Vicky Hawkes

Okay, good evening, everyone. Welcome to our webinar on varicose vein treatment. My name is Vicky, and I'm your host this evening. Our expert presenter is Mr Aaron Sweeney, a Consultant Vascular Surgeon. This 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 your name. Please note that the session is being recorded. If you do provide your name, and if you'd like to book a consultation, we'll provide contact details at the end of this session. I’ll now hand it over to Mr Sweeney, and you'll hear from me again shortly.

Mr Aaron Sweeney

Hello everyone. Well, that's my slightly younger-looking version, I think, but I'm a consultant vascular surgeon here at Benenden, having worked here for the last 10 years or so, and tonight we're going to talk mostly about varicose veins. What's available to you sometimes, and why do they occur? What treatments are available to you, and what are the symptoms that varicose veins cause? I spent a great deal of time telling people that varicose veins are not just a cosmetic problem; people have had them for many, many years, and they come and see me usually because something has happened, whether it's cramping, pain, bleeding, or skin irritation. But in this session, talk a little bit about my experience. I'll give you a little idea of what varus veins are. I'll briefly mention the grades of varicose veins because many people are told what grade they have, and then I'll tell you what's available to you, and then we'll do a little video of somebody who's had their veins treated, and at the end we'll do a question-and-answer session, which is normally the most important bit. I tend not to try not to bore you too much with too much information because many people have looked online to see what varicose veins are and what treatments are available. It can be very confusing, but they often have very specific questions. Sometimes you think they might be a little bit silly. I would avoid thinking that you'd be surprised at how many people would have liked to have asked the questions that you may well ask.

So that's me. qualified in 1992 from Dublin. You might have guessed that from my accent, it seems like an awful long time ago. I became a consultant in 2002, and just before I became a consultant, myself and my colleague saw a very good doctor doing laser treatments. It was originally developed in New York. We both thought it was a fabulous treatment, and although we first did it around 2000, it took us until 2005 to get it finally passed as a safe procedure. It often takes many years to make sure that something is safe, effective, and works well, and it requires a great deal of research. I perform around a thousand of these a year, a little less during COVID, and here at Benenden, we perform the largest number in the UK, so it's what we would call a relatively common operation, and I think it's very effective.

We can mention some of the bits and pieces, but essentially, the CQC thought we were pretty good. That's quite a hard rating to get, and most patients find us happy with the treatment they get. It's difficult to get 100%, indeed 100%. When you see that figure, you have to get a little bit worried. There's always a few people who find we didn't quite meet their expectations, but I try my best to do that.

So what are var's veins well people talk about valves and how a valve becomes blocked or broken I think it's best to think of var's veins or your veins like a Christmas tree so you have a large artery that brings all the blood down your leg from your heart it's supplying oxygen and stuff to your muscles and then that blood has to get back up to your heart to be pumped again and essentially it leaves your leg through a very large vein which is rather like the trunk of a Christmas tree and then there are but there are hundreds of branches that join that deep vein and those branches are mostly coming from muscle and they're surrounded by muscle so there's quite they have a bit of help in squeezing the blood up your leg and indeed just poling around the house you're draining about a litre a minute up your legs H so it's quite a large amount of blood if you're doing cycling it can be two or even three litres a minute it's an amazing amount of blood that whizzes down and back up your leg but if you think of the Christmas tree analogy most of the veins are draining muscle but some of them are actually draining the skin and you can sometimes see those little blue lattices like veins and many of them are just transverse but some of them are vertical and they sit just onto the surface of the skin there's two veins in particular one that runs down the inside of your thigh and one that comes out of the back of your knee that are notorious for going wrong and they have little valves because they're not surrounded by muscle and occasionally those little valves fail and then you get blood pouring back down again so instead of trickling its way up your leg from your skin you end up with a little waterfall of blood that can sometimes be quite long occasionally you see veins that are 40 or 50 centimetres long just under the surface you don't necessarily see them H but they often appear in the lower part of your leg and sometimes people wonder why those veins are really sore and the answer is well you might have 40 cm tube running right up to your groin that's not working so it's rather like a yard of Ale sitting under the surface.

