Vicky

Good evening, everyone, thanks for joining us.

We're just going to give it, another moment or two to allow everyone to join and get settled.

Hey, once again, good evening, and a very warm welcome to our webinar on varicose vein treatments and thermal vein.

My name's Vicky, and I'll be your host this evening.

I'm delighted to be joined by our expert speakers, Mr Aaron Sweeney, Consultant vascular surgeon, and Dr George Taggett, Private GP and thread vein specialist.

Tonight's session will begin with a presentation from Mr Sweeney and Dr. Taggart, followed by a live Q&A.

If you have any questions at any point, please feel free to submit them using the Q&A icon at the bottom of your screen.

You're welcome to ask anonymously or include your name but just a quick note that the session is being recorded, so any names that are shared may be visible in the recording.

To help us get through as many as possible, please keep your questions brief.

If you're interested in booking a consultation, we'll share all of the relevant contact details at the end of the session.

I'll now hand over to Mr Sweeney to start the presentation.

Mr Aaron Sweeney

Good evening, everyone.

That's kind of me, and that's a little brief CV so I've been a consultant surgeon for a long time now.

I was one of the guys who started lasering, veins, around about 2000, and brought it mostly to the well, initially to the NHS, but also to the private sector in, South London, mostly.

I've now performed a great deal more than 10,000 procedures, and for some years now, Bennington Hospital has been the largest provider of laser bearing treatments in the UK.

Dr George Taggart

Good evening, My name's George Taggart.

I, qualified in medicine at St Thomas' Hospital in 1991, and as a general practitioner in 1997.

I've been a GP partner in East Sussex since 1999, and developed a special interest in the treatment of thread veins, both on the face and legs in about 2017, and I've been practicing since that time.

Mr Aaron Sweeney

So, today we were going to talk a little bit about what varicose veins are, a little bit on grading, a little chat on what to expect if you come and see us, a little bit more on what your treatment options are, we're going to discuss a treatment called ThermaVein, which is an excellent way of treating smaller veins and then at the end, we're going to have a questions and answers session.

Often the Q&A session is the best, because we think we're explaining things reasonably well, and then people ask a few questions, and you realize that we haven't been but hopefully we're able to explain things reasonably well to you.

So, our CQC rating was outstanding, which is pretty exceptional around the UK at the moment but, many people find it, very relaxing here.

The important thing to remember is when you come to see us here, you're seen by a consultant.

So, whoever's going to treat you, sees you, does scans, etc, and makes sure you understand exactly what's available to you.

So you might want to read little bits of this, but if I say to you, varicose veins, I usually tell people, are a little bit like a Christmas tree.

You have one main vein in your leg called your deep vein, and that runs up your leg and can drain about a liter of blood per minute but if you think of it as a Christmas tree, it kind of makes sense.

There's loads of branches coming in, and some are very big, and they generally drain muscle, and some are quite tiny, and they drain the skin and all of them are going uphill.

Because we've all decided to stand upright, our veins have a bit of trouble, and so they have loads of little valves that keep the blood going in the right direction, but occasionally, that just doesn't happen.

And then it allows blood to pool back down your veins and stretch them, and that ultimately leads to your skin.

It can lead to small thread veins, or it can lead to damage to the skin, where it becomes itching or, sore.

Things that commonly indicate a varicose vein are night cramps in bed, or dry, itchy skin over the lower leg, mostly people mention different grades of varicose veins.

So, grade one is the small thread veins, they can be there are multiple ways of treating those now.

Normally, they're not painful, they're mostly cosmetic. Occasionally, they give people an itch.

Grade two are when you can actually feel them.

Grade three are when you can properly see them like this.

They're not necessarily painful, and indeed, you may have seen people with very large varicose veins, but absolutely no discomfort and no trouble and that's not unusual, and that's because other veins in the leg are taking over from this vein that's not working.

So this vein is not actually draining anything, it's just pooling blood.

It is going back down the leg, and the other veins nearby, which you can't see, are busily taking the blood up the leg.

Next bits are the more medically important varicose vein problems, they are when veins start to get big enough to damage the skin.

And the whole thing about varicose veins is you want to get rid of symptoms, so when you start getting ache or pain or itch, that's often a time to have something done.

And what you want to avoid is are the next levels, where your skin becomes very unhealthy and sometimes you can go on and develop an ulcer.

It takes ages to get to an ulcer and sadly, once you get an ulcer, it takes ages to sort that out and often it's many, many months or even years of skin that's broken down.

But that's unusual, most people, it's ache and discomfort.

You fix that, they walk out the door, and they forget us fairly quickly.

That's the bad ones, skip by that.

So, when you come and see, see me here, you I like to see you personally, take a full history, explain what's wrong with you, I do the scanning in clinic myself, I ask you really what you want.

