Vicky

Good evening, everyone. Welcome to our webinar on treatment for varicose veins and ThermaVein®. My name is Vicky, and I’m hosting this session.

I'm joined by our presenters, Mr Aaron Sweeney, consultant vascular surgeon, and also Dr George Taggart, private GP and thread vein specialist.

The presentation will be followed by a question-and-answer session. If you'd like to ask a question during or after the presentation, please do so by using the Q&A icon, which is at the bottom of your screen. This can be done with or without giving your name. And please note that the session is being recorded if you do provide your name.

If you'd like to book your consultation, we'll provide some contact details at the end of this session. So I’ll now hand over to our experts, and you'll hear from me again shortly. Thank you, Mr Sweeney.

Mr Aaron Sweeney

Hi there, I’m Aaron Sweeney. I'm one of the guys who's working here. I'm a vascular surgeon, so mostly I deal with veins and arteries, mostly veins nowadays, and I have been using a laser to treat varicose veins for quite some time now, maybe twenty years or so, and here at Benenden, we do the largest number of laser vein treatments in the country.

Dr George Taggart

Good evening. I'm George Taggart. I'm a GP. And I’ve been practicing in East Sussex since 1999.

I developed an interest in thread vein treatment, and I’ve been practicing in this field for the last eight years since 2017 and have recently joined staff here.

Mr Aaron Sweeney

Apologies for the noise. It's me.

So today we're just going to talk a little bit about varicose veins. I don't want it to be too technical, and most people have questions they want to ask. So at the end of the session. It's really nice if people type in a few questions, because you'd be surprised how much you learn from that. So what I’m going to do is just tell you a little bit about what varicose veins are. There are a few grades that people sometimes talk about.

I'll tell you a little bit about what's involved in a consultation.

We'll talk a little bit about what treatment options are available to you. We're pretty realistic here about what results to expect, and then Dr Taggart's going to talk about thread, vein treatments, and some of the new stuff that he's up to. But our last bit will be a question-and-answer session, which is really the thing that most people get most of their information from.

So we're doing pretty good here at Benenden. Get quite a high satisfaction rate, and the CQC rate is outstanding, which is pretty unusual. And we also do lots of treatment. And anyone who's been here recently realises. It's a pretty, clean, tidy place. It's not too busy, and it's normally easy to park at.

And so, first of all, what are varicose veins, and what kind of symptoms do they cause?

So sometimes people are a little bit surprised. Insurance companies often think of varicose veins as a cosmetic problem. But I would say that the vast majority of people who come to see me.

I've had varicose veins for at least 10 years. They normally have other things going on in life and don't have any desire for an operation. But something happens, such as soreness or pain, and then they come to me to try and sort that out.

Varicose veins cause many different symptoms. It usually starts with a little bit of swelling, normally around the lower leg.

You can sometimes see some veins, but occasionally people don't have any obvious varicose veins, but all the symptoms.

In general, people get achy, heavy legs, mostly at the end of the day. You sometimes get cramps that are nearly always in the middle of the night. When you have a slight stretch and varicose veins, it often produces dry, itchy skin, and that's not always over the varicose vein, but it is nearly always in the lower part of your leg.

So I won't be too technical about varicose veins. But just to say, I tell most people to think of veins like a Christmas tree. You've one main vein running up the inside of your leg that's called your deep vein, and then, rather like a Christmas tree, you've loads of branches coming in and joining that deep vein. The big branches are nearly always draining muscle. They're surrounded by muscle so they can squeeze blood uphill. But the problem veins are skin veins.

You have hundreds of these, and many millions of years ago, when we were walking on all fours, those veins were draining it almost horizontally, and because we decided to stand up, it stretched them a little bit and made many of them vertical, so they need little valves to keep everything going uphill, and those valves are really flimsy. They break easily, and once they break, they don't recover, and it is those valves, when they fail, that allow blood to pour back down the leg.

They fill up the veins and finally fill up the little veins on the surface and start to give you some symptoms.

So there are different grades. We talk about grades, one to four grade, one of the relatively small veins that don't usually cause pain, but they do cause a lot of distress and can be cosmetically very unappealing.

The second ones, you can probably feel them. They generally don't cause pain. Again, grade three is normally when they start to be visible on the surface, and that normally gives people some ache or discomfort, and they're normally the type that I treat.

Grade four is when they start to give you grief with your skin. So that's when skin becomes inflamed and sore and sometimes changes colour. And those veins, medically, I would say, need to be treated quickly on that one aside. That's just when things go wrong and your skin can become ulcerated. I don't want to scare you into having something done. Ulcers are reasonably rare, and they don't occur overnight.

