Your treatment will be precisely guided using modern scanning techniques, usually under local anaesthetic and sedation (unless you prefer to be asleep). Most patients are best served by laser surgery (EVLT) or foam injection (UGFS) and all modern techniques are employed when needed. All main leaking veins can be sealed in a single treatment session, although foam injections may be better spaced across a few weeks.
Thread / Spider veins
These are eliminated by administering a sclerosant liquid, using the tiniest needle to scratch the surface of the skin. Compression stockings are worn for a week. Multiple (2 or 3) treatments is the norm.
Red face / tiny vessels on the nose / face
Facial vessels are sealed with a tiny high-frequency electrical current, delivered precisely to the vessels under magnification. It is very easily tolerated (causes tingling sensation) and you may return to work straight after your treatment. Two to three sessions is usual.
Hernias can cause serious problems if left alone so they should be repaired (and they do not improve spontaneously!). A strong repair involves reinforcing the abdominal wall muscles with a mesh (often referred to as a Lichtenstein repair). This can be carried out as a day-case with a rapid return to full normal activities.
Circulation (PAD) problems
Narrowing of the arteries may cause problems ranging from stroke, through to leg pains and leg ulcers. Your assessment will be comprehensive and the full risks of this major surgery will be discussed sympathetically and comprehensively before embarking on this treatment.
These will be quickly and comfortably removed using local anaesthetic. Cysts, warty growths / moles and fatty lumps (lipomas) are easily eliminated and I take pride in producing the best cosmetic results.
These sometimes distress patients for years before seeking specialist treatment – please do come for an assessment! Most leg ulcers are caused by circulation problems that can be improved and permanent healing achieved.
We all get nervous sometimes – I have been through major surgery myself and I understand what it feels like. I provide calm reassurance whilst guiding you through any treatment that will help you.
Specialists often refer patients to colleagues if their expertise is more appropriate - you may have been referred by another consultant. Welcome - I look forward to helping.
Sometimes, after my assessment, I feel that one of my colleagues would be better able to help you. If that is the case, I will introduce you by way of referral to a more appropriate colleague, either locally or occasionally further afield.
I am often asked by lawyers for impartial experienced specialist opinion on legal cases. Your lawyer will contact me directly if they wish me to help in this way..
Veins in the legs have non-return valves that allow blood to flow from the legs back towards the heart. Varicose veins cause these valves to fail which leads to excessive pressure in the veins. It is this pressure which causes the familiar throbbing and aching and can damage the skin, leading to ulceration.
Treatment of varicose veins depends upon accurately eliminating all sources of high vein pressure. A colour duplex ultrasound scan will be carried out by me personally during your consultation and I will show you on the scanner screen how all your veins are working (and which ones are not). We can then discuss how different techniques to treat your varicose veins would work for you and thus formulate a bespoke plan to deal with your pattern of varicose veins.
The two most common techniques that I employ are laser surgery (EVLT / EVLA) usually under local anaesthetic and ultrasound guided foam sclerotherapy (which does not require any anaesthetic).
Laser vein surgery
This technique involves passing, under local anaesthetic, a slim fibre-optic catheter into the vein to be treated. Ultrasound scanning locates the catheter within the vein. The vein is then anaesthetised with more local anaesthetic so that as the laser closes off the incompetent vein it does not hurt you.
The technique is usually supplemented by injecting the visible varicose veins which have been pre-marked before surgery. They can then be removed through tiny incisions.
Treating one leg in this way usually takes about forty-five minutes (depending on how many varicose veins are being removed).
Once complete the leg is bandaged and you will return to the ward and allowed home after a brief period for the nurses to check that you are alright.
A couple of days later you will be invited back for the nurses to remove the bandages, check the tiny wounds and apply a class 2 compression stocking. This stocking should be worn for two weeks continuously and can then be removed before returning to clinic for me to check your leg.
Patients often find the stocking frustrating – Tricks to keep it up include wearing the waistband over the opposite shoulder or wearing tight shorts (such as cycling shorts) or tights over the top of the stocking.
Discomfort in the foot at night time may necessitate making small cuts with scissors in the stocking so it is less tight across the broadest part of the foot (please also check that the double seam has not ridden back where it would compress the widest part of your foot).
It is usual for there to be some discomfort / pain, especially along the line of the vein which has been “lasered”. The most common site of this is along the inner aspect of the thigh. I recommend non-steroidal anti inflammatory drugs (nurofen, brufen, ibuprofen, voltarol diclofenac etc), which may be supplemented by paracetamol. The advantage of these drugs is that in addition to being pain killers they also reduce the inflammation around the treated vein thus aiding the process of the vein settling down and becoming comfortable once again.
If you experience swelling of the whole leg which is painful, please contact the hospital. There is a small risk of deep vein thrombosis associated with varicose vein procedures. Thankfully they are extremely rare (1:10 000 cases) but if a dvt was diagnosed then it should be treated promptly.
After a fortnight I will check your recovery in clinic. I will inspect the wounds and scan your leg if I have any concerns. At this stage the leg is usually still a little bruised and there may be lumps which are a little tender. Sometimes there are numb patches due to bruising of little skin nerves. These things settle down as time allows your body to heal.
Most patients are keen not to wear their stocking any longer than the fortnight that I recommend. Some patients feel that they like the support that the stocking gives and feel more comfortable wearing it – if you wish to wear it for longer please do so, perhaps just during the day- time until you feel able to dispense with it.
If you are also considering having thread veins treated please retain your stocking and bring it to subsequent appointments – I recommend a week wearing compression after thread vein injections.