Vicky

Just going to wait a few seconds for people to join.

Okay. Good evening, everyone. Welcome to our webinar on varicose vein treatment. My name's Vicky, and I'm hosting this session. I'm joined by our Consultant Vascular Surgeon, Mr Aaron Sweeney. This presentation will be followed by a question-and-answer session. If you'd like to ask a question during or after the presentation, please do so by using the Q&A icon, which is at the bottom of your screen. This can be done with or without your name. But please note the session is being recorded. If you do provide your name, If you'd like to book your consultation. I'll provide some contact details at the end of this session.

I'll now hand over to Mr Sweeney, and you'll hear from me again shortly.

Mr Aaron Sweeney

Thank you. Right there, that's a likely better picture than I look at today. But I'm a Consultant Vascular Surgeon. Been so for quite a long time, and during this session I thought we might just run through all the a bit about my experience and what we do here at Benenden Hospital. Some of the treatments that are available to you are what to expect. Often people find it interesting to find out what symptoms are actually caused by varicose veins because you can be surprised. It's rare for people to have just cosmetic treatment for varicose veins. Most people have quite a few aches and pains and other symptoms associated with them. We at the end. I like to do a questions-and-answer session.

I try my best to explain simply what's involved, what varicose veins are, and what treatments are available. But quite often, many people have lots of questions. Sometimes I answer them during the chat. If I don't, feel free to post them. I'll try my best to answer each one that comes up, and don't be worried about feeling a little stupid about questions. It's surprising how many people would love to have asked the question that you're going to ask.

That's a little bit about me. I qualified quite a long time ago. Now I've been a surgeon since. many years ago, with my friend and colleague, Eddie Chaloner. We saw some people treating varicose veins with a laser that was around about the year old, and we thought it was a fabulous way of treating them beforehand. We'd been doing stripping, which we both thought was a fairly useless operation and luckily we were able to get it at the beginning of this kind of treatment and since then, I performed well over all of these and in Benenden, here we performed the largest number in the UK. Benenden for those of you who have not been here. It's pretty new. It's a pretty calm place and many people find us an excellent and easy place to have treatment. The CQC. has come along and rated us outstanding, which is really quite impressive. Yeah. If I just go on a little bit about what varicose veins are pain. If you think of your veins like a Christmas tree, you have a trunk, which is called your deep vein, and that drains all the blood out of your leg, up into your tummy, and then that goes to your heart, and it's pumped again. That main trunk can drain a litre of blood per minute and then think of all those side branches. They are mostly vein-draining muscles. Then you have lots of other little, tiny veins that drain your skin and because someone many thousands of years ago decided to go from all fours to standing up straight. that stretched some of the valves and stretched some of the veins, and they have a bit more difficulty getting uphill.

They have loads of little valves helping the skin veins drain blood uphill, and sadly, they occasionally break. When they do, the veins become a little bit dilated, and then they can become varicosed. When they do get a little big. You don't necessarily have to see them on the surface. You can sometimes have a tiny little vein in your calf, but it's been fed by a much larger vein underneath, and even small veins can become very painful. Often the first sign that you have America's vein is that your ankles become a little swollen. At the end of the day, you can get a few extra thread veins appearing or a bluish discolouration of your foot. Most people start to get a little bit of ache, and that again is mostly at the end of the day, because remember, your veins have to fill up to start giving you symptoms, and most people when they sleep lying down and your veins empty. From the skin, and you shouldn't really be symptomatic after a good night's sleep, but as the day goes on, they fill up.

You could think of it as old blood sitting just under the surface and that can often give you an ache or heavy or uncomfortable legs as the day progresses. Sometimes people get a lot of muscle cramps, especially in bed. They're usually quite bad and often have people jumping out of bed and/or running around the bedroom and the most worrying sign, though for us, a hospital environment is where the skin starts to become itchy. dry or sore because that can sometimes lead to more serious problems. When you perhaps go to your GP. to discuss things. You sometimes wonder, Am I burdening him with something useless?

And there are various grades of veins, I thought I'd quickly go through them because they're often discussed. The first is what we call grade one or thread veins. These aren't dangerous. They usually don't give any symptoms. They can be very annoying, but they're not medically dangerous. Most people leave those alone. Sometimes you can treat those with an injection called sclerotherapy. There are many different types of treatment for those veins because no one treatment works perfectly.

Medically, they're okay. but obviously a little bit annoying. Sometimes veins. Then they get a little bigger, grade two. Veins are usually veins that you feel, but they're often tiny little blue things, usually around skin creases like at the back of your knee again. Not dangerous, very unlikely, to ever bleed when you start to get to grade three. That's normally a size that's giving some symptoms; usually veins, especially veins that look a little like that, often give some ankle. Swelling can be a little bit painful. Skin is usually not that itchy, and they're often there for years before anyone ever comes to have a consultation. Most people have many other things to worry about when they have varicose veins that are not particularly painful. Usually it's kids or grandchildren, or something else.