People who know they have varicose veins and have symptoms related to their varicose veins very rarely get an ulcer because they know what's going on. Ulcers typically develop over years, and they start off with some itchy skin.

Then some redness that someone diagnoses as eczema or psoriasis, and people have various creams and potions, and intermittently it gets a bit better. But finally the skin breaks down. But that whole process takes many years, and it's really sad because it can be stopped long before it gets there.

With regards to consultations. When you come to Benenden, and you see one of us. So I would see you take a history and examine your legs. I do a scan called a venous duplex ultrasound in the clinic. So you don't have to come back for any extra scanning, and I draw everything for you. Tell you exactly what's available to you, and if you want to go ahead and book, you can do that on the day, but no pressure is put on you to do that, and I give you all your options, including the option of not having treatment and what to expect in particular. I don't like pressuring people into having something done.

In terms of varicose veins, treatments. Well, years ago people used to strip veins, and most people are very familiar with that, and that's where you do a cut in the leg. Disconnect the vein from the deep vein. You put a wire down the inside of the vein that's called a stripper, and you pull the veins out.

That is as brutal as it sounds. It was the only operation available for a long time, and it wasn't a particularly bad operation. It just has a problem with recurrences. So many people have been put off having varicose vein operations because they seem to always come back, or they know that their mom or their granny had multiple previous operations. That's not really the case anymore. Normally, nowadays, we.

Treat veins with something we call minimally invasive treatment. But essentially, you thread something up the inside of the vein. And here it's mostly a laser.

This picture is just to orient you slightly. It's the inside of a right leg. It's quite a slim leg, and just to orient you, there's a vein running down the inside, and that's showing a laser up the inside of the vein. So lasering is not like James Bond, where we are, with a laser beam from the outside. Laser energy is actually heat. So what we do is thread a small laser up the inside of the vein rather than doing a cut and pulling everything out.

You leave the vein in there; you laser the inside lining of the vein.

Essentially you're burning it, and when you do that, the vein shrivels up and disintegrates over a few weeks.

I normally do that under a local anaesthetic, but you can choose to have it as a general anaesthetic. There's no pressure put on you one way or the other. But around 90% of people have it under local. And I would say most people think of it as equivalent to a dental appointment.

When I’m doing that procedure, I have an ultrasound scanner in my hand, and I’m basically keeping an eye on exactly where the laser fibre is throughout. I'm usually chatting with you as well.

There are quite a few different types of treatment.

So sometimes you can think that one is better than the other, and you can broadly divide them into three. So there's a stripping-type operation, and most people don't do that anymore. It has very poor results.

The second treatment is injecting some kind of chemical, and that can work pretty well for smaller veins. It's an excellent way of treating small cosmetic veins. It works for some larger veins, but I found that it didn't work very well, and it had a high recurrence rate. So I tend not to use foam sclerotherapy for most veins, but I do use it when people have recurrent varicose veins, especially if they've had stripping done before.

There are other newer treatments, such as Claravane, or even injecting superglue. I tend to shy away from those because they are injecting stuff that probably shouldn't be there. And when you see the results of laser treatment, you realise that it's a very safe and effective way of treating the vein.

Laser treatment is one of the heat treatments. So there is another treatment where you use electricity that's called radio frequency ablation, and people even use a microwave. All of those treatments are equally good.

They all look pretty similar, and although some might produce less bruising in some research papers, essentially, they all work equally well.

So this is a picture of someone who's had just laser treatment to the vein that's running down the inside of their leg, which is the most common vein to go wrong. And this is a bit of an idealised picture. So on the left, it's what most people come to me with: veins that look like that with a little bit of swelling and some pain. If you laser the vein and don't remove any other veins. So that's a treatment called phlebectomies. The veins will reduce in size, and over a six-week period, they usually look pretty good at the end.

This is the kind of treatment I do for people who really aren't too fussed about the cosmetic appearance. They really want to get rid of the pain or the swelling or the ache, and it works well. It's a very low risk to you. It is a little uncomfortable afterward, but most people.

Are back to normal after a few weeks, although for the first few days afterwards I think it feels as if you've exercised a little bit too much.

And so just in summary there, there are many different treatments for veins here. I tend to laser veins, but I do the other treatments as well. I find most people have it under local anaesthetic, but you can have a general anaesthetic if you wish. I don't like pressuring you one way or the other, and I think I usually caution people, because when you look at the internet, everyone who has a varicose vein operation has a marvellous operation that was pain-free, and life was perfect afterward.

And I would say the vast majority of people who have a varicose vein procedure have had varicose veins for a while. They're not having it done necessarily for cosmetic reasons. It's usually because the vein is big and painful, and so afterwards it feels as if you've pulled a muscle or exercised a little bit too much. Most people would have some kind of painkiller for the first few days afterward, and although you'd probably work from home the next day, most people, if they commute, would take a few days off.

