour nursing shift and for the first time in years there was no throbbing in my legs.
Since Dr Netzer had explained there was a very small risk of a blood clot developing, I had an anti-thrombosis injection daily for the first five days.
But now I feel wonderful, and am looking forward to my holiday in Thailand this spring, when I know I’ll be able to walk for hours with no trouble.
Dr Florian Netzer is consultant vascular surgeon at London Bridge Plastic Surgery & Aesthetic Clinic. He says:
Over the past five years keyhole techniques have been developed with shorter recovery times
More than one in three of us develops varicose veins at some stage, when valves inside the veins become damaged and blood is not pumped efficiently.
It starts to pool in the legs, distending the veins so they are unsightly and painful.
While doctors don’t fully understand why veins become varicose, we believe the cause is 99 per cent genetic. They are more common in women than in men, and pregnancy can be a factor too.
The mainstay of treatment is compression stockings, but if the problem persists, patients may be offered one of several different techniques.
The problem is that all veins are different and vary from patient to patient, and all these methods have disadvantages and side-effects.
On the NHS, for example, many patients will be treated with vein stripping — making an incision on the ankle and groin and then threading a wire through the vein to pull it out.
However, the procedure can be painful and patients may need to have up to four weeks off work.
Over the past five years keyhole techniques have been developed with shorter recovery times — these include radiofrequency ablation, where we feed a thin catheter into the vein and apply a high-frequency current to shrink and destroy the vein.
However, this is not suitable for smaller veins because the high temperature can damage surrounding tissue, causing pain.
So for those smaller veins it’s preferable to heat them by radiofrequency using a different catheter with a smaller tip and a lower temperature.
Catheters are also unsuitable for tributary veins — these are small, curved veins connected to a main vein, like the branches to a tree. Because the tube is rigid, it can’t reach round the curves to treat them.
The best treatment for these curved veins is steam injections — using a catheter to blow short pulses of hot steam into them to heat and destroy them. But this won’t work well on larger veins because the hot steam doesn’t have enough power to ensure complete closure.
Some surgeons use laser — inserting a laser catheter to heat the walls of the vein so they collapse in on each other.
But as the surgeon cannot control the energy given out by the beam, and therefore risks damaging surrounding tissue, instead I use a small laser beam applied for just ten milliseconds.
This treatment is best for tiny spider and thread veins, smaller than 1mm.
Stripping is only really suitable for the biggest veins in the legs, but when these are ripped out in the standard way this can damage all the tributary veins, causing a lot of bleeding.
Instead, for these large veins, I use an endoscope — a slender tube through which I can insert different instruments to gently dissect the vein, while also applying an electrical current to seal them off without damaging the tributaries.
Most people with varicose veins are treated with just one of these techniques.
But by using different treatments in combination, we can get the best from each and avoid scarring, pain or bruising — it’s an approach I’ve been using in Munich for the past 12 years but this is the first time I’ve used it in Britain.
Before the operation, the patient has a 3D scan that gives me clear images of the veins and arteries from all sides.
Then I can plan the procedure, choosing the best method to treat each size of vein. The procedure itself takes around 45 minutes per leg, under local or general anaesthetic.
In most cases we use the two different radiofrequency catheters together with the steam and the laser, but sometimes we use the endoscope, too.
Patients go home without painkillers and can be back at work and playing sports the next day.
There is always a risk varicose veins will return but for this very reason it’s important to remove them gently, in case we ever need to treat the same leg again.
The treatment is available only privately. It costs 5,500 for one leg and 6,800 for two.