Many people who come to me have had varicose veins for years, and they normally only come to me when there's something happening. Usually that's when they get to grade four, when the skin starts to become inflamed. It can be a little red or change colour to a little brown sometimes, and normally, I would suggest you have something done if you start to get skin problems associated with veins and are a bit grim. All I say is that essentially people worry that if they have a small varicose vein, they're going to suddenly develop a large bleed or even an ulcer on their leg, and I would say it takes years to develop those and most people, once they realise they have a varicose vein, And it's the reason why their skin is itchy.

They normally never go on to develop an ulcer. in terms of what to expect when you come to see me at this hospital to have a consultation with regards to varicose veins. You come, and you see me. I perform the venous duplex scan, which is a type of ultrasound scan. Essentially, it allows me to see the inside of your leg. It's a little bit like a cardiologist using a stethoscope. I have an ultrasound almost attached to me surgically all day, and it allows me to see exactly where your vein is, which vein is not working, where it's coming from, and all allows me to tell you what's available to you. I try my best not to push you into anything, because I don't think that's the right thing to do and there are often many different options, including leaving things alone. Many people just want to be reassured that they can fly without being worried and that they're not lining themselves up for deep vein thrombosis or something like that. Usually, when you see me, I give you your options. Often people book their operation there and then, but most people take little time. We try our best not to pressurise you into booking. In booking an operation. Most surgeries are a day case; you walk in, walk out. It is a little bit like a dental appointment in terms of time and stress a little bit of chitchat about Paracusvain treatments. Things have gotten a little bit better since the last century, when, at the beginning of the last century,. They used to just inject varicose veins with some pretty nasty chemicals. They clotted off the vein, and they were really painful when you were able to have operations. People worked out that it was a good idea, probably to strip veins. But that's turned out not to be the case. Really, even the best operations have a lot of complications when stripping is involved. Stripping involves pulling the veins out completely. Usually, you put a wire inside called a stripper, and while it appears like a good idea to pull veins out completely, as your body is healing. It develops new veins; quite often you can have a very successful operation and then, a few years later, you develop all these new veins, and you're often in a worse situation than you were before you ever saw a surgeon. in terms of minimally invasive treatments like lasers. I'll go through a few other treatments. More than % are done under local anaesthesia. I do about %. Some people choose a general anaesthetic. That's fine. Whatever you choose is fine and most people I can treat with a laser EVLT or endovenous laser treatment are. It's the same thing. There are different types of lasers, but essentially, they all work the same way and do I do about a thousand operations a year and we do. Quite a lot of them. Pretty experienced here. this picture, sometimes a bit confusing. If you think of it as it's a person's right leg viewed from inside. It's the inside of the thigh and essentially, you have a big artery and a big vein; the artery sends the blood from your heart down to all your muscles and stuff and then the big vein. Your deep vein takes everything back up again, and what you're seeing here is a little vein arising from the groin running down the inside of the thigh, and that's nearly always the vein that causes trouble and that's the vein we usually treat, and you might get an idea that I've passed a little laser up the inside of that, and we call it sealing the vein. But essentially, a laser is a fancy way of burning something.

We use a lot of local anaesthetic around the vein to make sure you don't feel it, though. Sometimes people can be a little confused if you Google EVLT or lasers; you come up with a whole heap of different options and I would say There are common ways of treating veins. One is injecting something into the vein—a chemical of some sort. Say it's usually a type of soap. Surprisingly, that's been around for about a hundred years, pretty safe. I don't think it works particularly well on big veins, but it does work. If you inject enough stuff.

My usual preferences for a laser. That's because it delivers heat very, very carefully to the inside of the vein. But there are other heat sources. One is called radio frequency ablation, and essentially, that is electricity. But it sounds a little better, and it's called that, and it works just as well as a laser. There are. There's a treatment called foam sclerotherapy, which is where we mix up the stuff that we normally inject in veins into a foam and you use that to treat slightly larger veins. It works a little bit better and then there are a few other treatments: claravane, which is a kind of combination of sclerotherapy, and a little spinning wire, which works reasonably well and the last thing is glue. There are people who use a type of super glue to treat the inside of the vein. I don't. I find the vast majority of people I use a laser, and that's because I quite like the idea of just delivering a short, sharp burn to the inside of the vein rather than using a chemical term of what to expect. The before picture. There is what usually happens. You have a vein that pops out on the inside of the calf. starts to give you a bit of itch. You see me, and I do a scan and tell you, actually, it's caused by a vein that runs down the entire length of your leg. We laser that if I didn't do any small incisions called phlebectomies to get rid of the bumpy bits. What normally happens is the vein deflates after the laser treatment and then, if you wait long enough, it almost goes completely flat. I say almost because many people aren't particularly bothered about the cosmetic appearance and just want a simple operation that gets rid of their pain, itch, or ache, and a laser on its own nearly always sorts that out and other people say I would like it to look good as well. Can you help it on its way, and I would then do a few small incisions just to tidy up the vein, trying to make scars as tiny as possible, and this is very rare for me to ever put a stitch in a wound. We are next going to go to a patient who was operated on by my friend Eddie and just a little explanation of what to expect.