Some people just want to get rid of the ache and pain, other people like to make sure that everything looks perfect afterwards.

We have quite a detailed discussion, and basically, I like you to say what you want, and hopefully I'm able to deliver.

I talk a little bit about, having local anaesthetic treatments, or general anaesthetic treatments.

I kind of leave that up to yourselves.

Local anaesthetic is the commonest treatment here, but some people are afraid of needles, or, find them find it all a bit scary, and having a general anaesthetic is no problem.

So previously, people used to have their veins stripped, and stripping really involved a cut, usually in the groin, where you disconnected the vein, or the little branch of the Christmas tree that wasn't working correctly, and you put a wire, thing through it, and basically you pulled everything out, and that definitely got rid of the vein, but one of the problems is that often new veins grew afterwards.

Your body, as it was trying to heal itself, produced lots of small veins and quite often, they became big veins, and so varicose vein surgery, for a long time, had a bad reputation because it appeared that once you had one operation, you were almost, guaranteed to have further treatments.

For the last two decades, people have really been doing minimally invasive treatments, so whether that's with a laser or another piece of kit, it's all designed to damage the vein inside the body, allow your body to dissolve away the vein, and hopefully not to see any new veins appearing.

So this is the inside of a thin right leg, so you have an artery that brings all the blood down your leg, can be a liter, or a minute, or more if you're doing lots of exercise.

So a liter a minute has to come back up again, your skin doesn't get that much blood, but it still has to drain uphill, and the commonest vein to go wrong runs up the inside of your leg, and joins into the deep vein, just at your groin, just over where your hip joint is.

It seems to get a bit of a battering as time goes by, and that, combined with gravity, seems to cause trouble with the valve, and the valve fails.

So a laser treatment is threading the laser up the inside of the vein, and damaging it from within.

It's not cutting the vein out or pulling it out and again, there are many different ways of doing this, and they're all called different names, and there's different companies involved.

Essentially, they're either injecting some kind of chemical up the inside of a vein, or using some kind of heat treatment.

So the heat treatment can be a laser, it can be electricity, it can be a microwave, but they all look pretty similar, and they all actually work pretty well.

I just happen to use a laser all the time, but the other treatments are just as good.

The EVLT is endovenous laser treatment, that's where within a vein laser treatment.

Radiofrequency ablation is the same thing, only using electricity.

There's lots of injections you can do, and even people have tried to use glue, which I don't think works quite so well.

So, this is kind of what I normally see, is varicose vein, the left side, which is a little bit bumpy, often a little uncomfortable, but when I scan the person, usually I find a large vein running up the inside of the leg, which is much bigger than the ones you can see.

So, quite often, people have very small veins, a couple of bulges in their lower leg, and they wonder why their leg aches so much, and why they're so, why they're in so much pain, particularly at the end of the day.

Veins don't usually give you any grief first thing in the morning, because you've laid flat all night, and they've essentially emptied but this is kind of an appearance of what to expect.

So when I laser veins, normally, a few weeks later, everything is deflated, some people like me to remove all the little tiny banks, in which case I do that at the same time and it normally takes about 6 weeks for things to look reasonably well.

For people with symptoms such as itching or soreness, or their skin becoming a bit inflamed, the itching and the soreness goes really quickly, but if you've managed to, unfortunately, get some skin damage, and that's where the skin is a little bit darker in color, or red in color, that can sometimes take a little longer to go.

So I'm going to hand you over to my colleague now, and so people sometimes ask a few little questions, don't feel that anything is too stupid or dumb.

It's amazing the kind of questions people ask, and I realize that I really haven't explained things quite as well as I thought.

Thank you, Mr Sweeney.

Dr George Taggart

So we've heard from Mr Sweeney about the treatment of larger varicose veins, but at the other end of the scale, as, already mentioned, are the small grade 1 or thread veins, which typically occur on the face and legs.

Thread veins generally do not cause any physical symptoms, however, for many patients, they can cause significant cosmetic concerns and problems with self-confidence.

So here at Benenden, we use well-established, safe, and effective methods for the treatment of these veins.

So, for treatment of threadbreads on the legs, we use a technique called micro sclerotherapy and this involves the injection of a liquid, or sclerosant, into the vein.

I either use a concentrated saline solution, 20% concentration or a detergent-based sclerosant called Fibro vaie, or polydocanol.

All of these have the same effect, in that they cause a reaction to the lining of the vein wall.

Leading to clot formation, Fibrosis, or scarring, and eventual closing down of the vein.

Once the vein is closed down and empty of blood, it becomes redundant and is eventually reabsorbed into the surrounding tissues.

It is then no longer visible, and that's what we're aiming for.