In terms of what veins cause usually it starts with a little bit of leg swelling that often like happens when you're sitting in the seat for the day sitting in a seat for the day or for driving a car for example or just standing that's not particularly dangerous but occasionally you can see a few veins popping out most people get some kind of discomfort whether it's an ache or pain and most people pass it off as the normal thing that you'd expect after standing all day occasionally people get cramp at night in bed and the warning sign for me is when your skin becomes itchy or sore that's often a sign that you're progressing beyond just simple varicose veins and they're becoming a little bit more troublesome often people come to me when their legs are swollen and when I ask it's usually when they start blood pressure medication quite often certain blood pressure tablets they work by relaxing your blood vessels and if you already have a varicose vein well then the vein dilates even more so sometimes you get even more swelling and veins are nearly always worse in the summer because your veins dilate to help you lose a little bit of heat and that's why August and September are often our busiest months you would think with varus veins that if they were cosmetic it should be January because everyone has a New Year's resolution to get everything fixed but actually January February often quite quiet because your veins are a little bit constricted because of the cold and tend not to give you quite as much grief.

I was going to talk a little bit about grades of veins because that's often mentioned in GP letters grade one veins are essentially thread veins and we can treat those with sclerotherapy we that's a little injection works well eventually thread veins are quite difficult to treat which is why many people don't treat them we often inject a chemical called fibre vein it will eventually get rid of veins by damaging them but of course once you damage the vein your skin needs to essentially dissolve that vein so it often takes multiple treatments and your leg can be quite bruised so it can take a month or even many months for your legs to look acceptable so it's not a quick fix treatment and we often tell you that if you come for treatments of thread veins great two veins you can kind of feel them but again they're not dangerous you often see these on people's lower leg they only become a problem if they're attached to a larger vein underneath often people who are on blood thinners can have quite significant bleeds from what look like little tiny veins but in fact they've got a slightly larger one under the surface which they can't see The third-grade veins are where they really start to give you a bit of grief. They often bulge up onto the skin and can become painful quite often, and I think many people have seen H varicose veins that are enormous, usually on older BLS, and they give them no trouble, and indeed, they're not dangerous. So, these kinds of veins, if they're giving you ache or pain, you can certainly have them treated, but you could leave them alone if they're not causing you any trouble. Grade four is where they start to give you problems with your skin, and that can be eczema, itching, and soreness. little bit of redness, but the itching is what I look for, particularly at the end of the day and particularly in warmer situations, and then when you get on to grades five and six, they're often the scary bits of veins where people can develop ulcers or quite serious bleeds. I have to say it's pretty rare and ulcers really are rare in people who realize that their skin is sore because of a varicose vein quite often people who develop an ulcer have had trouble with their leg for quite some time they often have eczema itching their skin is a bit red and they get various creams and various steroid creams and their back and forth to their doctor and they sometimes don't have any huge varicose veins nearby so the diagnosis is essentially missed and then what happens is some years down the line they bang their leg or their grandchild kicks their ankle and all of a sudden the skin breaks and it just fails to heal so what would have been a really tiny minimal little injury a few years before becomes a major problem.

I'll quickly go through these, so they're a bit grim, but that's kind of what a vein ulcer looks like. I won't stay on that, but essentially, once you get them, I consider them to be a failure of medical treatment. It's a misdiagnosis that can always be treated long before you ever get to that stage, and it is very rare for people who've had their veins properly treated to ever end up with an ulcer. Indeed, sometimes people who do have ulcers do have varicose veins nearby, and we treat that, and it does seem to speed recovery up, but I have to say it is like watching paint dry as you wait for them to heal, and although surgery does help speed up that healing process, it still takes some months to get your leg back to being reasonable.

