varicose veins and thread veins treated by injections sclerotherapy PhotoDerm and surgery at the British Vein Institute

Varicose Veins, Thread Veins, Spider Veins, PhotoDerm, Sclerotherapy, Surgery, Thrombosis

Introduction

What are They?

Investigation of Varicose Veins

Ultrasound Guided Foam Sclerotherapy

Surgical Treatment

Thread Veins & Sclerotherapy

Painful Veins

New Treatments

Traveller's Thrombosis

Photoderm Treatment

Links

BVI in the Press and on TV

Vein Clinics

Reports and Papers

References

1. Abramowitz HB, Queral LA, Flinn WR, Nora PF, Peterson LK, Bergan JJ and Yao JST. The use of photoplethysmography in the assessment of venous insufficiency: a comparison to venous pressure measurements. Surgery 1979 86:434-441.
2. Andreotti L, Cammelli D, Banchi G, Guarnieri M, Serantoni C. Collagen, elastin and sugar content in primary varicose veins. Ric. Clin Lab, 1978 8:273-285.2
Anon. Oxpentifylline for venous leg ulcers. Drug and Therapeutics Bulletin 1991 29:59-60.
I. Ardron ME, Helme RD, McKernan S. Microvascular skin response in elderly people with varicose leg ulcers. Age Aging 1991 20:124-8.
II. Barabas AP, MacFarlane R. The use of peroperative venmography in the management of difficult primary and recurrent varicose veins. In: Diagnostic techniques and assessment procedures in vascular surgery, Ed. Greenhalgh RM, Grune and Stratton, London 1985, pp 447--58.
III. Bosanquet N. Cost of venous ulcers: from maintenance therapy to investment programmes. Phlebology 1992 suppl. 1 44-46.Brewer AC. Arteriovenous shunts. Br Med J 1950; ii: 270.
IV. Browse NL and Burnand KG. The cause of venous ulceration. Lancet 1982 ii 243-5.
V. Browse NL, Jarrett PEM, Morland M and Burnand KG. Treatment of liposclerosis of the leg by fibrinolytic enhancement: a preliminary report. Br Med J 1977 ii: 43 4-5.
VI. Burnand KG, Lea Thomas M, O'Donnell T, Browse NL. The relative importance of incompetent communicating veins in the production of varicose veins and venous ulcers. Surgery 1977 82: 9-14.(i)
VII. Burnand KG, Whimster I, Clemenson G, Lea Thomas M and Browse NL. The relationship between the number of capillaries in the skin of the venous ulcer-bearing area of the lower leg and the fall in foot vein pressure during exercise. Br J Surg 1981; 68: 297 300.
VIII. Burnand KG, Lea Thomas M, O'Donnell T, Browse NL. Relation between postphlebitic changes in deep veins and results of surgical treatment of venous ulcers. Lancet 1976 1 : 936-938.
IX. Cheatle T, Shields D, Scurr J, Coleridge Smith P. The rational management of varicose veins. Health Trends 1991 23:152-3.
X. Cheatle TR, Stibe ECL, Shami SK, Scurr JH, Coleridge Smith PD. Vasodilatory capacity of the skin in venous disease and its relationship to transcutaneous oxygen tension. Br J Surg 1990; 78:607-10.
XI. Cheatle TR, McMullin GM, Farrah J, Coleridge Smith PD, Scurr JH. Three tests of microcirculatory function in the evaluation of treatment for chronic venous insufficiency. Phlebology 1990; 5:165-72.
XII. Chittenden SJ, Shami SK, Scurr JH, Coleridge Smith PD. Vasomotion in the leg skin of patients with chronic venous insufficiency. VASA 1991 (in press).
XIII. Christopoulos D. Nicolaides A.N. Szendro G. Venous reflux: quantification and correlation with the clinical severity of chronic venous disease. Br J Surg 1988 75:352-356.
XIV. Cockett FB, Elgan Jones DE. The ankle blow-out syndrome - a new approach to the varicose ulcer problem. Lancet 1953, i:17-23.
XV. Coleridge Smith PD, Scurr JH. Optimum methods of limb compression following varicose vein surgery. Phlebology 1987 2:165 172.
XVI. Coleridge Smith PD, Thomas P, Scurr JH and Dormandy JA. Causes of venous ulceration: a new hypothesis. Br Med J 1988; 296: 1726-7
XVII. Colgan M-P, Dormandy JA, Jones PW, Schraibman IG and Shanik DG. Oxpentifyline treatment of venous ulcers of the leg. Br Med J 1990 300: 972-5.
XVIII. Cox SJ, Wellwood JM, Martin A. Saphenous nerve injury caused by stripping of the long saphenous vein. Br Med J 1974 1:415-417.
XIX. de Takats G. The injection treatment of varicose veins. Surg Gynec Obst 1930 50: 545-61.
XX. Dormandy JA and Stock G, Critical leg ischaemia: Its pathophysiology and management.Springer-Verlag, Berlin 1990, p XXI.
XXI. Dodd HJ, Gaylarde PM and Sarkany I. Skin oxygen tension in venous insufficiency of the lower leg. J Roy Soc Med 1985; 78: 373-376.
XXII. Edwards AT, DeFriend DJ, Corson RJ, McCollum CN. Oxygen-derived free radicals and ischaemia-reperfusion in venous ulceration. Br J Surg 1992; 79: 369.
XXIII. Faxon HH. Treatment of varicose veins. Preliminary high ligation of the internal saphenous vein with the injection of sclerosing solutions. Arch Surg 1934 29: 794-809.
XXIV. Fegan WG. Continuous compression technique of injecting varicose veins. Lancet 1963 ii:109-112.
XXV. Fernandes E Fernandes J, Horner J, Needham T and Nicolaides AN. Ambulatory calf volume plethysmography in the assessment of venous insufficiency. Br J Surg 1979 66:327-330.
