Ian Loftus: Varicose Veins

Varicose veins are extremely common, and can cause a variety of symptoms including pain, swelling and leg ulceration. Treatment options include compression hosiery, injection sclerotherapy, conventional surgery and more recently minimally invasive techniques with laser and radiofrequency venous ablation. At present in the NHS, varicose veins are the subject of treatment guidelines where therapy is only provided for selected patients.

At St Anthony’s and London Bridge Hospitals, we provide patients with a state-of-the-art ‘one-stop’ service for the assessment and management of varicose veins. Mr Loftus will perform a full clinical assessment and a ‘Duplex’ ultrasound scan to fully assess the nature of the vein problem. This is used to guide the treatment options. Very few people now require conventional vein ‘stripping’. This technique has been superseded by a variety of minimally invasive techniques which are more effective, safer and much less painful.

[Picture shows: laser and radiofrequency treatments use heat to close the main veins
that cause varicose veins. Often this alone, performed under a local anaesthetic, will reduce the symptoms that are experienced lower down in the leg.]

Minimally invasive ‘endovenous therapy’ has been developed whereby veins are treated by delivering energy via an ‘endovenous’ fibre introduced through a needle around the knee. The heat created by either a radiofrequency (VNUS CLOSURE FAST®) or laser fibre seals the vein completely without having to remove the vein. In some circumstances, this can be performed under a local anaesthetic and the patient is encouraged to walk immediately afterwards. Endovenous surgery can avoid the need for a general anaesthetic and large incisions, greatly reduces trauma to the leg and patients have a much quicker recovery compared to conventional surgery.

[Picture shows: the laser fibre is inserted into the vein under local anaesthetic, under
ultrasound control. The technique is very precise and avoids the need for vein stripping.]

Some varicose veins are suitable for an outpatient based treatment called injection sclerotherapy. There are 2 techniques- foam sclerotherapy for larger veins, and microsclerotherapy for thread or flare veins. Patients can attend the clinic, undergo treatment for their varicose veins without any anaesthetic, and can leave immediately and continue normal activities. Mr Loftus will discuss all of the options that are suitable for you.

[Picture shows: thread veins are unsightly and can be treated in the outpatient clinic using injection sclerotherapy. No anaesthetic is required and you can return to normal activities immediately.]

Mr Loftus has been at the forefront of adopting and developing laser and radiofrequency vein treatments. He runs national training courses for endovenous therapy, training surgeons from around the UK, and has run clinical trials in modern vein techniques.

[Picture shows: results of laser vein treatment are dramatically better than conventional vein stripping in terms or cosmesis, pain and recurrence.]