In regards what you do here if you come to Benenden you see me in outpatients so your consultation is with me and I will do a scan on your leg at the same time I spend quite a lot of time trying to work at exact exactly what you want so some people come because their legs are aching and I can tell them exactly what needs to be done there others want a cosmetic Improvement and I can tell you what's what you can have there as well most times people afterwards will book in there and then I usually we get usually we have you an assessment done on the day because most people takes them a while to get here and so we just treat you as if you're having something done and I tell you everything write a letter to you do a few diagrams and afterwards the hospital will contact you and see how you feel so there's no pressure put on you and I'm very keen that people know exactly what they're having done and that we're both fairly certain what exactly you want at the end of treatment Most people's surgery is done as a day case, and most of its done under local anaesthesia. I think in general people consider it a bit like a dental appointment; it's certainly not root canal work, and I say 95 plus percent will have it under a local anaesthetic, which sounds dramatic but actually is usually very light-hearted, not too sore, although I do have to give you some injections. So, in the olden days, you used to do a cut in the groin and disconnect one of those branches of the Christmas tree, and then you stuck a wire through the inside of the vein and pulled it out somewhere down the lower part of your leg, and that was an okay operation from a surgeon's perspective; you were actually treating the problem from a patient's perspective. It was a bit brutal, but the real problem was that afterwards, as your body healed, it sometimes produced new veins. Those veins weren't normal, and that's why he might have heard stories where people have told you if you have your veins done, you'll say you'll be forever having them done or don't have them done before you get pregnant because they'll just recur, and problems will arise for the rest of your life. And that's partially true: about 50% of people who had veins stripped, even if it was done correctly, get recurrences, and those recurrences can be quite difficult to treat, but they're not untreatable. One of the great things about EVLT or any of those minimally invasive treatments is that they've done away with that essential, essentially done away with the brutality of pulling everything out.

Most of the treatments involve sticking something up the inside of the vein, damaging the inside lining of the vein, allowing the vein to shrivel up, and then letting your body dissolve the vein. It is amazing how that happens in terms of how you do it. This is the inside of what looks like a lady's right leg, so up at the top of the slide is the groin, and you have a big red artery sending all the blood down and a big blue vein sending all the blood back up again. The normal vein that causes people trouble runs from your groyne down to your knee, and so we thread a little laser up the inside of that vein. We would normally do a few injections to cover it in a tunnel of local anaesthetic, so you don't feel anything when I'm lasering the vein, which is just a fancy way of burning. We use a scanner all the time to make sure we're in the right place, and the reason it took us so long to get this up and running from first seeing it in 2000 to actually getting it working all the time in 2005 was because we needed to work out exactly what power settings to use and also to make sure it was safe, and it's turned out to be a very safe and effective way of treating them, so when you look at treatment options available to you, it can sometimes be very confusing if I tell you that the nice is the government-funded agency that tells you what's a reasonable treatment, and there is an entire website dedicated to everything. I would say that NY says that the best way of treating veins is with heat treatment, so heat can be a laser or electricity, which they call radio frequency ablation, or you can use microwave machines. they all work equally well I just happen to use a laser because I've used it for many years and I'm quite happy with it there are other techniques where you inject a chemical into the vein some sometimes you add a little bit of air and that becomes a stuff called foam sclerotherapy which I think works very well for smaller veins I don't have I prefer to use a laser for the larger veins but other people use foam the biggest disadvantage with foam is that it does produce quite a lot of brown discoloration and that can be a little upsetting from a cosmetic point of view afterwards and the latter few there's a machine called ClariVein which I did use many years ago which seem seemed great but I found it at a higher recurrence rate but again other people think it think it's fantastic and then there has been a recently people have been using a type of superglue to glue the inside of the vein which I have which I don't use as I'm a little concerned about injecting chemicals that don't that stay inside your vein so appear instance after you have your veins lasered.