So, a typical appointment for microsclerotherapy would consist of an initial consultation, including careful examination, and an explanation of proposed treatment.

Subsequent appointments for treatment, will typically last 30 minutes, during which time, you would have multiple injections into the little veins and depending on the number of veins, that governs the number of injections.

Each injection site, I apply a small dressing and this needs to be kept dry and in place for three days.

It's an outpatient procedure, and normal activities, exercise, walking the dog, etc, can be resumed immediately.

Typically, patients will require a course of treatments, and each subsequent appointment is one month apart, so you can fully assess the success of the treatment and the need for further treatment.

So for treatment for, thread veins on the face, we use a technology called ThermaVein.

Now, this technology was established in the late 90s, and has been extensively and successfully used in vascular clinics ever since.

At Benenden, we're using the most up-to-date version of the technology currently available.

Attached to the machine, you can see, is via a wire, is a tiny nickel probe, which you can see in this illustration.

The probe is insulated along its entire length, and that allows the energy from the machine to only leave the probe from its very tip, which is about the width of a human hair and this means that we can use the lowest amount of energy possible, and deliver it extremely accurately which minimizes any side effects.

So, using the probe, Gentle pressure is applied to the skin overlying a thread vein and this blanches the vein, and then a burst of energy is delivered from the machine, which heats the wall of the vein causing it to collapse and stick together.

The probe is moved one or two millimeters along, and the process repeated so as one goes along the vein, It seals.

At the end of a particular vein, when it is now shut down and empty of blood it's no longer visible and as with micro sclerotherapy injections, when the vein is empty and redundant, it becomes absorbed into the surrounding tissue.

So, I have a couple of videos which demonstrate the treatment in action.

So, on this picture, you can see two little veins, and the one on the right is the one going to be treated.

The noise you hear is each is an impulse of, energy from the machine as it seals the vein, the vein on the right is now no longer visible.

On this video, these are more prominent thread veins on the side of the nose, the two at the bottom of the picture are the ones going to be treated.

You'll see the operator is applying pressure, blanching the skin, and then the veins is sealed with the energy from the machine you can see it just blanch.

There's no noise on this video, but it's the same process and after treating that thread vein, again, no longer visible.

So ThermaVein is an excellent treatment for, generally red and purple veins on the face, vascular blemishes, anywhere on the body and it can also be used on the legs as an additional treatment to microsclerotherapy or injection therapy when the veins are too small to inject.

Due to the heat energy of the machine, an inflammatory reaction follows treatment, and as you can see on this picture, prominent nasal thread veins have been treated, and in the picture below, the skin is left inflamed.

This inflammation Usually settles after 2-3 days but occasionally, it can last a bit longer.

Sometimes up to a week, and very rarely even longer than that.

So immediately after the treatment, we apply aloe vera gel and this is really soothing.

For the skin, and we recommend that you continue to use this, until the inflammation has settled.

Again, most patients require a course of treatment, and the number of treatments depends on the extent of the thread veins present.

As with leg treatments, subsequent appointments are one month apart, then you can fully assess benefits of the treatment so far.

Again, so the veins we see are typically red and purple, and they're on the chin and cheeks.

These are tiny thread veins around the nose, before and after pictures and a vascular blemish on the cheek.

On the left, before treatment, on the right, after treatment again, a small vascular blemish on just above the lip and some linear thread vanes.

On the face, which have been treated successfully and some more nasal paranasal veins.

So, in summary, thread veins are a very common problem they can be debilitating for some patients.

With microsclerotherapy and ThermaVein, we have well-established, safe, and really very effective techniques To improve the appearance.

Thank you.

Vicky

Lovely, thank you both.

Now it's time to move on to our Q&A session.

So we're delighted that so many of you have chosen to join us today, and we might not be able to answer every question, we'll do our best to cover as many as we can.

So in order for us to be able to get through as many as possible, we'd, ask that you please truncate your questions as brief as possible.

So onto the first, question.

Is a GP referral required?

I can answer that one, for yourself, the answer is no, come and see one of our consultants here.

Next question is from Pam. Pam says, you said veins grew back when stripped. Why doesn't that happen with modern methods?

Mr Aaron Sweeney

Because you're nearly always damaging the vein from within so you're not damaging necessarily the outside part of the vein, or in particular, the tissue surrounding the vein.

So when you pull a vein out with stripping, you're going to damage the surrounding skin, and maybe even near the muscle, and your body produces a whole lot of stuff that basically heals everything and during that process, it produces new veins.

Those new veins are not the same as the original veins you had and occasionally, they reconnect in, in your groin, where the original incision was made.

So then, a year or so later, you start to develop new veins.

