The National Institute for Health and Care Excellence (UK) new Guidelines for the Diagnosis and Management of Varicose Veins

NICE: The National Institute for Health and Care Excellence (UK) last month released guidelines for the diagnosis and management of varicose veins. 

http://www.nice.org.uk/nicemedia/live/14226/64566/64566.pdf

These guidelines provide further support that firstly Endothermal Ablation and secondly Ultrasound Guided Foam Sclerotherapy are the recommended techniques of removing varicose veins. Surgical stripping of varicose veins should only be considered if these techniques are NOT suitable. 

The relevant guidelines are to be found on page 10.  

Interventional treatment
 

1.3.2 For people with confirmed varicose veins and truncal reflux:

• Offer endothermal ablation (see Radiofrequency ablation of varicose veins [NICE interventional procedure guidance 8] and Endovenous laser treatment of the long saphenous vein [NICE interventional procedure guidance 52]).
• If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy (see Ultrasound-guided foam sclerotherapy for varicose veins [NICE interventional procedure guidance 440]).
• If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery.
  
  
  

Deep Vein Thrombosis Blood Clots and Prevention with Aspirin.

I'm frequently asked if taking aspirin will help prevent Deep Vein Thrombosis (DVT) in situations such as long haul international flights where there is a known increased risk of DVT.  Before answering this question it is helpful to understand some basic information about blood clots.

Blood clots arise due to thrombosis anywhere in the arterial or venous circulation. DVTs occur in the venous circulation.  Heart attacks and strokes occur due to blood clots in the arterial circulation.  Venous and arterial blood clots are very different.  

The process of blood clotting is thought to have evolved at least 50 million years ago.  Blood clots are composed of two components; a blood protein called Fibrin and particles in the blood called Platelets. Platelets aggregate together like a mesh and Fibrin acts like glue to hold it all together to form a blood clot.

Anything that might inhibit the development or activity of either Fibrin or Platelets will impair the formation of a blood clot. Modern medicine has come up with therapeutic methods that do this because a blood clot can be life threatening. Think Heart Attack, Stroke or Pulmonary Embolus. 

Aspirin interferes with Platelet aggregation by irreversibly inhibiting Thromboxane A2, which makes it useful in preventing arterial blood clots which cause heart attacks and strokes.  But Aspirin does not interfere with Platelet aggregation mediated by Thrombin which explains why it is not effective in preventing DVT which occurs in the venous system. 

Heparin and Clexane do interfere with Thrombin generation and therefore are effective in preventing DVT. 

If you are going on a long haul flight and want to minimize the risk of DVT then wear compression stockings, take a walk up and down the aisle for ten minutes every few hours.  Also, make sure you drink plenty of fluids - that way you'll need to walk down the aisle to go and visit the loo!

Fly In With Varicose Veins, Fly Out Without?

Yes it is possible, you can be treated and take domestic flights the same day if necessary.

This option is popular for those that are coming in to visit Brisbane from around Queensland as well as interstate. We have treated a significant number of patients from rural areas of QLD and the Northern Territory ranging from mothers that are coming down to drop their children off at boarding school and those that work in the mine fields and are on a tight rotation. 

We can offer after hour appointments and alternative days in order to accommodate your schedule. We can schedule initial consultations and treatments on the same day with prior arrangement. Both Dr Kemp and our receptionist Camryn have lived and worked in rural Queensland (Mt. Isa, Toowoomba, Townsville and Cairns) and so understand how difficult it can be to access specialised medical treatment. 

So don't delay FIFO your veins today!  

Surgical Stripping replaced - New Management Guidelines for Varicose Vein Disease.

The recently published evidence-based Guidelines of the Society for Vascular Surgery and the American Venous Forum¹ has been in response to meet the needs of the new paradigm shift in the management of varicose vein disease.

The new era of "minimally invasive technologies" has now progressed into the management of Varicose Veins so that the newer techniques of Endovenous Laser or Radiofrequency Ablation and Ultrasound Guided Sclerotherapy have largely replaced open surgery and stripping.

The German Society of Phlebology² and the Venous Forum of the Royal Society of Medicine³ have also issued guidelines that there is sufficient evidence to use the minimally invasive technique of Ultrasound Guided Foam Sclerotherapy instead of surgery.

References:

1. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011;53(Suppl):2S–48S

2. Rabe E, Pannier F. Sclerotherapy of varicose veins with polidocanol based on the guidelines of the German Society of Phlebology. Dermatol Surg 2010;36(Suppl 2): 968–75

3. Berridge D, Bradbury AW, Davies AH, et al. Recommendations for the referral and treatment of patients with lower limb chronic venous insufficiency (including varicose veins). Phlebology 2011;26:91–3

Stop Vein Stripping!

Many people might think that the only way to treat varicose vein disease is to have the veins removed through a process called surgical 'stripping' performed by vascular surgeons. Not only is this procedure invasive, the veins have a high chance of returning. In the US today, nearly 80% of patients are treated by EndoVenous Laser or Radiofrequency Ablation, which is a simple walk-in/walk-out procedure. 

The benefits of EndoVenous Laser Ablation (EVLA/ELA/EVLT) compared to surgical stripping include:

• Lower risk of complications,
• Less pain,
• No admission to hospital or need for a general anaesthetic, 
• No unsightly scars,
• Much faster recover time with most patients returning to work the same day,
• Lower risk of veins recurring, 
• More affordable. 

Some vascular surgeons in Europe and America are now switching and offering EndoVenous Laser Therapy to thier varicose vein patients as a preferance. 

The Leg Vein Doctor now offers this procedure at thier Brisbane and Toowoomba Clinics. 

Dr Kemp featured in Brisbane Style Magazine "Ask The Expert Panel" June Edition