Well clearly we've taken an easy one here so on the left a few little bubbly bits on the inside of the leg that's the inside of the left leg there was a vein running the whole way up to the groin that was actually causing this but you couldn't see it so we popped a laser in that laser the vein and a few weeks later you noticed that everything deflates so you can't really see that much if that was a hairy bloke leg you probably wouldn't need to do much more but six weeks afterwards it's usually gone but there were always a few bits remaining so occasionally people who want no visible veins afterwards we would do a few small extra little Nicks in the skin just to H get rid of those veins completely so just remember that's a good outcome, go back a little bit, and if you look at that, you know before and after in six weeks or so. The thing to remember is that when you have treatment, everyone talks about minimally invasive treatment and painless treatment, and it was wonderful, and anyone who talks about it says it was fabulous. I would say that people coming in for a varicose vein operation under my care think they're coming in for a bit of a bad day at the dentist everyone is a little bit stressed and a little worried that it's going to be painful I find afterwards they're usually extremely relaxed because it's not half as bad as they thought it was going to be they're usually in a bandage and relieve that everything is over so they go home and if they sign some if they fill in some satisfaction forms they are you know elated almost that that it hasn't been too painful but I would say it takes a few weeks to get over your vein operation so although you hear people talk about lunchtime surgery and walking in walking out and everything being perfect I think it feels like you've just done for men I usually say it's like the first football match of the year for girls. I say it's just like the first heavy gym workout the next day; it feels a bit stiff and achy.

Most people will take some kind of painkiller, whether that's paracetamol or Ibuprofen, and I think most people would, for example, walk the dog and do their normal things the next day, but I think you'd struggle a little bit if you were hopping on a train to go to Central London and whizzing around tube lines, etc. Remembering you have a bandage on your leg, it does restrict you a little bit, and I do feel that it's more or less like a pulled hamstring for the first few days. I think the second week is much better, although you certainly still know that I've done something to you, and I think it takes two weeks before you get up in the morning and forget that I ever did anything to you. I think that discomfort is gone at that stage, and then when you look down, you will probably still have some bruising. Most people afterwards can fly whenever they like. I think there's a myth that flying is associated with deep vein thrombosis; it's not really. There are quite a few people who have an operation and can head off whatever they like. I would just say that I know it's one mile from the car park to the gate in Gatwick because I measured it myself, and if you just had an operation, that's quite a long way. So, for most people, I say give it a couple of weeks before you go on vacation. It takes about three weeks to pass it off as a normal leg if you want to go swimming in a normal pool, and if you want everybody to pass a comment when you're away, I think it takes about six weeks for everything to settle down completely, so I think next we're going to go onto a little video just for one of our patients.

Jo Crossey

My name is Jo Crossey. I'm 58 years old well it did it was making my legs more uncomfortable as the ears went on feeling very heavy and tight especially in the hot weather my feet would swell and just generally feeling achy most of the time I did start working part-time and part of that reason was probably unconsciously thinking actually I can't keep on my feet all day long every day we thought it was worth the drive to go and especially when it was a beautifully new hospital it was it was a very pleasant experience and I wouldn't hesitate to go back again if I needed to in the future my GP referred me on the 22nd of January and I had my consultation with Benenden on the 31st of January so I was quite impressed by that the operation was very straight-forward. You are given a booklet to explain what the procedure is. Mr. Chandler, who I saw, also talked me through it, but obviously, when you're in consultation, there's a lot of information to take in, so I came home and read the leaflet. I also looked online for him, and he gave a very good explanation online. Everything that was in the booklet is exactly what happened on the day you talked through it, and the staff were very supportive and talked you through every process. I felt as if walking into a lovely environment like that meant that everything was going to be okay and that it would be state-of-the-art technology and processes, so I felt very confident that I was in good hands. My recovery was again like it said on the Tim; you know, I had to wear my bandages for 5 days and then take them off. I couldn't drive for 5 days, obviously, because they saved for insurance purposes if I had to stop quickly or if I was in an accident. Insurance might not be so happy if I was wearing bandages and then I was back to work in a week. It was a bit achy and a bit sore, but they gave you advice about putting your feet up whenever you could, rubbing in local anaesthetic gels, and wearing a support bandage if you needed to. I did that a few times because the weather was quite warm post-surgery, so I made use of those devices and advice, and it definitely has changed my life now in that I'm not feeling the heaviness in my legs, and I have been wearing shorts out, which I hadn't done before, so it certainly boosted my confidence in terms of that, and yes, getting back to running after two grandchildren If anybody was thinking about having their varus's veins done, I would recommend the Benenden hospital. Their technology and the processes they do are that it's just a laser treatment, which is the way forward in terms of not making you lie in bed, getting you up, and getting you mobile. Certainly, Benenden Hospital is highly recommended as far as I'm concerned.