With the newer techniques, mostly, if I'm talking I'm talking about a laser, the laser, it delivers heat to the inside lining of the vein, which is really fragile and when you laser the inside, you're giving it a burn, essentially, and the inside lining initially swells up, then shrivels up, and then the vein cannot work, because it's no longer super smooth.

But that doesn't damage the outside of the vein, and you don't get that reaction where new veins appear.

That being said, you do occasionally develop new veins, varicose veins, and your leg, so with stripping, I think the recurrence rate was about 50% of people had another operation.

I think with laser treatments, the recurrence rate is about well, I see 1% of people after a year, or within a year, because a vein has appeared and I think it's about 10% of people get a new vein after about 10 years, so it's relatively low recurrence rate.

Vicky

Lovely, thanks, Mr Sweeney. I hope that was helpful.

Next question, if you have grade three veins in both legs, would you treat them both together or on separate visits?

Mr Aaron Sweeney

It depends if we if I use local anaesthetic, I have to give you local anaesthetic injections around the vein, and there is a limit on how much local anaesthetic you can use in one go.

So, in one day, I should say if it's one leg, I can definitely treat one leg under local anaesthetic.

Sometimes, if it's two legs and there's lots of side branches, it might be a little bit too much for a single session, so you might have to have two.

Other people have a general anaesthetic, and again, you could have both sides done as a general anaesthetic.

Vicky

Great, thank you.

Next question, I think this is probably one for you, Dr Taggart.

Is there an age above which microsclerotherapy would not be advised?

Dr George Taggart

No, not at all, there's no age limit for the treatment at all.

It's a straightforward procedure with, no problems, no age-related problems, so not an issue.

Vicky

That's lovely, thank you.

Francis has a question for Mr Sweeney.

For the grade three to four veins, what is the self-aftercare after the operation, exercise, stockings, etc?

Mr Aaron Sweeney

So, I like it to get back to normal as quickly as possible.

So, if you look at adverts in various places, they will say that you return to normal activity straight away, I don't think that's quite the case.

I think most people, after I treat them, feel like they've pulled a muscle and I think it takes them a few days to get back to full a few days to get back to full speed, for example, going for a few mile walk.

I would expect people to walk the dog the next day, but I think it takes about two weeks or so to run or go for a long cycle, and around about the same time before you feel happy doing a full yoga class, for example.

But in terms of aftercare, I put you in a compression bandage immediately after the operation, I like you to keep that on for a few days.

It's a non-adhesive dressing, it's a bit like a very soft Velcro you can unravel it, and then after about four or five days, I'd like you to have a shower, and I don't particularly see any great reason to wear stockings, etc.

They rarely fit anyone and I think a lot of people find them very difficult to put on, there's not any great benefit.

There does seem to be a little bit of benefit in having some compression for the first few days, in terms of pain relief.

But overall, I like it to be as normal as possible, and once the dressing comes off, I like it to shower, and treat your leg as if it's, it's normal.

Vicky

Okay, thank you.

Hop that was helpful, Francis and next question, what are the risks associated with varicose vein removal?

Mr Aaron Sweeney

Yeah, so that kind of will follow on from my reasoning for using compression bandaging.

So, the most important thing after having a vein operation is that you're up and running so to speak.

I like it to be walking the dog the next day, etc. I don't like any dressings to interfere with that.

So the initial bandage is because I put some sterile dressings next to any little tiny nicks that I do in the skin.

Once you're up and walking, I feel that your risk of anything nasty is minimal in terms of what to expect, I think most people will expect to have a little bit of discomfort and pain afterwards.

Most people take some Nurofen, there are very few dangerous things that happen following vein surgery.

I, as a surgeon, worry, of course, about the most dangerous thing, which I think is a deep vein thrombosis.

That can occur after anything, a flight in an airplane, or a long journey, but it does occur very occasionally with varicose vein surgery and I like people to be up and mobile, because that reduces your risk dramatically.

If you would like an idea of the risk of developing a deep vein thribosis, for example, after pregnancy, is about 1 per 100 pregnancies.

If you broke your leg in a skiing accident, it can be as high as 1 in 10 and if you have a varicose vein operation, it's somewhere in the region of 1 per thousand procedures.

You might ask, what's my risk of getting a DVT, never having an operation, just being an ordinary Joe walking around?

It's actually one per thousand per year, which, is quite a low, low, low risk.

Vicky

Okay, well, thank you.

Next question is from Irene, and Irene asks, can varicose vein and thread vein treatment be done on the same day?

Vicky

Normally, I would say no.

The reason being that if you have a varicose vein, and that's causing the thread veins, you should get the varicose vein treated first, because it may well either get rid of the thread veins that you have, or the more likely thing is it will give you a really successful outcome following thread vein treatment.