Sorry when it's been stopped. If you just bear with us. I'm just going to restart the video, as some people couldn't hear it.

Jo Crossey

My name is Jo Crossey. I'm 58 years old. Well, it did. It was making my legs more uncomfortable as the years went on, feeling very heavy and tired. especially in the hot weather. Feet would swell and just generally feeling achy most of the time. I did start working part time, and part of that reason was probably unconsciously thinking. Actually, I can't keep on my feet all day long. Every day we thought it was worth the drive to go and especially when it was a beautifully new hospital. it was. It was a very pleasant experience and I wouldn't hesitate to go back again if I needed to in the future. My GP referred me on the second of January, and I had my consultation with Benenden on the 21st of January. I was quite impressed by that. The operation was very straightforward. You are given a booklet to explain what the procedure is. Mr Challoner, who I saw, talked me through it. But obviously, when you're in consultation, there's a lot of information to take in. I came home and read the leaflet looked online for him, and he did a very good explanation online. Everything that was in the booklet is exactly what happened on the day you were talked through it, and the staff were very supportive and talked you through every process. I felt as if I were walking into a lovely environment like that, that everything was going to be okay, that it would be state-of-the-art technology and processes, I felt very confident that I was in good hands. My recovery was again like it said on the tin; you know, I had to wear my bandages for days and then take those off. I couldn't drive for days, obviously, because they say for insurance purposes. If I had to stop quickly, or if I was in an accident, insurance might not be happy if I was wearing bandages, and then I was back to work in a week. It was a bit achy and a bit sore, but they give you advice about putting your feet up whenever you can, putting in local anaesthetics. Sorry rubbing in local anaesthetic gels, wearing a support bandage if I needed to and I did that a few times because the weather was quite warm. post-surgery.

I made use of those devices and advice, and it certainly My life now has changed in that I'm not feeling the heaviness in my legs and I have been wearing shorts out, which I hadn't done before; it certainly boosted my confidence. in terms of that and yes, getting back to running after grandchildren. If anybody were thinking about having their varicose veins done, I would recommend and the Benenden Hospital. Their technology and the processes they do are it's just a laser. Treatment is the way forward in terms of not making you lie in a bed, getting you up, and getting you mobile. Certainly. Benenden Hospital is highly recommended, as far as I'm concerned.

Vicky

That's great to hear from Jo. I think we're almost done with the presentation. Now. going to move on to the Q&A session. I have plenty of time to answer your questions. Please do use that Q and A icon at the bottom of your screen, and we’ve got a few questions coming in already.

If you can answer this one, Mr Sweeney. Would the NHS treat a grade three vein, or would this be free at Benenden Hospital?

Mr Aaron Sweeney

It depends on grade three. They usually don't treat. They nearly always only allow you to have treatment if you have skin damage, bleeds, or an ulcer, which obviously isn't the best way of doing things. But when I worked in the NHS exclusively, you initially could offer surgery for pain. But that's not often the case anymore and I think many people are being given outpatient appointments that are months in the future and then cancelled just before the date. My answer is in certain instances. I've heard of people having those veins treated, but not many. Most people are waiting years for any kind of treatment. Grade three, just to remind you, is where veins are visible. They're nearly always lumpy and a bit painful, but in particular they haven't. You haven't got skin damage. or itchy skin, and that usually excludes you from most NHS hospitals. as regards doing that here. Yep, that's what we do all the time. They're the commonest type of veins that I would treat and in fact, it's often much easier on you and me to treat veins as grade three because you nearly always get a very good result, both cosmetically and symptomatically. It's great, lovely.

Vicky

Thank you. Next question. Hi, I'm in my early thirties and have varicose veins after pregnancy. Would they go away later in life without treatment?