Vicky Hawkes

Thank you, and thanks for that interesting presentation. We're going to take some questions now, so first we have a question from Hugh, and Hugh asks, Can leaving veins unattended result in further damage to other veins?

Mr Aaron Sweeney

Not really so if you have varicose veins they can sometimes damage your skin but they rarely cause trouble to other veins sometimes however when veins get a little bit too big they can sometimes clot off and that's a condition called thrombosis is in inflame veins thrombosis is where you get a little bit of clot forming H that can sometimes extend a little and so occasionally people who have thrombosis can go on to develop a deep vein thrombosis so if you remember the tree analogy if one of the branches starts clotting off it can sometimes head right to the main vein however that's unusual so for most people I would say if you have varicose veins no matter how big they are if they're not giving you any grief you're not itchy they're unlikely to cause you too much trouble they probably will get a little bit bigger someone might tell you to wear a compression stocking nobody ever wears compression stocking because they're either too tight or too loose or too difficult to put on or too hot I think they work maybe for a day so in terms of do they cause trouble for other veins not really they just get a little bit bigger with time

Vicky Hawkes

Okay, thank you, and I hope that answered your question. The next one is from an anonymous attendee; they asked, Do varicose veins risk blood clots?

Mr Aaron Sweeney

Again, kind of, but not much actually, so you might say to me, If you've got a vein that's not painful, what's my risk of getting a DVT? DVT is a deep vein thrombosis. If you listen or read some stuff, you'd swear you're waiting to have one, and I would say it's about one per thousand people per year. You might also ask, if you did an operation on me, what's my risk of getting a DVT? Well, it's actually one in a thousand. Once medics start talking about one in a thousand, they just mean not that common, and one in a thousand to a medic is very, very uncommon, so I don't think varus FS on their own cause DVT and operating them can occasionally produce them, but if you're just an ordinary member of the public, your risk of getting a DVT per year is actually one in a thousand.

Vicky Hawkes

I hope that's put your mind at ease, and next up, we've got a comment question about ankle fractures: Is it common to have problems with varicose veins after an ankle fracture?

Mr Aaron Sweeney

It can be so that ankle fractures on the RO won't cause you any trouble with your varicose vein, but sometimes, depending on how bad the fracture is, fracture and broken bone are the same thing. If you break your ankle, it can be just a little minor crack or you can really go to 90 degrees, and in that case, it often damages not only the bone but also the surrounding muscle and veins, so people can often get varicose veins appearing after an ankle fracture, and the last bit is that ankle fractures immobilise your joints, and the problem with that is that that increases your risk of a DBT. So many bone fractures have a risk of deep vein thrombosis of one in 10 or one in 20; it's remarkably high, so sometimes after a bone fracture, you can end up with a DVT H, and that sometimes shows itself by your veins being a bit more visible in the lower part of your leg.

Vicky Hawkes

Next up, how do you treat the vein in the grin?

Mr Aaron Sweeney

So, if I tell you so, the normal vein runs from the groyne down to your knee. I thread the laser in from your knee and wangle it up the inside of that vein, right up to the groin. I use a little scanner, and then with that scanner, I can see how close it is to the main vein. That is essentially the trick with laser treatment: you don't want to damage the main vein, which you've never done, but your laser as close to that join as you can. So that's how you treat the groyne vein. Sometimes there are different types of groyne veins, so there can be some smaller veins around your groyne or different veins, and they're occasionally treated with foam, or even a little tiny incision, called a foamy

Vicky Hawkes

Thanks very much; that made sense. Patricia asks how soon after a limb anaesthesia I can have EVLT.

Mr Aaron Sweeney

It depends on what the angioplasty was, so if it was because you're not able to walk very well, I would give that about six weeks or so because an angioplasty is where you stick a balloon inside an artery, usually a vein, and you essentially squeeze open the blood vessel. That's quite traumatic, and I think it takes about six weeks for your blood vessel to be in reasonable shape to have anything else done, so I would wait quite a few weeks. I wouldn't have it done right away after that.