It is much better than the older procedure, but of course you may not have had the older procedure, so, from your point of view, having a varicose vein procedure, I think.

It takes you two or three weeks to get back to full speed. For example, back in the gym and doing your normal daily activities at full speed.

I'll pass you over to Dr Taggart.

Dr George Taggart

Thank you, Mr Sweeney.

Grade one veins, or red veins, are very common, and we all have them to some extent.

For some people, this can cause significant problems with their self-confidence. They may take great lengths to cover them up with a choice of clothing and makeup, and this can be very restricting.

Fortunately, we do have treatments these days that can address this and hopefully reduce some of that burden.

Thread veins in the legs for the treatment of thread veins in the legs. We use the treatment called microsclerotherapy, and this involves inserting a tiny needle into the very small veins and injecting a liquid called a sclerosant.

Here at Benenden we use either 20% normal sodium chloride or a chemical called fibrovane.

Injecting the liquid into the vein causes the lining of the vein to become irritated, and it leads to small clots being formed and eventually fibrosis and closing down of the vein.

This is a procedure that we can do in outpatients. A typical appointment lasts about 30 minutes, and during that appointment we would administer multiple injections to the veins, depending on how many veins there are.

Each injection site has a small dressing applied, and this has to be kept dry and in place for three to four days.

There's really very little other restrictions following the treatment, and you can walk in and walk out and drive yourself home.

The number of treatments you require really is determined by the extent of the thread veins, and that's something we discuss when we have an initial consultation with you.

For treatment of thread veins on the face, we use a different technique called ThermaVein®.

Now, the technology underlying ThermaVein® has been in existence for well over 20 years.

So it's really a very well-established treatment that has been proven to be very safe and effective in the treatment of thread veins on the face.

We use a tiny nickel probe, which is about the size or width of a human hair, and.

We apply the probe to the surface of the skin, overlying a thread vein, and with gentle compression, we squeeze the blood out of the vein on either side of the probe and use a foot pedal. The machine delivers a very short pulse of energy because the needle is insulated.

All of the energy from the machine comes out of the very tip of the nickel probe, and that really reduces the incidence of side effects and any pain experienced.

The energy we supply to the vein causes the vein to collapse and stick together at that point.

Once we have done that, we move the probe along at one or two and repeat the process, and as one goes along the vein, it seals and closes down.

When we have a sealed vein that's empty of blood. It's no longer visible.

Here we have a video of that. Actually demonstrates the process in action, which is probably easier than me explaining it.

So let's have a look at the first video. See, the thing disappears as they go along.

Each of those noises is impulsive energy from the machine. After it's complete, the vein has disappeared.

We have another video. If you look at the lower two veins on the screen, these are the ones going to be treated.

Again. The practitioner is going to move along the course of the vein, sealing it as they go along. No noise this time.

So, as you can see, once the area has been finished, the vein has disappeared from sight. The vein is still there. It's just as I’ve said, empty of blood and has been closed together.

One of the issues with thread veins is that they are part of the vascular system, which is under a degree of pressure. So blood is trying to get back into that vein, and inevitably some blood does that.

Treatment is generally part of a course of treatments. We can't guarantee veins will disappear in one session. So we have to repeat the procedure, and an average course of treatment would be two to four treatments.

It's a particularly effective method of getting rid of them purple and red veins that we commonly see on the nose, chin, and cheeks.

These pictures demonstrate before and after treatment.

Because we are introducing energy and heat into the skin. The skin doesn't particularly like that, and there's a degree of inflammatory reaction.

The skin goes a little bit red and puffy after the treatment, and this can last usually one to three days, sometimes up to a week, but very rarely two to three weeks, but that would be a very rare occurrence.

At the points where the treatment has been administered. You sometimes get little crusts or scabs of blood, but these rub off after two or three days.

As I’ve said, it is a course of treatment we never. We wouldn't repeat the treatment within 28 days, and that allows the skin to completely heal and the patient to decide whether they need more treatment or not.

Usually on the face. We would be treating two to four times.

Here we have some other pictures of typical red thread veins around the nose, and they're before and after the treatment, a little vascular blemish on the cheek.

Another vascular blemish. These are linear thread veins on the cheek, which are very easily treated with this method.

Vicky

Okay, thank you. Thank you both very much for that interesting presentation. We're now going to take some questions. So first question is from John, and John asks, and I assume this is relating to varicose veins. I understand I shouldn't return to running for perhaps three weeks, but as a keen walker, is it possible to overdo this activity?

Mr Aaron Sweeney

No, so most people, I think, would walk a dog the next day. Just not an energetic puppy. I think you'd feel stiff and tight, and.