XXVI. Gallagher PG. Varicose veins - primary treatment with sclerotherapy. J Derm Surg Oncol 1992 18:39-42.
XXVII. Gay, J. Lettsomian Lectures 1867. On varicose disease of the lower extremities. London:Churchill, 1868.
XXVIII. Goren G. Injection sclerotherapy for varicose veins: history and effectiveness. Phlebology 1991 6:7-11.
XXIX. Haardt B. Histochemistry of normal and varicose veins. Phlebology 1987 2:135-158.
XXX. Hehne HJ, Locher JT, Waibel PP and Friedrich R. Zur Bedentung arteriovenoeser anastomosen bei dem primaeren Varicosis und der chronischvenoesen insuffizienz. Vasa 1974; 3: 396-98.
XXXI. Hoare MC, Nicolaides AN, Miles CR, Shull K, Jury RP, Needham T and Dudley HAF. The role of primary varicose veins in venous ulceration. Surgery 1982 92: 450-453.
XXXII. Hobbs JT. Surgtery and sclerotherapy in the treatment of varicose vein. Arch Surg 1974 109:793.
XXXIII. Hobson RW, Mintz BL, Jamil Z, Breitbart GB. Current status of duplex ultrasonography in the diagnosis of acute deep venous thrombosis. In: Venous Disorders, Eds Bergan JJ, Yao JST, WB Saunders & Co, Philadelphia, 1991 pp 55-62.
XXXIV. Holman EF. Development of arterial aneurysms. Surg Gynec Obstet 1955 100:599-611
XXXV. Homans J. The aetiology and treatment of varicose ulcers of the leg. Surg Gynaecol Obstet 1917; 24: 300-11.
XXXVI. Layer GT, Pattison M, Evans B, Davies DR, Burnand KG. Tissue fibrinolytic activity is reduced in varicose veins. In Negus D, Jantet G Eds, Phlebology '85, John Libbey, London, 1986, p10-13.
XXXVII. Layer GT, Stacey and Burnand KG. Stanozolol and the treatment of venous ulceration - an interim report. Phlebology 1986 1: 197-203.
XXXVIII. Lewis JD, Parsons DCS, Needham TN, Douglas JN, Lawson J, Hobbs JT and Nicolaides AN. The use of venous pressure measurements and directional Doppler recording in distinguishing between superficial and deep valvular incompetance in patients with venous insufficiency. Br J Surg 1973 60:312.
XXXIX. Lindmayr W, Lofferer O, Mostbeck A and Partsch H. Arteriovenous shunts in primary varicosis: A critical essay. Vasc Surg 1972 6: 9-14.
XL. Linton R. The communicating veins of the lower leg and the operative technique for their ligation. Ann Surg 1938 107:582-593.
XLI. Linton RR. The post-thrombotic ulceration of the lower extremity: its etiology and surgical treatment. Ann Surg 1953 138:415-430.
XLII. McIrvine AJ, Corbett CRR, Aston HO, Sherriff EA, Wiseman PA and Jamieson CW. The demonstration of saphenofemoral incompetence; Doppler ultrasound cpmpared with standard clinical tests. Br J Surg 1984 71:509-510.
XLIII. McMullin GM, Watkin GT, Coleridge Smith PD, Scurr JH. Efficacy of fibrinolytic enhancement in the treatment of venous insufficiency. Phlebology 1991; 6:233-9
XLIV. McMullin GM, Coleridge Smith PD, ScurrJH. Which way does blood flow in the perforating veins of the leg? Phlebology 1991 6:127-132.
XLV. McMullin GM, Scurr JH, Coleridge SMith PD. An objective assessment of the effect of ligation without stripping the long saphenous vein. Br J Surg 1991 78:1139-42
XLVI. McPheeters HO. Injection treatment of varicose veins by the use of sclerosing solutions. Surg Gynec Obst 1927 45:541-7.
XLVII. Michel CC. Oxygen diffusion in oedematous tissue and through pericapillary cuffs. Phlebology 1990; 5:223-30.
XLVIII. Moyses C, Cederholm-Williams SA, Michel CC. Haemoconcentration and the accumulation of white cells in the feet during venous stasis. Int J Microcirc: Clin Exp 1987; 5: 311-320
XLIX. Negus D. Prevention and treatment of venous ulceration. Ann Roy Coll Surg 1985 67:144-148.
L. Nicolaides AN, Zukowski A, Lewis R, Kyprianou P and Malouf GM. Venous pressure measurements in venous problems In Surgery of the Veins. Bergan JJ & Yao JST eds. Grune and Stratton Inc Orlando 1985 pp 111-118.
LI. Norgren L. Functional evaluation of chronic venous insufficiency by foot volumetry. Act Chir Scand 1974 Suppl 444.
LII. Obitsu Y, Ishimaru S, Furukawa K, Yoshihama I. Histopathological studies of varicose veins. Phlebology 1990 5:245-254.
LIII. Persson AV and Powis RL. Recent advances in imaging and evaluation of blood flow using ultrasound. Med Clin North Am 1986 70:1241-1252.
LIV. Persson AV. Use of ultrasonic colour imaging in the evaluation of the vascular system. In: Nicolaides A and Salmasi A-M, eds. Cardiovascular Applications of Doppler Ultrasound, Churchill Livingstone Inc, New York 1988: 357-364.
LV. Piulachs P, Vidal Barraquer E. Pathogenic study of varicose veins. Angiology 1953; 4:59 100.
LVI. Pollack AA, Taylor BE, Myers TT and Wood EH. The effect of exercise and body position on the venous pressure at the ankle in patients having venous valvular defects. J Clin Invest 1949 28:559-563.
LVII. Pratt GH. Arterial varices. A syndrome. Am J Surg 1949 77: 456-60.
LVIII. Rivlin S. The surgical cure of primary varicose veins. Br J Surg 1975 62:913-7.