Vicky Hawkes

I hope that's helpful. The next question is from Sarah. Sarah asks, Can you treat patients who are on statins?

Mr Aaron Sweeney

Yes, that's the answer. Everyone seems to be on statins. I don't think it makes any difference; it's just that it's almost normal. I'm not sure how fabulous they are, but whatever everyone's on them, you definitely don't need to stop them, and that's an interest. An add-on to that would be if, for example, you're on a blood thinner such as a Apixaban or Rivero Xan, we don't stop those drug tablets.

Vicky Hawkes

The next one is: how much walking exercise does one have to do after the fact?

Mr Aaron Sweeney

Walking is difficult for some people due to other issues, yeah, so I say once you're out of bed, you're fine. It's remarkable how much your blood flow increases just by moving around the house. In the olden days, they used to tell people to walk five miles a day. That was basically because they thought nobody would walk that far, but they might walk a mile, and I would say that you probably don't need to do that. Most people say that once you're out of bed and walking around the house, you're fine. Anyone who has a two- or three-year-old gets more than enough exercise in the house with those, so I would say you don't have to actively go out of the house and walk around the neighbourhood once you're up and out of bed. That is the eye. The most important thing is that you're in bed after the operation because once you walk, your blood flow increases dramatically, which saves you from problems such as DVT and actually speeds up your recovery dramatically.

Vicky Hawkes

Okay, that's great, so keep moving. I think the anonymous attendee has asked, Do you treat the cause or the symptoms only?

Mr Aaron Sweeney

That's the whole point of the initial consultation with me that's for me to work at what's wrong with you because if you come to me with cramping or ache I want to make sure that the vein that you have fits the symptoms that you have so when if you have cramping aching itchy skin I want to make sure that if I do an operation on you you'd be very happy and everything will have gone go away and likewise if people come because of cosmetic issues I like to make sure that I don't just do the most superficial veins that will almost certainly recur if there's another varicose vein line underneath so I'm very keen to scan people and say tell them if the veins they see in the surface are actually caused by another vein and that you have to have that one treated to get any reasonable result so the whole idea is that from a cosmetic point of view you need to be happy with me and I tell you time scan time scales etc for that and for the other group there's often quite a big crossover but the other group who have achy sore legs I just want to make sure you don't have achy, sore legs a few weeks after I treat you, and indeed, you spent your good money on an operation.

Vicky Hawkes

Anna says that she's got peripheral neuropathy in her feet and legs. Would the laser treatment exacerbate this condition?

Mr Aaron Sweeney

It doesn't usually make any difference to that. Quite a lot of people have diabetes, and with some peripheral neuropathies, we would treat them, so I would not be treating the varicose vein. Treating the varicose vein is not going to make any positive difference to your peripheral neuropathy, so it would just be a by-the-buy, so to speak. I would be treating something else, whether it's EG pain or discomfort, but I wouldn't necessarily make any real difference to your peripheral neuropathy one way or another.

Vicky Hawkes

Jack has asked how successful treatment is if the skin is already discoloured from varicose veins.

Mr Aaron Sweeney

Well, if your skin's already disco-discoloured, that means your skin is damaged, so when you get brown marks, it's a type of scarring. If you have a varicose vein nearby, treating the varicose vein is only going to help prevent further progression of that scarring. It rarely gets your skin back to normal if it's just a little bit red and itchy. Yes, that should go back to being completely normal, but if for whatever reason your skin is quite scarred and brown or hard, your cosmetic result will not be as good, but I would say that if your skin is like that and you have a varicose vein nearby, it will certainly progress further, and that's one of the warning signs that you could end up with an ulcer, so discoloration of your skin wouldn't stop me from treating it; it would actually push me to treat you, but sometimes you can't get back to where you started before you had par veins in the first place.

Vicky Hawkes

Jack I hope that is okay for you. Next up is from Bridget, and Bridget asks how many veins she can get at one time in her case, saying that she's got loads.