What I’ve noticed is triathletes. For example, they are back running at a normal pace at three weeks. They usually go cycling every two weeks. But I think those impact-type exercises, like badminton, tennis, or running on tarmac, hurt a little bit, and I think it takes you about three weeks to feel able to.

Get back to full speed.

Some people have no pain at all, and they just get back straight away. I don't think it makes sense; it's certainly not dangerous, or is it? It doesn't.

Cause any recurrences, for example. So I would say, once you feel like running after the procedure, just fire away.

Great. Thank you. And John also asks when he can return to driving. So driving is interesting. So if you have a general anaesthetic, we normally say, wait two days. If you have your right leg treated, I normally say, wait until you're absolutely sure you can do an emergency stop. And if you drive an automatic car. Probably the following day you could drive. If you have your left leg treated.

The slight. The reason why we're a bit careful about getting people to drive straight away is that you can occasionally feel unwell after having procedures. Sometimes people get a little stressed, and you can even faint. So most insurance companies don't like you to drive.

Home after the procedure, and I’m always worried that you're not able to do an emergency stop because of a bandage. I put it on. So I ask you just to be a bit sensible. But most people, after three or four days, are back driving their car if they wish.

Vicky

Okay, hope that was helpful for you, John. The next question is from Jocelyn, and Jocelyn asks, can a laser be done on a patient who has had heart valve replacement surgery and is on anticoagulants? I know that previously going through from the top, it wouldn't necessarily work due to potential scarring around the heart being in the way of the laser.

Mr Aaron Sweeney

So the answer to that is that it's fine doing lasers, even if you're on anticoagulants.

I laser from below up. So I don't go near anyone's heart. It's all from the lower part of the leg upwards. I normally stop around about the groin, because that's usually where the varicose vein joins the big vein. A lot of people who have had heart trouble have high blood pressure, and they're often on lots of medication that tries to relax their high blood pressure. That's often why you get grief from your varicose veins because they relax a little bit, too, and get even bigger. So quite often. The reason people come to see me is because they've just been started on various blood pressure medications, and veins that weren't giving them any trouble for 15 years suddenly start to give them aches and discomfort. Many people are on.

Anticoagulants for dodgy heart rhythms or previous surgery, and I would normally give you a blood thinner when you're having your procedure just to be for extra safety. So I usually say that if people are on anticoagulants, they just stay on them, and I do your operation.

Without stopping them.

Vicky

Great! That's lovely. Thank you, Justin. I hope that's reassured you.

The next question is from David. David asks if you've got visible bulbous veins, but no discomfort or swelling is treatment only necessary for cosmetic reasons, or is there a preventative medical reason?

And David says he's had veins like that, level three-ish, on his legs for 15 to 20 years.

Mr Aaron Sweeney

Yeah. So I have to be very careful about saying you should have things for preventative medical reasons. I think nowadays you can scan people and find loads of stuff, and I think you could keep surgeons really, really busy. I tend to say to people, you need a reason for having your veins done and not a potential problem. So if your skin is damaged or you're itchy. Then I would say medically, you should have something done.

If you have varicose veins that are very large, I will tell you they're not going to go away themselves. But you're not necessarily going to have a complication. But if I were you, I would say the reason is if you have a varicose vein that's visible. But you have no symptoms. Then your reason for having the treatment is cosmetic. That's not a bad and unreasonable thing. Plenty of people.

That done, I just caution you that there are a few little complications associated with varicose vein surgery. Not that many, and I would usually say to people, if you don't wear shorts, and you're embarrassed all the time because you have these chunky veins in your calf.

It's a reasonable treatment, and in terms of risks to you. It's not much more risky than having your wisdom teeth removed. So it's an effective, quick treatment.

It does take a couple of weeks out of your life in terms of discomfort. But it's a reasonable cosmetic procedure. But if you came to me and said, I don't care how they look; I just want to know. Is it going to cause me grief in the future?

I'd say, hold off, because you can always have them treated when they start to give you grief, and plenty of people have very large varicose veins and no trouble at all, and I don't think you should be scared into having an operation.

Vicky

That's great. Lovely, thank you.

The next question is from Thelma, and Thelma asks, By cutting off veins, does that mean muscles are being fed by those?

Mr Aaron Sweeney

Get restricted supply, not quite so varicose veins. You might think they're big, so they are important, or that you shouldn't get rid of those veins because they're obviously doing something.

Otherwise they wouldn't be there. And I would say to you that most veins in the skin are tiny. Their biggest ones are less than the size of a shoelace. If you have a varicose vein, it's varicose because it's not working.

That means it's pooling blood, and many of them are not just pooling blood. They're sending it back down your leg. So doing the complete opposite of what they were supposed to do. All the other veins in your leg are trying their best to get that blood back up towards your heart, but sometimes they get a bit overwhelmed, and that's why you end up getting dilated veins and skin that becomes irritated.

