About Us
We are a female team based at 4 Upper Wimpole Street in central London. We aim to provide you with a welcoming, relaxing and reassuring environment prior to and during your treatment.
Who Are We
Dr Marianne Vandendriessche is a distinguished vascular surgeon and consultant working out of the London Vein Institute and specialises in vein treatments. She has a particular interest in venous problems and can offer you private treatment for all vein problems including varicose veins, thread veins and facial veins.
How we treat a vein
Recently several new techniques have been reported in the medical literature. The
main aim of these is to avoid surgical removal of varicose veins. The idea is to avoid
the need for general anaesthetic, incisions in the legs and a hospital operating
theatre. One of the most promising of these is Ultrasound Guided Foam Sclerotherapy.
Treatments
Surgery
This has been the standard treatment for large veins. In the past “strippers” were inserted at the ankle and passed up to the groin or back of the knee. The veins were then pulled out but sometimes there was minor damage to adjacent structures, such as nerves and lymphatics. This problem was overcome by inverted stripping and stopping just below the knee.
Incisions have been used to remove the dilated and tortous varicose veins and these wounds were closed with stitches in the past. Even with method, the scars were hardly visible if well placed. However, the cosmetic aspects and long term results have steadily improved. Surgery is performed as a day-case or often more comfortably as an overnight stay. Often there is only one small (3-4 cm) incision in the skin crease at the groin which is closed with a single fine nylon stitch under the skin. Occasionally a small incision (2-3 cm) is used in the crease at the back of the knee and very occasionally there may be one or two other small incisions (1-2 cm), again closed with a single fine suture under the skin. The smaller but prominent veins are removed at the same time through minute incisions (1-2 mm) which leave no mark. However, there may temporarily be some redness or blueness which is associated with the healing process. General anaesthesia is preferable but is light with a rapid recovery. Strong but elegant stockings in fashionable colours (from white to black) are worn for a week and can be removed at night for bathing, showering, and sleeping. Special strong elegant socks are provided for men. Normal activities including driving can soon be resumed. The few sutures are removed seven to ten days later. Surgery is therefore much more refined than previously.
Ultrasound Guided Foam / Sclerotherapy
Introduction
Recently several new techniques have been reported in the medical literature. The main aim of these is to avoid surgical removal of varicose veins. The idea is to avoid the need for general anaesthetic, incisions in the legs and a hospital operating theatre. One of the most promising of these is Ultrasound Guided Foam Sclerotherapy.
History
The use of injections to cure varicose veins dates back more than 100 years. In 1942 Orbach described a method of creating a foam or froth with the solution he injected. He claimed that this increased the efficacy of injection treatment. This method was used by a small number of surgeons but never found a great following. In 1992 Juan Cabrera, a surgeon from Granada in Spain, found that he could greatly enhance the effect of injection treatment by making a foam of very small bubbles, which he called ‘microfoam’. He used ultrasound imaging to guide his injections into the main surface veins and found that he no longer needed surgical methods to treat his patients. Over the last 6 or 7 years the use of foam injections has spread widely in France, Spain and Italy. It is now being enthusiastically taken up in several European countries. Experts in treating vein problems have used a number of different methods to create the foam that they inject but the result is the same: using a foam greatly increases the effect of the treatment without producing any additional side-effects.
What is injected?
The solutions that are injected are exactly the same as those which are already used to treat varicose veins. These are mixed with air to create a mousse or microfoam. It has been shown that this is perfectly safe to inject into the veins. The air is rapidly absorbed from the veins leaving the solution to treat the veins.
Why does foam work?
When a solution is injected into a vein it is immediately diluted by the blood, reducing its efficacy. Foam pushes the blood out of the way and completely fills the vein: the foam is not diluted by the blood. In fact, far less solution has to be injected to obtain the same effect.