Mr Aaron Sweeney

Depends what they are if you thread veins well there's a limit on how much stuff chemical I can give you in one go I try to do as much as I can but that there is a definite limit on that and with regards to varicose veins will interestingly orphan the varicose vein say for example coming from your groin down the inside of your leg has multiple branches and quite often you just treat the main vein that's cause causing trouble and all the other side branches deflate away so you often don't have to do quite as much as you think from a varus's vein point of view from a thread vein or those cosmetic small blue veins you do have to treat all of those that's why that takes a long much takes many treatment episodes to get it looking good

Vicky Hawkes

Okay, thank you. Francis asks if she's on blood-thinning medication. Would she need to stop that medication at some point before?

Mr Aaron Sweeney

No is the usual answer. So, everyone who has a varicose vein operation has a blood thinner on the day that's to allow you to get home from the hospital and gives you a 24-hour period where your blood is a little bit thin, and that's to try and reduce the risk of a DVT. Sometimes people who were previously on drugs such as Warren or Apixaban would have to stop it for a variable amount of time beforehand, and I couldn't really see the point in that because we anti-coagulated everyone, so for some years now, I have not stopped Apixaban or Warrun for most people, and we just get out and treat them. You bruise a little bit more than perhaps someone who's not on a Apixaban, but it seems to make no real difference, and it doesn't seem to increase the risk of bleeding. I'm all right; when I'm doing veins, you're always going to bleed, so the whole idea afterwards is that I send you home not bleeding, so it doesn't really matter whether you're on a Apixaban or I've given you blood thinner either way. I try my best to make sure that there aren't any spots on your dressings when you leave the hospital.

Vicky Hawkes

Someone's asked: Can varicose veins affect your overall circulation?

Mr Aaron Sweeney

Yeah again kind of so if you've got a whole lot of blood sitting in these veins normally they don't give you much grief in the morning and as the day goes on they fill up and then you go to bed at night or you lie down at night and all that old blood essentially seeps back into your muscle which is why you get a bit of cramp and your legs feel like they're on fire or they can feel a little bit Restless but when you're actually exercising your veins the blood in your veins are essentially siphoned up your leg so surprisingly exercise doesn't usually make veins more painful for most people there's always exceptions to that so varicose veins don't really they're not particularly bad for your circulation as such the problem is how your skin reacts so if by having blood pooling in your lower part of your leg your skin is unhappy well that's that is bad for you H because your skin will become darker in colour and may well become itchy or even ulcerate but for most people with varicose veins it doesn't really make that much difference once you're walking around and doing your stuff your circulation is essentially normal okay

Vicky Hawkes

Thank you. Cinthia asked: Is peripheral vascular disease an outcome of the problem?

Mr Aaron Sweeney

No, they're two different things. so peripheral vascular disease or Peripheral arterial disease sometimes called pad is where the blood going down to the muscles in your leg is just not getting there H easily enough the main arteries going down your leg are rather like motorways and peripheral artery diseases like Road works it can sometimes block the blood vessel completely or sometimes narrow it and it's okay at sort of quiet times but the moment it gets rush hour when you're walking fast for example the blood just cannot get through these blockages so that's completely different from veins which are basically after all the blood has been delivered veins take it back up again so they're not and there not they're not involved in the inflow of blood into your leg varicose veins are kind of think of it as a slow outflow from your legs

Vicky Hawkes

Thank you; there are just a couple more questions left. Someone's asked if I'm on a blood pressure tablet and have EVLT, will the veins come back?

Mr Aaron Sweeney

EVLT is pretty good, so it depends on how you answer that question. For most people, I tell them that their risk of a vein returning within a year is around 1%. Some people will tell you that once your laser a vein, it's gone, so your recurrence rate is zero. What most people are asking is, if I have my veins treated, when are they ever going to come back? Well, most people don't. I tell people around 10% of people will have another trip to a vascular surgeon at some stage in their life it's nearly always for a vein on the other leg but so they don't necessarily recur but if you've had varus veins once you're a little bit more likely to get them again the important thing there is to is how you answer the question as to whether veins recur or not if you're on a blood if you're having for example if you got a blood pressure medication even if you very large varicose veins treating them with a laser it should get rid of that vein completely that's the whole point of having the having the treatment so I would say that if you come to me with a vein I should get rid of it for you and you shouldn't be back to see me anytime soon

Vicky Hawkes

Okay, it's good to hear Jacqueline's asked, Can you have surgery on varicose veins in a lower leg that also has permanent bruising?