So when you think of the removal of varicose veins, sometimes people think that you're damaging your circulation. You're not really doing that.

When you get rid of a varicose vein, you're getting rid of a vein that's doing the complete opposite of what it's supposed to be doing, and all the other veins nearby essentially have a little bit of a holiday because now they're just doing their own work, which is really just draining about a teaspoon of blood per minute. It's a tiny amount that flows through the skin.

Vicky

Okay, lovely. I hope that was helpful, Thelma.

And the next question is from Stuart. So Stuart's a golfer, he says. I'm 81 and play golf three times a week. How long would I be laid off from golf?

Amazingly?

Mr Aaron Sweeney

Golfers get back to playing golf extraordinarily quickly. So most people who have a vein treated with a laser are back playing golf. About a week later they have a bit of an excuse for playing a bad round, but they do get back quite quickly, and I think golfing is a bit like walking, so most people are walking the following day. It's just a case of 18 holes might take you a week or so to get up to that.

Vicky

Thank you very much. The next question is from Angela, and she asks, I’ve got osteoarthritis in my left knee, and my varicose vein is directly behind. Would that be a problem?

Mr Aaron Sweeney

Not really. You'd be unfortunately sore from both sides of your knee, but afterwards it doesn't stop you from having treatment. In fact, sometimes it is very difficult to tell whether osteoarthritis is causing the pain in your leg or whether your veins are. And I really always think that veins shouldn't be.

Essentially asymptomatic. First thing in the morning, because you've managed to lie flat all night. So if you get up in the morning and you've got instant pain in your leg, that's more likely to be arthritis.

If you do, you are going fine during the daytime, and it's only in the evening that it's painful. It's more likely to be your varicose vein, but plenty. People have both problems, and sometimes getting rid of one makes life a lot more bearable.

Vicky

Okay, lovely.

The next question is from Sarah. Sarah's had an injection in her calf, which worked, and then about 10 years ago, EVLT, which didn't work for her, and so she's concerned about paying for it again and it not working again. Have you got any advice?

Mr Aaron Sweeney

Yeah. So EVLT is not perfect. So I usually quote people; 1% of people pop back to me within a year to show me something.

It's very rare to have a recurrence of that vein, but sometimes you can get a new one popping up nearby and about.

10% of people at 10 years have another vein that needs treatment.

Varicose veins. It's not just one vein that goes wrong. You do have a. You're predisposed to getting varicose veins in your legs. So quite a lot of people.

If you're 18 and you have a varicose vein. Unfortunately, you're going to have trouble for the rest of your life, not necessarily yearly operations or anything like that. But you're certainly going to have recurrent problems if you're 60, and you've never had any trouble before. I don't think I’ll ever see you again after having your vein treated.

With regards to recurrences and following EVLT. What can happen is, if you've had your veins stripped before, and then you come and have your veins treated with a laser. The reason you're getting recurrences is because of the original stripping operation, and sometimes, if you have a varicose vein injected, it's not necessarily a brilliant way of treating them, and sometimes it kind of half treats them, and it makes it very difficult.

Following that, to get a good result that will leave you forgetting about your veins forever. So in general, if you have your veins lasered for the first time, nearly always. That's the end of your problem. Although 10% might pop back in 10 years. It's nearly always with a vein on the other side. So, from your point of view of paying for your veins, I would say.

You do need to be a little bit careful. I would never tell someone that that you've done and dusted. You'll never be back with any vein problems.

I always like to do the ultrasound myself.

The duplex scan in the clinic, so that I can tell you more or less straight away how likely it is that I’m going to fix you, because sometimes it's very obvious to me that.

The problem with the person's veins is going to be an ongoing problem. There are veins that can occur because they've been stripped before. But there are other veins that even arise from inside the pelvis, and I think you need to be very careful that you spot that at the beginning. So you don't.

So you can send someone a message correctly that there may well be trouble in the future.

Vicky

Okay, lovely, hope that was some helpful information there, Sarah, and next probably one for Dr Taggart. Can you have ThermaVein® treatment at the same time as laser treatment?

Mr Aaron Sweeney

I think that would be inadvisable. I think it's important to understand what treatment is causing, what results, and indeed potential side effects. So it would be much better to have one or the other, not both at the same time. So I would certainly advise against having both.

Vicky

Okay, lovely, thank you.

And the next question is from Brenda. Brenda had sclerotherapy by Mr Sweeney about seven years ago, and following this, she had telangiectatic matting, which never went away, and she came for another consultation a couple of years later with a different consultant. Who said that it would likely happen again if she had another session? She's got quite a lot of spider veins on her legs, and she'd be interested in finding another way of treating them. Can you suggest something?