LIX. Romson JL, Hook BG, Kunkel SL, Abrams GD, Schork MA and Lucchesi BR. Reduction of the extent of ischemic myocardial injury by neutrophil depletion in the dog. Circulation 1983; 67: 1016-23.
LX. Rudovsky G. Intravenous prostaglandin E1 in the treatment of venous ulcers - a double-blind, placebo-controlled trial. Vasa 1989 suppl. 28: 39-43.
LXI. Sarin S, Shami SK, Shields, Scurr JH, Coleridge Smith. The role of superficial venous insufficiency in venous ulceration.J Vasc Surg 1992 (in press).
LXII. Sarin S, Scurr JH, Coleridge Smith PD. Comparison of sapheno-femoral ligation with and without long saphenous vein stripping. Br J Surg 1992 79:464.
LXIII. Scott HJ, Cheatle TR, McMullin GM, Coleridge Smith PD and Scurr JH. A reappraisal of the oxygenation of the venous blood of varicose veins. Br J Surg 1990; 77:934 936.
LXIV. Scott HJ, McMullin GM, Coleridge Smith PD, Scurr JH. Venous ulceration and the role of the white blood cell. J Med Sci & Tech 1990; 14:184-7.
LXV. Scott HJ, McMullin GM, Coleridge Smith PD, Scurr JH. A histological study into white blood cells and their association with lipodermatosclerosis and ulceration. Br J Surg 78: 210-1, 1990.
LXVI. Scurr JH, Coleridge Smith PD, Cutting P. Varicose Veins: Optimum compression following sclerotherapy. Ann RCS 1985 67:109 111.
LXVII. Sethia KK, Darke SG. Long saphenous incompetence as a cause of venous ulceration. Br J Surg 1984 71: 754 5.
LXVIII. Stibe E, Cheatle TR, Coleridge Smith PD, Scurr JH. Liposclerotic skin: a diffusion block or a perfusion problem? Phlebology 1990; 5:231-6.
LXIX. Sullivan GW, Carper HT, Novick WJ and Mandell GL. Inhibition of the inflammatory action of interleukin-1 and tumour necrosis factor (alpha) on neutrophil function of pentoxifylline. Infection and Immunity 1988 56: 1722-9.
LXX. Sumner DS, Londrey GL, Spadone D, Hodgson KJ, Leutz DW, Stauffer ES. Study of deep venous thrombosis in high risk patients using color flow Doppler. In: Venous Disorders, Eds Bergan JJ, Yao JST, WB Saunders & Co, Philadelphia, 1991 pp 63-76.
LXXI. Svejcar J, Prerovsky I, Linhart J, Kruml J. Content of collagen, elastin and water in walls of the internal saphenous vein in man. Circ Res 1962 11:296-300.
LXXII. Thomas PRS, Nash GB and Dormandy JA. White cell accumulation in the dependent legs of patients with venous hypertension: a possible mechanism for trophic changes in the skin. Br Med J 1988; 296: 1693-5.
LXXIII. Turner Warwick W. The rationale and treatment of varicose veins and varicocoele. Faber and Faber Ltd. London 1931.
LXXIV. Vanscheidt W, Stengele K, Wokalek H and Schöpf E. Perikapilläre Fibrinmanschetten - ein O2 -Diffusionsblock? VASA 1991 20:142 - 146.
LXXV. Vasdekis SN, Clarke GH, Hobbs JT, Nicolaides AN. Evaluation of non-invasive and invasive methods in the assessment of short saphenous vein termination. Br J Surg 1989 76:929-32.
LXXVI. Wilkinson L. The presence of immune cells in vascular disease. M Phil Thesis, University College London, London, 1987.
LXXVII. Wolfe JHN, Morland M, Browse NL. The fibrinolytic activity of varicose veins. Br J Surg 1979 66:185-187.
LXXVIII. Wilkinson L, Bunker C, Edwards JCW, Scurr JH, Coleridge Smith PD. Leucocytes: their role in the aetiopathogenesis of skin damage in venous disease. J Vasc Surg 1992 (in press).
LXXIX. Zukowski AJ, Nicolaides AN, Szendro G, Irvine A, Lewis R, Malouf GM, Hobbs JT, Dudley HAF. Haemodynamic significance of incompetent calf perforating veins. Br J Surg 1991 78:625-629.