Mr Aaron Sweeney

Yes, you can.

Vicky Hawkes

Can taking away the damaged veins leave you with fewer veins, causing problems as you get older?

Mr Aaron Sweeney

No, that's not really the answer to that, so the most important thing is, if you think again of the Christmas tree, if the main vein is perfect, you're fine. you have hundreds of veins most of the muscle veins are draining quite large quantities when you're exercising the skin veins are miserable little things but you have loads of them most of them are smaller than the size of a shoelace and they drain about a teaspoon of blood when you see a varicose vein it is one of those veins so those miserable little shoelaces not working they become large and you think well actually that's quite a large vein surely I need it and I would say to you that that vein is not working correctly that blood is just pooling there in fact quite often it's not it's not just pooling it's actually flowing in the opposite direction so the reason you're getting symptoms is it's overwhelming all the other little tiny H shoelaces that are trying their best to get blood uphill so when you remove that vein you're often given the rest of your veins in the SK in your skin a holiday because they suddenly only have to do their own job and they don't have to do they don't have to take care of that waterfall that's falling down from your groin so sometimes people say well if you get rid of one vein will that put more pressure on the others the answer to that is definitely no you get rid of a varus vein the rest have a little holiday that's why your legs feel better afterwards

Vicky Hawkes

It's good to hear Bernice ask, Do you need to be accompanied for this treatment?

Mr Aaron Sweeney

Not really, I would say to you, though it does feel a bit. It's a bit stressful, so it is lovely if you've got someone to give you a lift home afterwards. Plenty of people get a taxi to the train station and head home. There's no particular medical contraindication for that. I would just say that does feel a bit stressful. You're usually relieved afterwards that it's not quite as bad as you thought it was going to be, but I would say the ideal would be that someone gives you a lift home afterwards. It's just because you do feel a bit stressed out.

Vicky Hawkes

Okay, and our final question this evening is: Is there a genetic predisposition to varicose veins?

Mr Aaron Sweeney

It depends on which parent you love, so I would say yes, you can get them from your parents; most people don't. You might say, Why do girls get them more than guys? And that's actually your hormones. sadly you got a hormone called progesterone which goes really high just before you deliver a baby or just before you have a period and that hormone is kind of designed to relax everything to allow baby to pop out but it relaxes veins as well that's why girls get veins a little bit quicker than blokes but so genetically well if you're a girl you're a bit more likely to have Troublesome veins although blokes get them little bit little bit older very occasionally I see people who are aged 13 with varicose veins that's definitely genetic but for most people I think it's just a bit of bad luck hormones standing and life most girls don't get any varicose veins in their 20s I think it's usually when you're in your 30s that you start to notice veins, but that's normally when you have a few kids and you're a bit exhausted from that and don't have any time to look after yourself. The commonest age group of people having varicose vein treatment is actually in their 40s or 50s. You'd be surprised that everyone thinks it's 18-year-olds making sure that everything looks good. I would say the commonest group is much older, and I've had their veins for many, many years, but I've had other life issues that just haven't been taken care of, and I haven't had enough time for themselves.

Vicky Hawkes

That's all the questions we have time for. I'm sorry if we didn't answer any of yours. If you want to see the next slide, Mr. Sweeney, please thank you, lovely. As a thank you for joining the session tonight, we are offering 50% off the value of your initial consultation, a call back from your dedicated private patient advisor, and sending an email tomorrow with a recording of this session and further information and updates on news and future events at the hospital. We'd be really grateful if you could complete the survey at the end of this session to help us shape future events as well. Our private patient team can take your call until 8pm this evening or between 8am and 6pm from Monday to Friday. Using the number on the screen. You can also book your consultation on our website with the discount code VEINS50. A link to the book will appear after you've submitted your survey response. Our next webinar is on hip replacement surgery, and you can sign up for this via our website. On behalf of Mr. Sweeney and our expert team here at Benenden Hospital, I'd like to say thank you very much for joining us today, and we hope to hear from you very soon.