Mr Aaron Sweeney

The simple answer to that is no. People often ask, Why do you get veins during pregnancy? and unfortunately, that's due to hormones. You get a very large spike of a hormone called progesterone in the last trimester, and progesterone is a hormone that will dilate things or relax things to allow a baby to pop out. but unfortunately, it relaxes varicose veins. Often, ladies who have a baby in the pelvis put a lot of pressure on them, and a large dose of progesterone makes your veins dilate. If you have varicose veins, they will get worse and they don't. Baby or progesterone doesn't usually cause varicose veins. They're nearly always there, but small, and then pregnancy makes them worse. The bad bit of that is that after the baby has appeared, etc. Your veins usually get a little smaller, but if you've had varicose veins, they're still there, and they're not going to disappear completely. They might get a little better once the pressure and hormones are back to normal. But most people who have varix veins after pregnancy will probably end up having something done at some stage. Sometimes people ask me, Well, if I've had my baby and I've still got, I've got varicose veins, and they drove me nuts during pregnancy. Do. I have to wait years before you can have them treated. The answer is, no, plenty of ladies have them done the first few months post-pregnancy. even if you're breastfeeding, but just continue doing it as before, doesn't it, and often people say, Well, I'd like just to. I've been told to wait until after I have babies because they may. The operations don't work well; that might have been true with stripping, but it's not really true of laser treatment. I would say if you've had a baby, you still have varicose veins, and they're still giving you grief. It's entirely reasonable to have them treated. It'll be a little better after the baby comes. but they'll still be there.

Vicky

Okay and with subsequent pregnancies, would that be the case as well?

Mr Aaron Sweeney

They come back or not. Usually, most times, when you laser a vein. Essentially, when I laser a vein, you're threading a laser up the inside of the vein, and you're delivering a burn that essentially destroys the vein; it is effectively gone. If you have a further pregnancy, that vein is gone; you shouldn't get varicose veins again. You can always develop a new vein. That's pretty unusual, to be honest. Most people after laser treatment have a recurrence rate. of around about %; it's quite a low recurrence rate. But I would caution that exact number. Because if you look at it, I usually look at what happens to people in the years after they've had a varix vein operation. About % of people return at some stage in the next few years, and that's usually for a varicose vein on the other leg. Having a varicose vein fixed doesn't mean you're absolutely out of the woods, but most times. The vein that was giving you trouble at that time doesn't come back to give you grief in the future.

Vicky

Okay, that's good to have that some comfort for ladies out there. The next question is from Therese. She asks. Good evening, Mr Sweeney. I have a lot of grade-one veins on my legs. My job entails standing for over an hour a day; by the end of the day, my ankles are slightly swollen, tired, and heavy. Would it be in my best interest, health-wise, to get them treated?

Mr Aaron Sweeney

Grade one and thread veins, which are the small veins that are just palpable or thread veins. They shouldn't really give you that much in the way of symptoms. Having them treated is not going to make your legs feel better at the end of the day. It can be that you have some varicose veins underlying that that you can't see. Sometimes you can have quite large veins running underneath the surface, but they're not quite at the surface, and they can certainly give you a lot of ache and pain from a symptom point of view, treating grade one and two veins. That shouldn't make your leg feel better; it might look better, but it shouldn't feel better, and the ache and pain can be. If you're standing all day in a busy job, that may just be one of those things that you have to unfortunately put up with. But sometimes you can have an underlying varicose vein under the skin. That's actually the real cause of everything.

Vicky 

Okay, thank you. That's helpful next comment, really, rather than a question from Helen. Helen says I don't have any symptoms. Mom would be entirely cosmetic, and for vanity we would treat those as well. Yeah.

Mr Aaron Sweeney

I Try my best to say to people that most people come because they've had veins for ages. They're too busy with kids and life to have anything done, and then they finally come. Usually when a hot summer occurs, or their skin starts to get sore. Other people come because I just don't like the look of them. I think it's an entirely reasonable talent, treated, no matter what way, from a cosmetic point of view. I think it's reasonable. An awful lot of people, after they had their veins done, suddenly feel delighted that they're able to wear shorts, etc. They don't have people commenting on the bruise on their leg, and they feel a little bit more confident. you might say. Well, am I putting myself at an awful risk by having an operation? For pure cosmetic reasons? The answer is, no, you might ask, is there any complication that I worry about or anything dangerous? Well, any operation has a small risk of developing a thought called a DVT. Vein surgery can produce a risk of less than one per person for the people we operate on and just to put that in perspective, DVT can occur out of the blue. in about one in every two people per year, or it happens in everyone in pregnancies, and sometimes, if people break their legs skiing, the risk is one in to try and give you an idea of the risk associated with anything. I think vein surgery is relatively low-risk surgery and quite often people feel really happy afterwards, because suddenly they're able to show off their legs a little. I tried to make sure they looked really good afterwards, but it often gives you a bit of a mental uplift and I think, from a cosmetic point of view, I have no problem. Thanks for that reason alone. I think it's a low-risk procedure that gives a very good boost to your ego. absolutely, and thank you for the question.

Vicky 

Claire's asking, Can you be treated if you have a pacemaker fitted?

