THE BLOG

A NICE End to Vein Stripping

21/08/2013 12:01 | Updated 20 October 2013

Endovenous surgery (or "keyhole" surgery for varicose veins) started in the UK in March 1999 when I performed the first endovenous operation in the country. Since that time, myself and my team have been showing the advantages of this new approach over the old "tying and stripping" surgery.

In 1999 and 2000, it was already clear that the endovenous approaches, whether they be radiofrequency ablation or endovenous laser ablation, were much less painful than tying and stripping, allowing a much quicker return to normal life or work, as well as giving a much better cosmetic result with the tiny pinhole incisions rather than the older larger surgical approaches that needed stitches.

By 2005, we had already shown that stripping the varicose veins caused the veins to grow back again in a significant number of people as part of the healing process - but the new veins that grew had no valves meaning that the surgery was ineffective in the medium to long term. Throughout the last decade, we have been showing that veins closed with the endovenous techniques, when used correctly as per our protocol, rarely (if ever) open up in the medium to long term. Research we are currently presenting around the world has shown near perfect results even up to 14 years later.

As we all know, the medical world moves slowly, particularly when it comes to recommendations or guidelines. In many instances when drugs or malignant conditions are being assessed, there is a very good rationale for this slow change and there are many examples to support a thorough and well-reasoned (albeit slow) approach. However, venous disease is much easier to understand and ablation of the veins, easier to measure and identify. Although there are still great debates about some of the techniques that use chemicals such as foam sclerotherapy, the endovenous techniques (heating of vein walls from the inside to permanently destroy the veins) has been well measured and understood now for many years.

Unfortunately, as the UK does not have a recognised body of phlebologist's, and most vein surgery is still done by vascular surgeons or general surgeons who spend the majority of their time treating other conditions rather than veins, it has meant that both the NHS and the private medical insurance companies have allowed, if not encouraged, vein stripping rather than endovenous approaches.

As such, it is a huge relief that the National Institute for Health and Care Excellence (NICE) has come down in favour of endovenous thermoablation surgery as the preferred option for the treatment of varicose veins.

The guidelines allow the use of foam sclerotherapy if endovenous laser or radiofrequency isn't possible or can't be performed for other reasons - and open tying and stripping of the veins is rightfully relegated to those who can't have either thermoablation of foam sclerotherapy - which in my 14 years' experience is no-one. Thus only doctors who can't do the new procedures or institutions that haven't bought the equipment will offer the outdated stripping procedure.

Without doubt, provided the doctors providing the service are adequately trained and use the most effective protocols, patients with varicose veins and other venous conditions of the legs will receive far better treatment than they ever have done before. It will of course be interesting to see how both the NHS and private health insurance companies will introduce new guidelines, particularly in view of their reticence to embrace these new techniques over the last decade.