Previous Page

Arteries bring blood from the heart to the extremities. Veins contain one way valves and channel blood back to the heart. When there is obstruction of veins, or when prolonged pressure is placed on the veins, the valves stretch and no longer close properly. This allows blood to travel back down the veins towards the feet. The veins in the legs that are near to the surface of the skin enlarge and result in what is commonly called varicose veins. These can range from minor dilatations to large bunch of grape-like structures in the calf. Very small purple or blue veins in the skin of the legs are called "thread veins" or "spider veins" or dermal flares and often occur alongside large varicose veins. Some people are only affected by dermal flares. Both types of varicose veins are probably caused by the same factors. Varicose veins is a slowly progressive disease which if left untreated can lead to marked skin change damage or ulceration near the ankle. Why do varicose veins arise? Varicose Veins, Thread Veins, Spider Veins, PhotoDerm, Sclerotherapy, Surgery, Thrombosis Heredity is important in the development of varicose veins, thread veins and spider veins. Up to 20% of the adult population have varicose veins and experience discomfort as a result. Many people know of other family members with the same problem. A recent study showed that where both parents had varicose veins there was an 80% chance of their children developing varices. Environmental factors also play a large part in the development of varicosities, for example, prolonged standing - especially for workers such as nurses, sales assistants, flight attendants, waitresses and teachers, for example. Diet may also be a factor, and our Western diet with high content of fat and refined sugar with low fiber content may contribute to the development of varicose veins, spider veins and thread veins. Varicose veins may also become more frequent with advancing age, but may appear at any time of life and small varices are sometimes seen in school children. Although all factors such as puberty, pregnancy and the menopause also influence the course of the disease. As many as 70 - 80% of pregnant women develop varicose veins during the first trimester. Pregnancy causes an increase in hormone levels and blood volume which in turn causes veins to enlarge. Later in pregnancy, the enlarge uterus causes increased pressure on the veins in the pelvis. Approximately 60 - 70% of varicose veins due to pregnancy will disappear within a few months of delivery. Little research has been done to investigate the role of the pill and hormone replacement therapy (HRT) in the development of varicose veins. These probably have no influence on them. What are the symptoms Treatment of varicose veins and thread veins by injections sclerotherapy PhotoDerm and surgery Varicose veins may cause feelings of fatigue, heaviness, aching, burning, throbbing, itching and cramps in the legs. These symptoms are often accompanied by swelling of the ankle, which frequently appears after long hours of standing. Some people are very troubled by the aching that varicose veins produce. Even small dermal flares can result in severe aching which prevents standing for any length of time. What can I do to prevent them? Treatment of varicose veins and thread veins by injections sclerotherapy PhotoDerm and surgery Many of the things that seem to cause varicose veins are difficult to avoid such as a family history of Western way of life. Where possible standing still for long periods should be avoided. Walking is much better for the veins and helps the blood return to the heart from the legs. In occupations that require extended periods of standing then a few steps should be taken at regular short intervals to help circulation. Wearing support stockings may also reduce the likelihood of varicose veins. No creams or drugs are available to prevent varicose veins. The earlier varicose veins and dermal flares are treated the better the long term and cosmetic outcome.