The Treatment
Treatment is usually performed in a treatment room or ultrasound examination room, and not an operating theatre. The patient rests comfortably on a bed. In order to treat large varicose veins, it is necessary to block the main vein feeding the varices. This could be done surgically, but with foam treatment all that is necessary is to put a needle into the main affected surface vein. This is the only part of the procedure which might cause discomfort and is usually performed with a small amount of local anaesthetic. The position of the needle is carefully monitored using ultrasound imaging so that it is in exactly the right place. Next, the foam is injected whilst watching its progress using the ultrasound machine. Surprisingly, injecting the foam causes no discomfort, although the leg may ache slightly afterwards. Once the foam has filled all the main surface vein the top end of the vein is pressed on to keep the foam in the surface veins. The varicose veins in the leg are checked to see if foam has entered these from the main surface vein where the injection was given. A few further injections are usually given through a tiny needle in order to make sure that all the varicose veins have been completely injected. The whole treatment usually takes no more than 15 – 20 minutes. Finally, a firm bandage is applied to the leg. The aim of this is to keep the veins compressed so that they do no fill with blood when the patient stands up. The bandage is usually worn for a week followed by an elastic compression stocking for a further week. When the bandages are removed at the follow-up appointment it is usual to find that all the varicose veins have gone. They can sometimes be felt as small lumps beneath the skin. The leg may be a little bruised at this stage, although this is usually fairly minor. Lumps which can be felt at this stage slowly resolve over several weeks. If any varicose veins have not been completely treated in the first session are injected and bandaged to complete removal of all veins. If varicose veins are present in both legs it is standard practice to treat them on separate occasions about one week apart.
Who is the treatment suitable for?
Most patients with small or moderate size varicose veins can be treated in this way. Those patients with very extensive large varicose veins are usually best treated surgically to obtain a more rapid result. Some patients with large veins lying close to the skin are better treated surgically since brown discoloration of the skin over the treated vein may occur. If there has been previous surgery to the veins of the leg this does not cause any difficulty in using foam sclerotherapy. In fact, it is often far easier to treat recurrent varicose veins by foam injections than by more surgery. If varicose veins recur some years after initial treatment then it is straightforward to use the same method foam sclerotherapy again.
Who performs this treatment?
At present only a handful of surgeons in the UK are experienced in this treatment. It needs a specialist who is skilled at ultrasound imaging as well as injecting veins. By contacting the LVI you can obtain an appointment.
How well does ultrasound guided foam sclerotherapy work?
Several detailed clinical series have been published in the medical press. These suggest that 80 – 90% of saphenous veins (the main surface vein) are permanently occluded by this treatment when examined one or two years later using ultrasound imaging. This is similar to the success rate claimed for other new techniques such as VNUS Closure and Endovenous Laser Treatment (See: New Techniques). Surgery also has its failures and after two years further varicose veins may have appeared in about 10% of patients. Clinical trials are currently in progress which directly compare surgery and foam sclerotherapy.
Pre Sclerotherapy treatment
Post Sclerotherapy treatment
Microsclerotherapy
Microsclerotherapy is a technique used for the removal of surface and spider veins, sometimes known as broken or thread veins. It involves using a very fine needle to inject a sclerosing agent which irritates the lining of the veins causing them to stick together and the small veins then vanish. The procedures are carried out by experienced vascular surgeons.
The veins can disappear immediately but sometimes there may be some bruising which can last for several weeks depending on the size of the blood vessels treated. If bruising occurs, the treated areas may temporarily look worse and it is necessary to be patient to obtain a good result. Rarely, thicker bruises in larger veins can persist for several months and very, very occasionally there may be some discolouration of the skin, and this could take several months to fade. Firm bandages or stockings are worn for five to fourteen days depending on the size of the vessels and the extent of the treatment. Bruising is seen more frequently on fine skin where the veins are more visible. It is also possible for some larger ‘feeder’ veins to develop a small degree of inflammation when the vessel can feel hard and a little sore. These symptoms resolve spontaneously as the veins are absorbed and disappear. Larger veins may require compression for a little longer to minimise this problem.