Vicky

Next question is from Nicola.

I think we've answered the bit about, exercising after vein treatment, but she also asks, is treatment painful during and or after?

Mr Aaron Sweeney

Yeah, so I normally tell people it's a bit like going to the dentist.

Everyone thinks it's going to be a bad day, and normally afterwards they say that was nothing close to a dental appointment.

I do have to give you injections around the vein.

I'm injecting local anaesthetic, so you do feel me doing the jabs.

The needle I use is so small that I can't take a blood sample, for example.

So, and I usually say to people, if they can manage a trip to the dentist, with a little cleanup or something like that, you'd more than manage varicose vein operation.

Vicky

Great, I hope that's helpful, Nicola.

Next question is from Jenny, and Jenny asks, I've got a varicose vein that runs over my kneecap, would that be an issue for treatment?

Mr Aaron Sweeney

No, that's one of the commonest ones we do, because every time you kneel, you probably find us very uncomfortable.

That would be a normal vein for me to treat.

Vicky

Okay next question, I have clusters of veins on my legs, which look like bruises. Which is the best treatment?

Mr Aaron Sweeney

Depends a bit.

Normally, you do a little scan on you just to see if you've got an underlying vein, underlying varicose vein producing that, but if you don't, I think it may well be best treated with some sclerome.

Vicky

Okay, lovely, thank you.

Next question, again, about exercising. Are there any exercises to avoid after varicose vein treatments?

Mr Aaron Sweeney
Not really. If you're a powerlifter, lifting 200 kilo and doing 200 kilo, squats, yeah, I don't like you to do that, but normal stuff like cross trainers, cycling, etc, are fine.

The moment you feel able to do it, I feel you should do it.

Vicky

That's great.

Next question is around the positives and negatives of removing varicose veins, and what happens if the veins aren't removed?

Mr Aaron Sweeney
So, I'm very particular on this, that I do not try and push you into having an operation.

So, for most people, they can have a varicose vein forever, and it doesn't cause them much trouble.

Most people who come to me have had varicose veins for at least a decade.

They start off usually being a bit uncomfortable around the time of, first or second pregnancy, but people are just a little bit too busy with kids and life.

And it often takes 10 years or so before anyone comes near me, so they are quite benign.

The problem is that eventually you reach a stage where either they don't cause you any trouble, or they start to.

The trouble is usually itching or discomfort.

The discomfort, most people can put up with that for donkey's years.

It's the itching that really causes trouble, and that's the normal reason someone comes to me, is that they've had veins for years, and then they start to get a skin problem, whether it's itch, soreness.

So, I rarely push anyone to have an operation unless I can say that they're clearly going to go on to develop an ulcer.

So, for most people, I think it's an elective procedure.

It's designed to get rid of the ache, itch, or soreness in your leg.

It doesn't you do not need to cancel a holiday to have that done, and I think you can work at a time that suits you best.

I rarely think people need to be pushed into having the operation.

Vicky

Okay, thank you and following on nicely from that's a question from Robin.

Robin asks, I've got a varicose vein on one calf, no problems or symptoms.

Should it be treated as a preventative measure to prevent development of further problems?

Mr Aaron Sweeney

Yeah, I think you have to be a bit careful.

So, if every day you wake up, look down at your leg, and you're fed up with that vein, I think that's a reasonable reason to do it.

It's a very low-risk procedure, and you get over it quite quickly.

However, I would never say to you, have something done on the off chance that it might cause you trouble in the future that's not a reasonable thing.

So, quite often, I will scan both legs if you come to see me, and when I scan, I might pick up another varicose vein on the other leg.

If you're having no symptoms, I generally don't come near that.

I think sometimes we are so good at scanning people that we pick up loads and loads of stuff, and I think you'd be forever in an operating theater if you did everything that was found on a scan.

So, I'm very clear that people have a varicose vein operation for a specific reason.

Not necessarily because of something that might happen in the future.

Vicky

Hope that, helps.

Next question, similar to one that we had, earlier.

My varicose vein runs up the front of my leg and is now in the knee is that treatable?

Mr Aaron Sweeney

Vicky

Almost always, yeah.

Next question is from Lucy, and Lucy asks, I've got a lot of varicose veins on my lower right leg.

What's the maximum number of veins that can be removed in one session?

You'd be I hope you'd be pleasantly surprised.

I most people only ever have one operation, on on each leg with me so I normally can get rid of almost well, I would say everything.

There's enough local anaesthetic to do that, and sometimes if somebody has a particularly complicated set of varicose veins, I ask them to be asleep, and then I don't have to worry too much about giving them loads and loads of injections.

So, the short answer is I nearly always get rid of everything that's bothering you in one session.

Vicky

That's great, thank you.