Mr Aaron Sweeney

I might. Well, I might say sometimes, when I treat thread veins, you can end up with lots of little thread veins near where I’ve treated them. Usually that's where people have had previous stripping operations. It rarely happens just on first-time veins, so I’m not 100% sure, but there are.

Plenty of different treatments for varicose veins and thread veins, I would say.

The reason there's loads of different treatments is that nothing works perfectly, and I think sometimes it is nice to get a very good result, and everyone is happy. But sometimes things don't go perfectly. That's the same with laser treatment. Occasionally there's an odd vein left over afterwards. That needs to be retreated now with sclerotherapy. I normally, if I’m doing it, tell people that sometimes it doesn't work, and often I say.

It takes quite a few treatments to get a good result.So I don't know whether some.

So I mean, I think there are different. As we. As we mentioned earlier, there are different types of liquid you can use for sclerotherapy. So that's one possibility using something different. And ThermaVein® occasionally can be used.

To help with telling the matting, so that it would really depend on the appearance of the examination and having a chat through the options. So there are options, but whether, as Mr Sweeney says, they would be successful is something we'd have to discuss.

Vicky

Okay, lovely. Thank you both. And the next question is from Jill, and Jill asks, are there any complications that can arise from varicose vein treatment?

Mr Aaron Sweeney

Yes, is the answer. So the only one I’m ever interested in, because the one that causes trouble is a deep vein thrombosis. So that's where the large veins are. So if you think of that Christmas tree analogy, the main trunk occasionally, you can get a clot forming in that.

It's pretty rare in my practice. It occurs in less than one out of every 1,000 people that I operate on.

I'm paranoid about that because I don't like seeing it. I like people who have their veins done to have them done. Walk out the door, and a few weeks later forget that they've ever had anything done. I try to minimise that by giving you a blood thinner on the day of the procedure. It's a drug called Clexane, and I like you to be up and moving and mobile and here.

Both I and the nursing staff are very keen that you're out of bed walking around in your normal way. That can just be around the house, etc., because once you're out of bed after a vein operation, your risk of a DVT is tiny. All other complications from varicose vein surgery are relatively small and easily fixed.

So occasionally I don't get every single vein, but I can treat that when you see me in outpatients afterwards. Sometimes they can be a little more painful than I’m expecting. I'd like to get you back quick then and change your medication to make sure you're not sore, and sometimes the bruising takes a little longer than you'd expect to settle. So people can get a type of skin staining, particularly if you have very nice olive skin that tans easily, and sometimes that can take a little bit longer to settle.

If you, when you see me in. If you see me for a consultation, I go through that in some detail with you. I try not to scare you, because for most people. Varicose vein surgery is relatively straightforward, but I do mention all the things that can potentially go wrong, but thankfully they are really rare, and vein surgery for the most part is pretty straightforward, although, as I mentioned earlier, it does take about two weeks for a leg. That's a bit sore and achy.

Vicky

Okay, lovely. Thank you. I hope that was helpful, Jill.

So you kind of alluded to this earlier. But is there any benefit in having earlier surgery for veins rather than later?

Mr Aaron Sweeney

Maybe. I think if you get them early, you're unlikely to have any complications. They're a little bit easier to deal with when they're smaller.

But plenty of people, but nobody really comes to me the first time they see a varicose vein. They nearly always wait years, and it doesn't really, from a surgical point of view, matter whether I do them in year one or year 10. I think some people suffer a complication where the vein clots off, and that's a thing called thrombophlebitis. So phlebitis is inflammation, and your veins, if you think of them as a slight balloon, can stretch and stretch, but then eventually they don't stretch anymore, and they start to split. That splitting forms a little clot inside, and your body hates clots, and it tries to dissolve the clots.

So you get swelling near that area, but because veins are slightly leathery in texture, it takes a little while for them to dissolve, which is why anyone who's had a dose of thrombophlebitis knows that it takes four to six weeks to settle, and it is really painful.

Vicky

Okay, thank you.

We'll do a couple of questions on foam sclerotherapy now, so could foam sclerotherapy cause problems with the veins nearby by putting more pressure on them?

Mr Aaron Sweeney

Not really. But just remember that foam sclerotherapy is me injecting a chemical to try and block off veins or irritate them so much so they do go quite hard, and your body then.

Tries to help me in dissolving the veins. So you do occasionally get some redness nearby, and so it doesn't necessarily put more pressure on the veins nearby, but you do get swelling, and so it is a bit painful nearby.

Vicky

Then another one. I've had thread veins on my legs treated once by sclerotherapy. I didn't see any difference. Is there a more effective treatment now, or did it not work because it was just one treatment?