If there are only a few scattered small veins, they may all disappear with the first treatment. When more extensive, 50% of the vessels treated at any one session may vanish and at least 80% of all vessels treated during the course of Microsclerotherapy can be expected to be eradicated. With repetitive sessions a complete clearance can be achieved. Occasionally, the vessels are more resistant and then stronger sclerosants are used. It is possible to drive immediately after treatment and normal life can be resumed. Excessive exercise should be avoided to allow the veins to close and because the restriction of the bandages prevent full bathing or showering. It may be helpful to avoid standing still for long periods and it will be more comfortable to elevate the legs while sitting. New vessels may appear at certain times when there are hormonal changes, such as with pregnancy and at the meopause. An annual tidy up visit is then recommended. Microsclerotherapy is a very successful treatment for the eradication of surface veins when correctly performed, and a good outcome can generally be expected.
Pre Microsclerothtrapy treatment
Post Microsclerothtrapy treatment
New Techniques
Overview
Recently several new techniques have been reported in the medical literature and reported in the media as possible alternatives to surgery. The aim is to avoid surgical removal of varicose veins and so avoid the need for general anaesthetic, incisions in the legs and a hospital operating theatre. Some of the methods summarised below only partially succeed in this aim but can be useful in eldery patients and others where it would be preferable to avoid anaesthesia.
VNUS Closure
VNUS Closure used a wire passed along the vein from the knee or calf towards the groin to treat large varicose veins in the thigh. The progress of the wire is monitored using ultrasound imaging. When the wire is in the position the end of the catheter is heated electrically and the vein is destroyed. (see www.vnus.com for more details)
Laser treatment for varicose veins
This method is similar to the VNUS Closure technique: a laser fibre is passed through the vein form the knee or calf towards the groin to treat the large varicose veins in the thigh. Again, the progress of the wire is monitored using ultrasound imaging. When the laser fibre is in position the laser is fired to heat the vein. The vein near the end of the laser fibre is destroyed. Gradually the wire is removed from the leg until all of the diseased vein is treated.
Ultrasound Guided Foam Sclerotherapy
Large veins have been treated by sclerotherapy for several decades with considerable success and this method has now been improved by the use of ultrasound visualisation to control the injection, and also by converting the sclerosant fluid into a foam. The method is an alternative to surgery for large varicose veins. The main surface veins are injected with a special foam under ultrasound guidance. The foam destroys the lining of the vein and a firm bandage is applied to the leg and must remain on the leg for up to two weeks. This method is suitable for treating both the underlying veins as well as the prominent varicose veins. This procedure does not require an operating theatre and is usually carried out in a consulting room or treatment room. The injection causes only trivial discomfort.
Conclusion
There is no magic treatment for varicose veins!
Surgical treatment is an established, effective treatment for large varicose veins. Microsclerotherapy is the best available treatment for thread veins and small varices.VNUS Closure and Laser Treatment are alternatives for large varicose veins. These methods reduce the extent of incisions made in the legs as well as post-operative bruising, but they do not treat the tortuous, visible tributaries. Because the cause (the proximal incompetence) if present is not treated there is a greater risk of recurrence. They are more expensive than surgical treatment.
Ultrasound guided foam sclerotherapy is useful in patients who may prefer to avoid surgery, or may be elderly or considered unfit for surfery. The final outcome will take longer to achieve but admission to hospital and general anaesthesia are not needed and again the proximal source is not treated but if there is a recurrence, it is easily repeated. It is inexpensive compared to surgery.
Insurance Companies
Marianne Vandendriessche is covered by most insurance companies. Should you wish your treatment to be covered by your insurance company we will need your G.P. referral letter along with policy number and authorisation number issued by your insurance company. Please note that microsclerotherapy is not covered by insurance as this treatment is considered cosmetic treatments.