Mr Aaron Sweeney

Yes, is the answer.

Vicky 

That's easy. I hope that's helpful, Claire. The next question is from Emma. How long would I have to wait between having each leg done?

Mr Aaron Sweeney

Depends. Sometimes people have both legs done as a general anaesthetic. That's not the usual. Most people have one side done at a time. I like to do them one leg at a time, because I think it keeps you very mobile afterwards. Most people have the first week feel a little sore. Although it's sometimes described as pain-free, I would say The operation is about as stressful as a dental procedure, and afterwards it feels like you've pulled a muscle or you have done a mile run for the first time in a few years; your leg feels stiff and achy, and I like you to be mobile, because once you're mobile, your risk of a DVT or any serious problem is virtually zilch. The answer to your question is, I like you to be mobile; that normally means to weeks between each leg, and normally that works. Some people have it one week, and then the following week have it and the other side done. People sometimes wonder, Why can't I do both sides under local in a single session? And that's because there is a limit on how much local anaesthesia I can give you in a single day. You can give people too much, and I can certainly fix one side. I struggle a little bit to do depending on the size of the person. Sometimes very small people. I can definitely do one leg, but I would struggle a bit and would run out of local anaesthetic, which would be a bit of a disaster if I were doing the other side. Thank you.

Vicky 

Thanks, Emma. Next question: is there any requirement not to fly for some weeks after EBT treatments?

Mr Aaron Sweeney

The answer is that is, it depends. Who you ask. I would say, Nope, many people fly in, have this done, and fly back to a different country, and that doesn't seem to cause any trouble. Often people worry that flying is associated with DVTs, and they buy flight socks, etc and are running up and down the aisle of aeroplanes on even short flights. I would tell you that the risk of a DVT on an aeroplane is really tiny. It's amazingly small. It's no riskier than really driving the car to the airport. It's just that it's just reported a little bit more frequently. Your risk on a flight to Australia is something in the region of one in a million, one per million flights. I mean, it's truly tiny. If people want to fly somewhere. I don't think there's any great medical reason. You can't do that, I would say. However, your leg feels a bit sore and I did measure how far it is from the Car Park at Gatwick to the easyJet Gate, and it is a full mile. I think, with hand baggage and a sore leg, going a full mile might just be a little bit grim. The other thing is if I laser the vein in your thigh. You sit directly on that in the plane. I normally say, Give it a week or two before you go after an operation. You're always bruised. but for the first weeks. Most people don't go swimming, not because they can't, but because they don't want anyone asking them what's happened. They feel a little upset or embarrassed, maybe, by the bruising and I would say it takes about weeks to pass your leg off as normal; nobody is asking you a question. probably about two weeks for nobody to be able to spot anything like a little scar. But normally it's about weeks before you feel you will not be spending your entire holiday explaining Barker's veins to somebody.

Vicky 

Okay, lovely. Thank you. Yeah, that's helpful and next question, is there any benefit to losing weight?

Mr Aaron Sweeney

My varicose veins appeared after pregnancies of being overweight and in teaching. No! The honest answer is that everyone is used to being told to lose weight. I don't know who came up with that idea, as far as veins are nothing to do with being a little overweight. If you're very, very heavy, and morbidly obese. Yeah, it sometimes gives you trouble, but it gives you an awful lot of other things as well. Being a little heavy is not the reason why people have varicose veins and reducing your weight is not going to miraculously cure your varicose veins either. Being a teacher is probably the main reason why varicose veins hurt. Because you're standing all day. Teachers, nurses, and people in those kinds of standing jobs. If they have varicose veins, they tend to have a rough time, whereas other people who are in an office can get away with things. Because if you're seated, it's normally not quite bad. I never tell someone that they have to lose weight. I mean, that's just not a reasonable thing to say to somebody.

Vicky 

Okay, thank you. I hope that's. What you wanted to hear next question is from Joe. Joe asks, once the vein is removed, how does the blood that needs to return to the heart actually find a route back? And what effect does this have on activities?

Mr Aaron Sweeney

Well, if you think again of your veins as a Christmas tree. It's the main vein, the middle bit, or the trunk of the tree—your deep vein—that's draining a pint or a litre a minute, depending on how much activity you're doing. You have the smaller veins. The next set of veins, which are draining muscle. Then you have the tiny ones that are draining your skin, but like a load of little blue shoelaces underneath the surface, they all drain about a teaspoon of blood. Varicose veins occur when one of those veins, one of the hundreds of little blue things that are draining your skin, stops working. Instead of draining their little teaspoon of blood uphill each minute. They're not doing that. They're filling up, and some of them are actually draining blood in the opposite direction. Although you can look at your leg and see America's vein and think it must be very important, it must be a very important vein because it's big. That's not true. What it's actually doing is it's not doing its job. But more often than not, not only is it not doing its job, it's actually doing the opposite. It's sending blood back down. The other veins nearby are actually working overtime, trying their best to get blood to go uphill and failing because this one vein is sending it all back down again. When you get rid of that, then the other veins nearby suddenly have a holiday because they're only doing their own job and that vein that's gone was really only taking a teaspoon a minute. It really wasn't contributing much and there are hundreds of other veins nearby; getting rid of the vein doesn't reroute itself; it actually stops it from flowing backwards. The other veins Have a holiday and your symptoms tend to reduce a great deal because all the other veins are quite capable of dealing with the blood that's there.