Mr Aaron Sweeney

Yeah, I suspect that would be because you only had one treatment. We always recommend or always advise people. It's going to be more than one treatment. There are various reasons why it may not have worked. As we mentioned earlier, the veins are under pressure, and there is a degree of reopening of some veins.

So it usually involves a course of treatment. And almost certainly because you only had one treatment, if it was done successfully in the first place.

Vicky

Okay, thank you.

Next question. Kind of mentioned this already, but this is from Christina. So Christina's got a few veins in her left leg, which, getting more lumpy, she's also got osteoarthritis in her left knee, and the pain is getting worse.

Swelling started four weeks ago. How does she tell if it's down to her veins or arthritis? She's been sent round in circles regarding who to see.

Mr Aaron Sweeney

Yeah, a bit difficult. I would say that it's sometimes really, really difficult to work out the difference between arthritis and vein pain. It's often the case in people who have sciatica or backache with pain radiating down their legs. It can be a bit of a nightmare trying to work out. So I would say that.

If you were able to put on a compression stocking, that normally gets rid of vein pain. But it's sometimes really difficult to put a compression stocking over arthritis in your knee. So knee arthritis is a problem.

The fact that the swelling only started four weeks ago.

That is unlikely to be varicose. Vein. Related veins are usually something that takes years to develop. The swelling has been there for ages, whereas arthritis, which many people talk of, they don't really know what it is. If you think of arthritis as where your joints should be super-duper smooth where two bones come together. Arthritis is where the edges get a bit rough, and you get a few spiky bits, and quite often you just.

By doing one particular movement, you can just irritate that spiky bit, and that produces swelling. As your body tries to fix that area. So I think swelling that occurs for a short period. I think that's probably going to be our arthritis, but it can be really difficult to tell veins if they're giving you. Loads of grief are usually tender when you touch them. So if the pain is directly over the vein, it is much more likely to be the vein.

Vicky

Okay, Christina's posted a follow-up question. She says she's also got Crohn's disease. Is varicose vein treatment okay for her?

Mr Aaron Sweeney

It's fine. You'd be amazed at the number of people who get treated for their veins. Often, sometimes people think, is there an age limit? No. 96 was the oldest person I did. And that's just because she was having a terrible grief with itchy skin, and I think she was essentially ignored because of her age. And, as I say to people who are 90 coming to me. Well, if you're fitting well at 90, you're probably going to make 100 and something. So 10 years with a sore leg seems pretty miserable to me, and so I generally encourage people to have veins fixed based on if they're getting trouble or if it says sore.

Vicky

Okay, I hope that's helpful, Christina. The next question is from John. John says he's had a couple of instances of phlebitis. Will having done so prevent reoccurrence?

Mr Aaron Sweeney

Usually it does so if you think of phlebitis as usually the last little bit of vein starting to clot off, but usually you've got a little pipe underneath, leading to the deeper vein, and that stays open and keeps on allowing blood to pour back up onto the surface. So that's often the reason why you get a single dose of phlebitis. You get over it, and then you get it back again.

It just never seems to be, seems to be never-ending. So I normally will do a little scan. See where that phlebitis is coming from, and it might be something really simple. You just pop a little laser in, and it stops all that phlebitis from occurring.

Vicky

Okay, lovely. Thank you.

A question from Philip. Philip asks, how would I know which treatment will be best for my veins? There are several options with different consultations to be listed. But which consultation do I book?

Mr Aaron Sweeney

And that's Philip and Sunny, and a skill in okay, yeah, most people I laser their veins. I very rarely strip them, and I almost never do foam sclerotherapy unless I have to.

So usually I can tell from within a few seconds of starting your scan. Whether you're suitable for a laser, you can pretty much tell you that straight away all the different treatments, as I say, that they really come down to whether you inject a chemical into a big vein, which I tend not to do, or whether you stick a laser up, or one of those heat treatments, and they all work reasonably well.

And the second bit, really, which is Dr Taggart's area, is one of the smaller cosmetic ones on the surface, and that's, I think, a completely different kettle of fish.

But from a treatment point of view. I usually tell you straight away. What's the best option?

I would say for the first time. Varicose veins. It's almost always a laser with a few nicks in the skin called phlebectomies.

Vicky

That's great. Thank you. The next question is for Dr Taggart, so can you perform ThermaVein® treatment on bed veins on legs?

Dr George Taggart

You certainly can. I mean, thread veins are generally for the tiny purple and red veins. Anything that's blue means. It's a larger calibre vein and has more blood. So thread vein is not effective for larger veins but for tiny veins above the ankle.

We can use thread vein, certainly, but it tends to be less effective.

On larger veins and in the legs, the veins are under slightly more pressure. So again, sclerotherapy works better in the legs.