Lucy's asked a follow-up question, can you drive after varicose vein treatment?

Mr Aaron Sweeney

Not on the day sorry, for varicose vein operations, not on the day.

Your insurer doesn't like you to have an operation where I've injected loads of stuff, put you in a bandage, and then get you into a car.

I think it's because they're afraid you might be get a little lightheaded, or a crash.

With regards to thread pains you can, you can certainly drive after that.

Vicky

Lovely, thank you.

Next question is about, how can I please ask how you help with patients who have a phobia of needles?

Mr Aaron Sweeney

Yeah, so that's very common.

Most people who are needle-phobic have a general anaesthetic, I have to say, and we just make sure they don't see needles, and you can do things like put creams in the hands so you don't feel the needle, but I always feel that people have phobias of loads of things.

There's no point in pushing them around, trying to get them to get rid of the phobia on the day.

So, I deliberately ask people, or I show you how many injections I would give you and it's pretty obvious to me, people who have a phobia of needles, that it's very common.

I just don't see any point in stressing yourself out.

The risks of general anaesthetic versus local anaesthetic, that is more or less the same, and I think if you're going to have an operation, you want to make sure you're not stressed out from it.

So, most people with a bad needle phobia, they have a general anaesthetic.

Vicky

Next question, what's the recovery time for each of the vein treatments?

Mr Aaron Sweeney

From a varicose vein point of view, I usually say to people it's about 6 weeks before you forget that anyone that I've been near your leg, and when you look down, it looks okay.

But, I think it takes the first two weeks, I think you know I've done something.

I think you ache a little bit, might take some almost certainly you take some Nurofen or something like that but when you look online, people say that you're back to normal the next day that's not quite true.

You do normal things, like walk the dog or walk to work, but I think it takes two weeks to get up in the morning and not really think about your leg, and maybe about 6 weeks before you look down and go, they're all gone now.

I applied dressings, so they'll be in place for three days.

Dr George Taggart

You do get some very localized inflammation, which is what we're after, but it can cause a bit of itch.

Other than that, after three days, we're back to normal, I do encourage you to stay active during that time not run a marathon, but as Mr Sweeney said, walking the dog is perfect.

We want you to be very active, not sedentary, so there's really very little restriction after microsclerotherapy.

Vicky

Lovely, thanks very much.

Next question is from Sherilyn.

Sherilyn says, I've had primary bone cancer and had most of the bone replaced with a megaprosthesis. She's now got a grade three vein in that leg.

Would removal be recommended, given the risk of infection?

Mr Aaron Sweeney

Yeah, the risk of infection wouldn't worry me.

Sometimes when you've had major, operations on your leg, or, for example, large fractures or broken bones.

I worry a little bit that the deeper vein, is damaged.

That's the reason why you have I do all your scans, is I'm really looking to make sure your deep vein is perfect and if you just remember that analogy with the Christmas tree, the deep vein is the central trunk.

You need to make you need to be absolutely certain that that is in perfect condition before doing any varicose vein operations, so infection, that doesn't that's very rare, but you just need to make sure that you don't, that the deeper vein is perfect.

Vicky

Thank you.

Yeah, I hope that was reassuring, Sherilyn.

Next question is from Royce, and they asked, varicose veins stage three behind their left knee.

They've had a EVLT, but recur which is recurred, and then fibrovane and recurrence again.

Is it worth pursuing, and if so, what treatment?

Mr Aaron Sweeney

Yeah, again, it's a bit difficult to say.

I mean sometimes, if EVLT is the first operation you've had, the recurrence rate's low, but if you've had a previous stripping.

Even if there is are veins that you could laser afterwards, you still have a pretty high recurrence rate.

The back of the knee is often a complicated spot, and you are more prone to getting recurrences there.

But if you've had a couple of operations and they keep recurring, that is a difficult vein problem, and I certainly wouldn't say that you're not going to get another recurrence, that just wouldn't be right.

Vicky

Okay, thank you. Hope that's helpful, Royce.

Next question for Dr Taggart.

Would Therm of A and be undertaken by a doctor or a nurse?

Dr George Taggart

That would be a doctor myself, so I'm the only I do all the ThermaVein at Benenden.

Vicky

Lovely, thank you.

Next question is from Victoria, and she asks, I have varicose veins in my groin, are they easy to treat?

Mr Aaron Sweeney
It depends, is my answer.

So sometimes you can have varicose vein in your groin that actually comes from inside your pelvis.

It's called pelvic vein incompetence, and you can think of it as a varicose vein that doesn't start in your leg, it actually starts in your pelvis.

It depends, because sometimes there are really fairly complicated procedures to get rid of those, depending on how much pain they're causing.

