Vascular surgery

Anything to do with arteries or veins in the human body comes under the general title of vascular disease. Vascular translates to vessel, which in this case refers to the vessels that carry our blood from our heart (arteries), around our bodies, and back to our heart again (veins).

The arteries carrying freshly oxygenated blood via our lungs feed the capillaries, which in turn feed the organs of our bodies. This is then returned via the veins back to the heart and lungs so they can be oxygenated again. Our arteries are susceptible to disease - which causes hardening and gradual narrowing. This can present with a variety of symptoms such as pain on walking, stroke or heart attack. The main causes of this are raised blood pressure, high cholesterol, and smoking.

The key role of the veins is to return the blood to the heart. For this to work efficiently (or even at all), our veins contain one-way valves to stop the blood flowing backwards on its way back to the heart - fighting the force of gravity if we're in a standing or walking position. If any of those valves malfunction, then problems of varying degrees can occur to the vascular system. This is just one example of what can cause vascular disease, but it's also the reason for the most common vascular disease of all: varicose veins. 

When a valve malfunctions, it can lead to back pressure in a vein, and that in turn can lead to the vein stretching and swelling, the visual result of which can be clearly seen if the veins concerned are the peripheral veins, that is, the veins closest to the surface of our skin.

It's not just the clearly visible look of many varicose veins, it can also cause all kinds of bumps and lumps to appear in our legs as the veins become extended and have nowhere to extend other than outwards.

There are two reasons why varicose veins are a problem for people, the first is on medical grounds, where a person's physical quality of life is being affected. This includes a great deal of discomfort as well as further complications, such as skin discoloration and leg ulcers being likely to set in if the condition is left untreated.

The second is more about the cosmetic look of varicose veins, and although this is dismissed by some, it can have a debilitating mental effect, which causes stress and can lead to other problems for the sufferer. 

If you've seen your GP about this condition and been referred to Three Shires, we'll be in direct contact with you to discuss your next steps. You may also have been referred to us via your medical insurance company, in which case, the next step is to set up an initial appointment.

Lastly, you may have decided to come to us direct, either to see what options you have or to get a second opinion. In all cases, you are welcome to call us on 01604 620311 to find out more. We also run regular free evening clinics to help you find out more. 

In a few cases, no treatment is required other than periods of rest and ensuring you spend as little time as possible in a standing or sitting position (walking is important though as it helps with circulation).

A compression or surgical stocking can also help to alleviate the symptoms of varicose veins by containing the swelling and inhibiting their outward movement.

Compression stockings are tighter at the ankles and loosen as they go up the leg to encourage blood flow in an upward direction. This is not a problem where the valves in veins are working correctly and stopping blood from leaking back downwards again, but to date, there are no methods that can fix valve problems other than surgery to remove the affected vein entirely, so containment using compression stockings works well where surgery is not chosen (or not an option).

There can be complications with stockings though, and a blood pressure test is necessary to ensure there are no other conditions that could be made worse by the wearing of them.

If varicose veins are suspected during an initial examination, a duplex ultrasound scan will be done so your vascular consultant can determine the condition of your veins and, check for issues with valves. 

Depending on your condition, there may be a number of different options you can take to relieve the symptoms, however, sometimes there is only one recommended course of action, and that is to use surgery to remove varicose veins.

There are two types of vein in the body, deep veins (buried deep below the skin) and periphery or superficial veins that are fed by the deep veins and run closer to the skin's surface.

It is these superficial veins that cause the discolouration and lumps to appear as they extend and travel outwards.

Historically, veins could be stripped out completely using open surgery, but that is usually no longer necessary, and instead minimally invasive surgery techniques can be performed to seal the veins in-situ and remove the problem. 

One such minimally invasive operation is called radiofrequency ablation. This involves placing a tiny tube (called a catheter) through a pinhole cut in the skin and inserting a probe into the tube inside the affected vein.

High frequency radio waves are then applied to the affected parts of the vein to seal it and shut it off from its blood supply. The vein is then slowly absorbed back into the body and disappears

Radiofrequency ablation is one type of endothermal ablation, endovenous laser treatment is another.

This uses the same technique with a small incision and catheter, but this time the probe that seals the vein uses heat from a laser to do its job.

Everything is guided by ultrasound and the entire vein can be treated in one go as the probe moves along the vein. 

Another option is called sclerotherapy. This is used on the smallest veins (sometimes called spider veins) and is done by injecting a chemical called a sclerosant into each vein using ultrasound to ensure exact delivery of the injection.

This causes the vein to swell, and block off. It can take a few weeks for the vein to disappear completely (and longer if it's used on a larger peripheral vein). 

Treatment for varicose vein is relatively safe. The 2 main risks are that veins can recur and also there is a small risk of blood clots from surgery (all surgery carries a certain amount of risk) and can lead to the possibility of deep vein thrombosis (DVT). If you have had DVT in the past, this will be discussed in your initial consultation as it may affect your choice of options.

You will have bruising after any of the operations discussed so far, which can be quite extensive depending on how many veins need to be removed. This will disappear in time, but an important part of your after care from any operation is the need to walk as soon as possible to keep the blood flowing. 

Most operations for varicose veins are same day operations and you will be able to go home soon afterwards (and even drive a car if necessary) as only a local anaesthetic is required for most people.

A compression stocking will need to be worn for 2 weeks afterwards followed by checks to ensure everything is going well.

Should you need to stay overnight at Three Shires, your comfort is assured as all our rooms are private with en-suite facilities and 24 hour medical care.

If you'd like to discuss your needs or get more information, please do call us on 01604 620311