Press Articles

The scotsman - Mon. 2nd oct. 2006

Varicose veins are more than a beauty issue


Dr Kieran McBride, medical director of the Scottish Vein Centre at GP-Plus in Edinburgh, is pioneering methods of non-surgical treatment for varicose veins. Picture: Phil Wilkinson

LUMPY, bumpy veins on the legs are often regarded as just another unsightly sign of getting older. For women, it can signal the end of wearing shorter skirts or dresses that show off their legs.

But varicose veins are more than just a cosmetic condition - they can be uncomfortable and painful, and patients are often referred for surgery to have them removed. Yet patients can do little, if anything, to prevent the problem in the first place, as varicose veins are caused by the forces of gravity gradually taking their toll on the body.

"Varicose veins are very common, particularly as we get older," says Dr Kieran McBride, medical director of the Scottish Vein Centre, based at GP-Plus in Edinburgh. "Blood in the legs normally flows up the legs back to the heart, but it is under low pressure so gravity tends to push it back down the leg. This is normally prevented by valves in the veins.

"Most varicose veins are caused by a faulty valve in the groin or behind the knee. This allows blood to be forced out into the veins under the skin from the main veins inside the leg muscles. This leads to the valves in the superficial veins becoming faulty, and the increased pressure in these veins causes them to enlarge."

While women are more at risk of varicose veins earlier in life, particularly if they have children, McBride says it is also a major problem for men. "By the time you are 50, as many men have them as women," he says.

"Yet men don't do much about them, and they learn to live with the symptoms, like aching, itching and burning. It can become quite severe and can cause significant problems. In a minority of people, they can ulcerate and become a chronic ordeal for the patient."

However, the standard surgical treatment can actually put people off seeking help in the first place, adds McBride, as many people are nervous of having a general anaesthetic.

"Generally, very few people seek treatment," he says. "The perception is that it requires surgery under general anaesthetic, and that has been the traditional method."

While this "surgical stripping" of the affected vein usually works, McBride says a significant minority will suffer complications, and almost a third will have a recurrence of the problem. "The way surgery has dealt with it was to tie off the top of the main vein and then strip out the distended vein from the thigh," he says. "That is still an effective treatment, and is the proven treatment. The problem is that is has a 15 per cent complication rate, and a four to six-week recovery time."

McBride, a consultant interventional radiologist with NHS Fife, is now running the first Scottish clinic to offer new non surgical treatment - using a thin laser fibre to burn away the affected vein.

During Endovenous Laser Ablation (EVLA) treatment, a small needle is inserted into the varicose vein at knee level or at the upper calf, and a flexible fine wire is passed up the vein to the junction at the groin or the knee crease. A fine tube is then passed over the wire into the vein and the laser filament threaded up the tube. Once the fibre is in position, the laser is turned on and the vein will shrink, closing up from the inside.

The procedure is carried out under local anaesthetic, leaving a five millimetre nick on the skin and, apart from wearing a compression stocking and avoiding sport for a couple of weeks, the patient can return to normal activities almost immediately.

McBride says EVLA treatment is only carried out after an extensive initial consultation, including an ultrasound scan of the levels of blood flow in the affected leg. Currently, the SVC is the only clinic in Scotland offering EVLA and foam sclerotherapy treatments - sometimes recommended for patients who have had EVLA to help shrink bulging "branch" veins, or to treat patients who have thread or spider veins. Foam sclerotherapy involves injecting a chemical solution into the vein which then causes it to shrink or close up.

EVLA treatment was approved by the National Institute of Clinical Evidence (NICE) in 2004, and provisional approval was given for foam sclerotherapy in June this year. McBride concedes there are some sceptics within the medical profession who doubt whether the new therapies are better than traditional surgical treatment.

"There is a certain reluctance in the surgical community and a few in radiology," he says. "When the evidence is gathered, we want to sway those who are disbelievers. There is enough evidence out there to convince me that it's got real promise, and that it could replace surgery, probably in the majority of cases."

While EVLA treatment is currently only available for private patients, at a cost of around £2,000, McBride says he is keen NHS patients should have that choice available to them.

He is currently in the process of discussing a feasibility study with NHS Fife to test his theory.

After the capital costs of equipment are paid, McBride says that the treatments could actually prove more cost-effective to the NHS than traditional surgery, which requires a theatre team and longer post-operative recovery in hospital.