Sometimes, if they're not causing any pain, they can be treated very locally, either by removal or even an injection of a type of foam.

Vicky

Lovely, thank you.

Next question, I have a couple of red, dry sores over car vein, not cleared by steroid cream from my GP.

Would these have to be cleared up before surgery?

Mr Aaron Sweeney

Short answer is no, and sometimes the sores are actually caused by the vein irritating your skin, so often treating the vein gets rid of everything.

Vicky

Okay, thank you.

Next question, I'm 40, and I've had varicose veins since I was 25. Is this normal, or am I at higher risk of issues?

Mr Aaron Sweeney

I usually see them on older people.

Yeah, that's common, I've seen them from age 13 onwards.

Most people notice them when they're in their 20s.

If they're a lady, they sometimes have some babies, and that, you're big spikes of progesterone during pregnancy dilate veins, so they often get a bit worse, and then you have a baby, and then you're busy, and the veins reduce slightly.

But once they've started, they don't disappear so they will get bigger as time goes by ao it's not unusual.

A common age I think, for operations is around 50 but the first time they appear is around about 25 to 30, so you're normal.

Vicky

Okay, how reassuring.

Next question, why are muscle cramps symptoms of varicose veins?

Mr Aaron Sweeney

Yeah, don't know, but we think it's because the blood essentially sits in that vein, for most of the day, so you might think that it

Loses a bit of oxygen, builds up a little bit of lactic acid, and it appears when people lie down in bed, it seeps back into the muscle.

That's kind of what I think happens, but either way, it is one of the things that happens all the time, and quite often, the thing that people are most delighted with after their vein operation is that they're not jumping out of bed at night.

So, though there are multiple causes of, cramping, everyone seems to receive some kind of quinine for those.

If you have a varicose vein, I usually say wear a flight sock and see if that gets rid of the cramping, because that, although that's not a real treatment, it sometimes gives a very good idea as to whether the vein is the cause of your cramp.

Vicky

Thank you, next question.

I have varicose eczema, but cannot see any veins, how do you know where the vein is?

Mr Aaron Sweeney

Well, that's because we ultrasound your leg, because you can see everything underneath.

And, you can often pick up veins that are really quite large.

Some of them can be 40 or 50 centimeters long and as wide as your thumb, but because they're about a centimeter under the skin, you don't see them and varicose veins are only really visible on the surface when the smaller veins start to stretch.

But the slightly larger branches of the main vein can be what we call incompetent, or not working correctly, and give rise to quite a lot of varicose eczema without anyone realizing that there's a varicose vein underneath the skin.

Vicky

Okay, lovely, thank you.

Next question is from Sheila, and Sheila asks, my varicose vein is large and at the top of my leg, can this be done with EVLT?

Mr Aaron Sweeney

Well, EVLT, or lasering, is usually we're lasering the vein that is causing all the varicose veins.

So when we laser veins, we're actually threading a wire of something that's straight the branches that come up on the surface, we often I often treat with a few little nicks in the skin called phlebectomies, where I break the vein up underneath the surface, so

In you, I would probably be scanning right up into your groin to see if there's an underlying vein.

I'd probably laser that, that would deflate everything, but it never gets rid of it completely.

So the bumpy veins, if they're up near the top of your thigh, I would probably treat those with a little tiny incision.

Vicky

Okay, great, thank you.

Thanks for your question, Sheila.

Next question is from Nick, and Nick asks, my legs twitch quite sharply at night, is this a symptom of varicose veins?

Mr Aaron Sweeney

Not necessarily, no and I think varicose veins produce tons of different symptoms, from a little bit of swelling, a little bit of ache, some cramping, itching, but they're not exclusive to varicose veins, so sometimes there are other conditions that produce similar, so it's difficult to say.

Normally, I'd scan you and make sure if there's a big varicose vein there, then more than likely that's the cause of your trouble.

I usually tell people that if you have a very obvious medical problem and symptoms that are clearly, common with that problem then, you know.

That's probably the reason why you're getting all the trouble.

It's unusual for people to have two separate problems producing the same symptoms.

Vicky

Thank you.

Now, we'll take a couple of questions on thread veins now.

First one, is there any risk of bleeding or scarring of the face after thread vein treatment?

Dr George Taggart

So thread veins, the reason we can see thread veins are is because they're very near the surface of the skin.

Now, although we are putting the probe on top of the skin, occasionally, we do, get a tiny speck of blood mainly because the vein is so near the surface.

So you can be left with a little scab afterwards, but that rubs off in a couple of days, and scarring is not an issue.

I mean, it is possible, in theory, to scar the skin if you treat a particular spot too much, but the whole skill of the treatment is moving along the vein, and not dwelling on one one particular spot.