Vicky 

Okay, thank you. Thank you. My next two questions are somewhat related. Can a vein previously treated with EVLT over a few years slowly invigorate itself? And I guess, related to that, how long does EVLT last? And if the vein does reinvigorate itself, how would the vein then be treated?

Mr Aaron Sweeney

Most times, EVLT, when you're starting properly the first time. Varicose veins nearly always work. It's only a very small number. Where it fails, he can reopen again if people are on blood thinners, but even then, that's rare. Many people who've had a varicose vein operation, though, can get another vein. Sorry. Not that many people can get another vein, or Sometimes you can treat one vein and miss one; that's pretty rare when a vein is lasered; essentially, the laser energy is effectively killing the vein; those veins are going to come back. Sometimes they can reopen if you don't give enough energy and sometimes another vein nearby can appear. That's pretty rare, it would say.

How long does EVLT or laser treatment last? Well, it should be done and dusted. But not everyone is exactly the same, and sometimes people have had previous operations, or a little bit difficult because of multiple veins, or because of the medication they're on, and they can occasionally get new veins appearing, or even the same one reopening again, as I say, reopening again. That's really rare. But occasionally I see people where a new vein pops out, and it can even appear like bumpy veins in the exact same spot that they had them before they came to me. But I would usually scan them and say, Well, actually, it's a new vein that's popped up and you're one of the % at years that develop a new varicose vein.

Vicky 

Okay, thank you and the next question is from Marilyn and Marilyn asks, Hi, is phlebitis the same as varicose veins? Can this be treated?

Mr Aaron Sweeney

Yeah. Phlebitis is irritation or inflammation in a vein. All veins contain blood.

if the inflammation gets bad or the vein is slightly enlarged. enlarged, the blood can sometimes clot. That's called thrombophilia. If you have sore, tender veins, that's phlebitis. if they become hard and lumpy and particularly painful. That's Thrombus phlebitis and I hope that answers that phlebitis and varicose vein symptoms, varicose vein pain. Almost the same thing. Phlebitis is the Greek, I think, for pain, and itis is inflammation.

Vicky 

Okay, hopefully that makes sense to you. The next question is from Tracy. Tracy asks if hormones aggravate or cause varicose veins, as you mentioned, just around dilating the veins under normal circumstances.

Mr Aaron Sweeney

No, I would say, just to think every lady has essentially had progesterone. that progesterone levels wax and wanes with each period cycle. Just before you have a period, you get a spike of progesterone and post menopause. When people go on various different HRT medications, your kind of replacing what you already had. It's not that you're overdosing yourself with progesterone or oestrogen; essentially, you go back to baseline level. If you have veins, HRT. Can something make them a little bit worse? But to be honest, I don't think it makes much difference at all. I don't think it causes varicose veins. By the way, I think sometimes there are certain spikes in life when people get varicose veins. You might think it would all occur when someone's. Now, the common stage for varicose veins is in your fifties. It's not quite in your thirties.

Vicky 

Lovely, thank you. I hope that reassures you, Tracy. Next from a Yvette, a Yvette asks my legs. Feel a bit tingly at the end of the day. If I've been on my feet a lot, I have no other symptoms except that the vein is lumpy, and my GP. said it was vacuous veins. What grade would this be if it's lumpy?

Mr Aaron Sweeney

It's probably three if your skin looks a bit discoloured; it can be great for varicose vein symptoms to come in. There are many different symptoms, and there were some very nice studies done years ago, where people went to have a vein operation because they had pain. They had their vein operation done, and then they discovered there were many other things that were going on that they just didn't realize. People often tell me their feet feel either cold or hot. They can have tingly sensations, a kind of slight numbness in the foot. foot cramp, itching, or a feeling that somebody is touching your skin with a feather or water running down the inside of your leg. There are many different symptoms. It's a bit, and sometimes, when you have a varicose vein. People say, well, clearly, that's the cause of your symptoms. Not always the case. There are other things, but it's very rare for somebody to have two things going on at the same time if you have an obvious varicose vein. Nearly always the symptoms in your leg are due to the varicose. Fain. It's rare to have two things at the same time going on.