But the answer to your question is, yes, we certainly can in certain circumstances, if the vein is small enough.

Vicky

Great, hopefully that was helpful.

Got a couple more questions from Angela here, so she asks, can laser treatment of a vein cause a blood clot or an infection?

Mr Aaron Sweeney

Kind of, so it doesn't usually cause an infection. The top of a laser fibre is the same temperature as a lit cigarette. It's about a thousand degrees, so effectively when you laser the inside of the vein. If there were ever any blood clots in there, they've been completely destroyed.

The question is, does it cause a blood clot? It depends on what kind of blood clot. So a deep vein thrombosis?

Yeah, occasionally one in a thousand. It causes that. But sometimes people say they've had their veins treated, and they notice they're a bit lumpy afterward, and they're told. That's phlebitis, and you've got a clot in there.

That's not really true. But if you do laser a vein, there's invariably going to be a little bit of clot inside. It's not dangerous. It dissolves away. So technically, you can have blood clots after a laser, but they're not usually dangerous ones, and they dissolve away, and it's a normal part of the operation.

Vicky

Great. Angela goes on to say, If you've got a large varicose vein and don't want it treated with a laser. Can you have the smaller veins treated, the ones that come from that vein?

Mr Aaron Sweeney

You can, I would say. That's not necessarily the best way of treating them. People used to do that, and they got lots and lots of recurrences. So it depends. I think sometimes people have a very small vein, perhaps in the front of their shin, and they say, Well, I just love that removed. I don't want to go through all the rigmarole of having a laser.

That's entirely reasonable. I just would say to you.

If you have, if it's caused by a varicose vein running up the inside of the leg, you get a better long-term result with a laser, but I certainly wouldn't refuse to do your operation. Lots of people come to me with small veins on their lower leg on their ankle or foot, and I would say to them, Well, probably the best treatment is to have laser for the bigger vein and then small little incisions and remove the smaller veins, but you can quite easily just have the small ones removed. That's fine. It just might mean that they recur a little bit, not necessarily quickly, but in the years following treatment, you might well notice them recurring.

Vicky

That's great. Lovely, hopefully. That was some help for you, Angela, and our last question this evening is from Diana, and Diana asks, Have you got any lifestyle advice on how to prevent varicose veins in the future?

Mr Aaron Sweeney

Not really amazing. No one knows the reason my varicose veins occur.

We know what a vow that fails is, but nobody knows why some people develop them and other people don't.

People talk about. If you're heavy, you're more likely to get veins. That's not true. Blokes and girls. You get them more or less equally, ladies. You get them a little earlier because you've got hormones, and one of those hormones is progesterone, and progesterone, where you get a huge big spike in your final trimester. It dilates everything. It relaxes ligaments to allow the baby to pop out, but unfortunately it also relaxes your veins.

So if you have some varicose veins. That's the reason why you get a bit of grief in your final trimester in pregnancy, or indeed, even at period time, where you get a slight spike every period. That's why your legs can hurt quite a lot, or why your veins give you lots of grief.

Just before your period starts. So from a prevention point of view. Yeah, wearing stockings makes no difference. It's just one of those things. It's life. And you occasionally just get dealt a bad hand, and you get some veins. But there's nothing you've really done to make that happen. It's just a bit of bad luck and a bit of gravity.

Vicky

Dr Taggett, do you have anything to say on thread veins? Any way that people can prevent those at all?

Dr George Taggart

Not really. I'm afraid they're less pressure dependent. So I think it's one of those things. We all get thread veins and.

Again, compression really doesn't make any difference. Unfortunately, otherwise no one would have them. I think so. I think it is one of those things. It's more genetic than anything we do ourselves. So I’m afraid not.

Vicky

Okay, that's an honest answer there. So thank you to everyone for your questions. I'm sorry if we didn't answer all of them. If you provided your name, we will get back to you with an answer.

So as a thank you for joining this session, we are offering 50% off the value of your first consultation using the code on the screen there. Call back from your dedicated private patient advisor an email with the recording treatment, information and loyalty, scheme reward points, and updates on news and future events at the hospital.

So we'd be grateful if you completed the survey at the end of this session to help us shape future events as well. If you'd like to discuss further or book your consultation, our private patient team can take your call until 8.30pm. This evening, or between 8am and 6pm Monday to Friday, using the number on the screen.

We've got some more events and webinars coming up on hip and knee surgery, hernia repair, and cosmetic surgery. And you can sign up for any of those on our website.

So on behalf of Mr Sweeney and Dr Taggart and the expert teams here at Benenden Hospital. I'd like to say, thank you very much for joining us tonight, and we hope to hear from you very soon. Thank you, and goodbye.