Given that low energy of this form of treatment, scarring is very, very rare indeed.

Vicky

Caleb, we hope that was helpful.

And another question about thread veins, could the thread veins on the inside of my thigh be treated at the same time as a few on my face.

Dr George Taggart

Yes, indeed.

The length of the appointment is half an hour, so we can treat as much as possible in that time, so depending on the extent of the veins, and whether they need thermovane or injection.

On your thigh, they could certainly be treated at the same time as facial treatment.

Vicky

Okay, thank you.

Next question is from Sally.

Sally says, I have varicose veins in both legs, I wear compression stockings always, except in the gym and love spin classes, is this foolish?

They're just so uncomfortable during sport.

Mr Aaron Sweeney

No, I think, I usually give people the option of wearing compression stockings.

I don't know anyone who wears them, so, my hat's off.

The I find most people find them too uncomfortable to wear, and for daily life, they're a bit miserable.

Some people, of course, they have no option.

With regards to exercise, things like running and walking, you get a kind of a siphon effect in your veins, so varicose veins don't usually give you trouble with that.

Spinning classes are slightly different, because you are slightly creased, and that compresses the bigger veins in your pelvis, and sometimes cyclists end up having more trouble with their varicose veins.

You sometimes see that on guys in the Tour de France, for example. they often have very large veins at the end of a long track but it's because of the particular position you're in.

So cycling, amazingly, sometimes causes veins to be a little worse, it doesn't cause veins, and I wouldn't say don't cycle.

I can see a few other questions I might just answer quickly, just, so some people think about compression stopings, do they stop you getting a DVT on an airplane?

Yeah, not really, the risk of a DVT on an airplane is truly tiny.

So people sometimes ask me, is it safe to fly with varicose veins? If it's safe to fly, or drive a car, or whatever I don't think being in an airplane puts you at any great risk.

I think wearing a pair of flight socks that are too tight or, are uncomfortable is the wrong thing to do, as it sometimes irritates the vein.

And sometimes people get a little bit mixed up between a deep vein thrombosis and where a vein on the surface clots off.

That's a thing called thrombophlebitis, which is very painful.

And sometimes you can get that in an aeroplane, just because you're scrunched up in a particular seat, or wearing badly fitting stockings, and they kind of crease the vein and damage it.

You might say I can see some questions like, do you have to stop HRT before the procedure?

No, most people who have laser treatment with me, I give them a small dose of a drug called Clexane, which is a blood thinner, and that's just to reduce your risk of a DBT and allow you to have an easy time for the first 24 hours or so.

I really don't feel you need to go walking around straight away, the following morning is fine to start getting back to normal.

Vicky

I'll just have a couple more questions, because we only have time now.

I've had sclerotherapy on my legs approximately 30 years ago for thread veins, they've reappeared as bruises, can I have treatment again?

Dr George Taggart

Yes, you certainly could have treatment again.

It's under we use a magnified light with polarized light to examine the thread veins, and it's probably reappearance of thread veins rather than bruises, but a group of thread veins can appear, like a bruise, so I suspect that's what you're seeing and that could certainly be treated again.

Vicky

Lovely, thank you.

And we'll just take this one last question here from Lucy.

Lucy has grade 4 veins and is very hypermobile, would this make treatment difficult?

Mr Aaron Sweeney

No not particularly very common, I don't think hypermobility or Ehlers-Danlos Syndrome really is the cause of varicose veins.

I think they just occur randomly and I just I can see a few other bits of questions that I maybe didn't answer, or didn't wasn't that clear on.

So, there are lots of different treatments for your for varicose veins, it's often a combination of treatments when I when I do things to you.

So, I laser veins that would have been stripped in the past anything I can thread a laser up, I do some.

Anything that's a bit bumpy, I generally do a small incision, and I have a little instrument that goes under the surface and breaks the vein and anything that's smaller than that, sometimes I use, some foam or I do nothing and wait and see, and then we arrange for you to have some sclerotherapy.

So sometimes people have heard about a treatment called ultrasound-guided foam sclerotherapy.

That's the same stuff we inject up thread veins, but when you use it in larger veins, you make it into a foam so that it fills the vein.

That essentially gives a chemical burn to the inside lining of the vein, I tend I do use that a fair bit.

It's usually on recurrent veins, but I don't use it as the primary treatment of a straightforward varicose vein, because I think it has a higher recurrence rate.

And I don't like the discoloration that's sometimes left on the skin when you treat large veins with foam.

So often, I would say to people, have laser treatment when I can and if veins are too tortuous, or they're complicated recurrences, I sometimes use foam then.

It's the reason why I scan you during clinic, is really so that I can tailor it to whatever it's likely to, fix your problem.

Vicky

Okay, lovely.

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