Vicky 

Okay, thank you and the Yvette follows up by saying I had sclerotherapy years ago for cosmetic reasons for fed veins. They've now returned and have varicose veins. Now, what would you suggest?

Mr Aaron Sweeney

Okay, thread veins are the vein of many ladies lives. I would never tell somebody when you're having your thread veins treated that I would get rid of them all, and you will have perfect legs forever. Most people have regular jobs to keep them in check. There are some people who have legs that never have a thread vein. They are very, very rare for most people. It's a bit of hard work to get them to look good and you need regular treatment. Then that's not every week like a haircut. It is often every few years people come back and have treatment for those red veins. I would pay when people sometimes come for consultation; they think that well, I'll have one treatment, and that will sort of sort me out for summer. That's never the way it works. Most thread vein treatments involve two or more treatment sessions. Your legs look really bruised after that and it takes many months sometimes for your legs to settle down enough for you to be happy, and then, in the years that follow every few years, you often come back for one quick mot. If you have varicose veins as well. They can be treated with surgery. But most times when you have lumpy veins, I would suggest. there's an underlying problem. You have that treated with a laser, or if they're bumpy, just to do a small incision and remove the pain. I think that cosmetically looks better.

Vicky 

Lovely, thanks for your questions and next up is a question from Terry. Terry asks. I have thread veins that look like red-blue socks. I've had electrolysis laser over years and have an appointment with you in September. I want to know if these can be treated as I get older. I worry about the risk of ulceration, although I admit mine are mainly cosmetic.

Mr Aaron Sweeney

Okay, I would say I'm cautious about. I don't like telling people you can be. It's straightforward to fix you. That's not the case. Many people, if they have had thread pains for many years, are never going to get rid of them completely and I would say to you. from a medical point of view. You can usually sort everything out so you don't bleed, and you don't end up with an ulcer or dodgy skin, and I can give it your symptoms. But if you've had multiple operations and you have lots of thread veins, it's sometimes impossible to get that looking good enough for you to wear sandals or shorts. without visible veins. I'm normally kind of honest with people, partly because I like being honest, but because people get really annoyed if they go through one or more treatments and end up with legs that look much the same as they were before they ever started. I would. I always caution people about what to expect. As I say, you can fix the symptoms and you know, worries about ulcers normally sort all that out. Thread veins are different and especially if you've had multiple previous treatments. multiple operations, or you've had them for or years, and your skin looks quite blue and mottled. sometimes. You just can't fix those.

Vicky 

Okay, thank you very much. Next question somebody asked. There are blood-thinning medications.

Mr Aaron Sweeney

Quite often, when I operate on people, I would give you a DVT to make sure you don't get a DVT. I tend to leave people on whatever they're on before the operation; that could be Clopidogrel aspirin, or it can be even Rivaroxaban or warfarin. I don't find I tend to leave people on whatever they're on whatever drug they're currently on, and I sometimes add a blood thinner. If you're on nothing at all.

Vicky 

Okay, thank you. The next question is from Jasper. They ask. Hi, my sister was saying something about a vein restructuring of some kind that can be done. which was done to her son as opposed to vein, removal of foam, fill, or whatever. She wasn't quite sure what it was exactly that she was trying to describe in the past.

Mr Aaron Sweeney

People have tried to repair the valves in varicose veins; in Germany they did that for a long time. Interestingly, the exact reason why people end up with varicose veins is not entirely known. It can be a bit of inflammation around the valve or a failure in the collagen around veins. The one thing that did work out was that you can do beautiful operations to repair them. But if the problem is that the vein itself is intrinsically wrong, the valves fail again. The recurrence rate following that type of surgery for varicose veins is quite high. Sometimes in children it's slightly different, because if a child has a varicose vein or a vein abnormality, that's almost certainly going to be a genetic problem. that changes the whole scope completely. There are many genetic problems that can give rise to what looks like a varicose vein. But in fact, it's not and the treatment options there are very, very different.

Vicky 

Okay, I hope that's answered your question, Jasper. The next question is from Beth, and Beth's a teacher, and she's got a stage vein, which she's had for years. What's the recovery time after treatment?

