The NHS will treat them only in the most extreme cases. But one leading vascular surgeon warns… varicose veins are like icebergs – most of the problem lies beneath
21:21 GMT, 30 June 2012
Perfect pins: There are many private treatments that can improve your legs
Varicose veins are so often dismissed as just a cosmetic issue.
Yet most weeks in my clinic I see patients who have travelled from all over the country, many in constant pain and at their wits’ end.
They have saved for months to see a vascular consultant – even at the reduced rates we offer.
What’s most frustrating is that varicose veins can be easily and permanently resolved, but bureaucracy prevents us from treating them as we would wish.
Unless you are literally bleeding from your leg, you’re very unlikely to be offered surgery on the NHS.
Back in the late Nineties, I was in charge of a thriving vein clinic at Middlesex Hospital. We had patients coming in on a weekly basis for treatment and advice, and were a training centre for vascular doctors.
Varicose-vein surgery was the most common procedure on the NHS. Then in 2001, the National Institute for Health and Clinical Excellence (NICE) decided it wasn’t necessary. At a stroke, patients were whisked off waiting lists and my clinic closed almost overnight.
Varicose veins – which affect as many as a third of us – develop when a vein enlarges. It usually occurs in the superficial veins (those nearest the surface) in the legs.
They are caused by various factors. Obesity will put extra pressure on the leg veins and some of us have a genetic tendency to weak vein walls.
As we get older, veins naturally become more prone to stretching, and in pregnancy, hormones and the pressure of the baby affect vein walls.
Veins have valves in order that the blood flows in the correct direction – towards the heart. When a vein is stretched or enlarged, the valves don’t function and the vein becomes incompetent.
Instead of blood going up the leg as it is supposed to, it goes both up and down and pools. Once it has started, it’s like a domino effect. As one valve fails, there is more pressure on the next one, and so on.
Once this domino effect has started, these veins will only get worse. In many cases they can seriously affect or even destroy quality of life.
Most of my patients with varicose veins are suffering from a potentially serious medical condition that is causing them a great deal of distress. Their veins are unquestionably unpleasant to look at, being lumpy and dark blue or purple.
But they also cause swelling and pain in the legs, itchy and restless legs and swollen ankles.
Most patients will visit their GP on numerous occasions. But by the time you have noticed your varicose veins, they will be worse than you realise. They are like icebergs. Most of the problem lies beneath.
However, according to the savage NICE guidance from 2001 – which has seeped down into most PCT (Primary Care Trust) recommendations for GPs – ‘most varicose veins require no treatment and can be managed in primary care’.
It is suggested that referral to a consultant occurs only if the veins are bleeding.
The key recommendation is wearing compression stockings for at least six months to encourage circulation in the leg. But these are available in only five sizes, meaning that they don’t fit the largest patients. Neither are they comfortable.
Even if you manage to obtain that
elusive referral, vascular surgeons are under such pressure that they
may not have time to respond to cases marked as non-urgent.
have even been suggestions that PCTs have encouraged consultants to
‘bounce back’ referral letters to GPs, which effectively means they are
refusing to see patients.
Obesity will put extra pressure on the leg veins and some of us have a genetic tendency to weak vein walls
Over ten years, there was a 34 per cent decline in the number of total finished consultant episodes for varicose-vein treatment. A total of 55,609 procedures were performed in 1998-99, whereas only 36,923 were performed in 2007-08.
All of this is, of course, about money. But in my opinion, rapid and immediate treatment in many cases would ultimately save millions of pounds.
Treating varicose veins at onset means that these complications won’t arise. Frankly, it’s like having chest pains and being told that you can’t have treatment until you’ve suffered a heart attack. It’s likely that the reduced number of operations is leading to increased complications in the condition.
A large proportion of sufferers will go on to develop venous stasis. This is poor blood circulation in the legs, which presents a risk of blood clots.
Many will develop leg ulcers, which are
open and painful wounds. An estimated half a million people in the UK
suffer from recurring ulcers.
Rapid and immediate treatment in many cases would ultimately save millions of pounds
Ideally, the dressing for an ulcer should be changed two or three times a day, but many patients will be having it changed at a clinic only once a week, by which point they stink horribly. As open wounds, they are prone to infection and are an extremely debilitating condition. They are likely to need surgery.
The NHS is spending between one and two per cent of its annual budget on the treatment of ulcers. Up to 70 per cent of these, I believe, will be down to varicose veins.
Ian Loftus, consultant vascular surgeon and spokesman for the Royal College of Surgeons, suggests that we need to find a proper scoring system for varicose veins, based on how much the patient is suffering and whether there are signs of long-term damage. He also suggests using ultrasound to assess them.
Admittedly, in the very early stages you may have to live with them, especially if the problem is predominantly cosmetic. But if circulation in the lower leg is compromised and it looks as if the condition will deteriorate, we can offer various treatments with excellent success rates and a low chance of recurrence.
Radiofrequency ablation introduces a catheter into the vein and heats it up, causing the vein wall to close.
Lasers can be used to destroy the veins and the effectiveness of a procedure called sclerotherapy – which injects foam into the veins and forces them to collapse – has come on immensely in the past decade.
A surgical option is a technique called inverted vein removal, where we turn them inside out and remove them. It’s much less invasive than the old stripping technique and has the lowest rates of recurrence.
For now, in all but the most extreme cases, patients have no option but to go private. Prices for a consultation, including scans, average about 500. Treatments range from 2,500 to 5,000, with lasers and radiofrequency being the most expensive, despite having the highest levels of recurrence.
We spend so much money talking about preventative medicine. This could be implemented so easily – what a shame it’s not likely to happen.