Medical technology and techniques are constantly changing and usually improving to the benefit of patients and doctors alike. However, the National Health Service is often slow in adopting new advances.
The latest National Institute for Health and Care Excellence (NICE) guidance on treatment for varicose veins is therefore to be welcomed as recognition that many NHS patients are still being treated by out-dated and unnecessarily invasive procedures.
NICE has formally recommended that open surgery should only be offered as a last resort to patients unsuitable for minimally invasive surgery - in skilled hands, well over 90% of patients suffering from varicose veins can be treated with lasers rather than open surgery.
Over the last decade there has been a gradual shift away from traditional 'open' vein surgery (the so called 'tie and strip' operation) towards the newer operations that use lasers and other heat-based techniques. These are safer, less invasive, and quicker - patients can leave the hospital on the same day, an hour after the procedure. Heat-based techniques also produce less scarring, as they involve fewer incisions.
In addition to being a better clinical option, NICE calculates that the minimally invasive procedures are cheaper, as there is no requirement to put the patient to sleep through general anaesthetic.
Despite the clear advantages of the minimally invasive options and although laser techniques for vein surgery have been performed in the UK since 2002, many surgeons and hospitals have continued to offer exclusively the standard stripping operation in both the NHS and private sectors.
According to the Health & Social Care Information Centre (HES), approximately two thirds of the 35,000 patients that seek varicose veins care through the NHS per year are still treated by open surgery. Many of these procedures are carried out by 'general surgeons', who are not specifically trained or experienced in the newer techniques for vein treatment.
The new NICE guidance should produce a further move towards the wider uptake of training in and performance of the latest technology within the public sector, for the benefit of patients.
Anyone seeking varicose vein treatment should refer to NICE's advice and request an opinion from an experienced vein specialist offering minimally invasive procedure before accepting to be treated by open surgery.
Eddie Chaloner is a Consultant Vascular Surgeon
Mr Chaloner is a pioneer in laser treatment for vein surgery. He was the first surgeon in London and the South of England to use the EVLT laser system in 2002 for the minimally invasive treatment of varicose veins. His practice Radiance Health are the largest users in the UK of Angiodynamic EVLT laser fibres.