Mr Aaron Sweeney

It depends. In an ideal world, you have your veins done, and you take weeks off feet up. Treat yourself a little bit, and you'd go back on week totally symptom-free, although your leg looks still a bit bruised. Most people don't have those luxury teachers; I normally tell them you could go back quicker than that. But you'll be a little bit sore. I definitely would not go back to teaching a load of kids the day after having your veins done, because it's a bit sore you'd be. You're messed up for the whole day, and you'd be a bit knackered by the end of the day. I would say if you can give yourself a few days. That's fine, at least a week as a teacher or a nurse, and, in fact, nurses and teachers are the ones who really should take weeks off following surgery. They never do because of the way they are and I'd say a few days is okay. But I would really say that the first week is a bit rough if you have to go back, and if you can take a week off, and you'll be okay if you can do it during a period where you have weeks off; you'll be much happier. Plenty of people who work for themselves say, Well, I have to go back to work. I don't really have an option. They go back and they just say, Yeah, it was a bit. bit grim, bit achy for the first few days. Not miserable, but certainly a little uncomfortable and I had to take some kind of painkiller to keep on top of things.

Vicky 

Okay, I hope that was helpful for you, Beth. A couple of questions here about pre-existing conditions. Somebody asks, I'm prediabetic. Is that a problem? And somebody else asks that they're. Is it possible to have treatment when they have atrial fibrillation?

Mr Aaron Sweeney

The prediabetic thing isn't a problem and atrial fibrillation? Yeah, loads of people have that. That's not a big problem. If you're on a blood thinner again, that's not a problem. We usually just keep you on the blood thinner and treat you as if you weren't on a blood thinner. It doesn't usually make that much of a difference. Sometimes it does so. Occasionally we stop the blood thinner a couple of days beforehand. That's unusual. Most times I just leave you on your current medication.

Vicky 

Okay, I've got a couple more questions. One from Claire could severely foot and calf cramps, night cramps, and foot itching be caused by the possibly grade. varicose veins in my thigh?

Mr Aaron Sweeney

Yes, is the answer to that. That's because you can see it in your thigh. But actually, all the back pressure goes down towards your foot. Most people with varicose veins get symptoms in the foot on the calf. They don't usually get them in the thigh; you can, but most times vein symptoms are nearly always calf and foot kind of.

Vicky 

Yvette again, Hi Yvette. Do you agree? Varicose veins running families seem to have in mine.

Mr Aaron Sweeney

Yeah, kind of. Yeah, this is one of those things you inherit because you really want money, but you end up with varicose veins. Yeah, sometimes, if one of your parents has them, you're going to be a bit more likely to get them. But quite often it's not. It's not one hundred percent. Often one of the family. One of the siblings has perfect legs, and the other has varicose veins. It's a bit of a look at the drawing.

Vicky 

Okay, and question from Emma. Silly question. No such thing. Does lying on a bad vein at night make it worse?

Mr Aaron Sweeney

It doesn't, usually. But if you've had a rough day and your vein is inflamed, and then you go to bed, and you naturally just lie there and put a bit of pressure on it. Yeah, it sometimes makes it a bit sore, but I wouldn't be going to bed with pillows between my legs on the off chance that it might cause a bit of pain. That's a bit of overkill.

Vicky 

Okay. question about varicose eczema. Can it be cured by having your veins done?

Mr Aaron Sweeney

Yes, is the answer once it is varicose eczema. There are a couple of things that look like varicose eczema, such as psoriasis, but it's usually pretty obvious that varicose eczema nearly always occurs around the ankle. It rarely occurs elsewhere, and you need to have a decent old varicose vein nearby to give you the eczema. If you have eczema and are very constrained, you can see and feel it. Fixing the vein nearly always sorts out the accent.

Vicky 

Lovely I'm going to make this our last question from Tracy. Tracy has a couple of thread veins on her ankles and tenderness on one side of the calf that feels like a slightly raised baby when she touches it. I don't get swelling and only get an ache. If sitting too long or her legs get cold. She can feel the heat in her calf sometimes. Not to the touch, but inside. It's a feeling of heat around the vein; a symptom about it?

Mr Aaron Sweeney

Yes, and you'd be amazed. Sometimes people come to me with just an itch. or just soreness around the ankle, and they cannot see any varicose vein, and then I do a scan, and they can have a few cm varicose vein that can be the size of your thumb. but because none of the side branches have gone. You don't see any varicose veins on the surface. very occasionally, and often happens in elderly people. They arrive with an ulcer and no other varicose veins, and then you scan them, and you go. There you go. That's you; that's the reason for the ulcer and then, if you ask them, I am what symptoms they had. They're usually pretty wishy-washy with a bit of itch. There's a few little thread veins, but one of the things they say is, yeah. My leg was always really hot during the summertime. I always felt there was something wrong. It was a bit crampy at the end of the night. They aren't kind of super symptoms, which would put up a red flag. They're often a combination of a few little things. I would say to people that you don't imagine leg symptoms. If you have an achy leg or sore leg, or it feels hot or feels itchy, that's not in your head something as close that if you have an obvious virus vein there, that's probably the cause. But sometimes you can have a vein that just sits under the surface, barely visible. Normally, it's pretty obvious to me when I see it, but of course you're not looking at legs morning, noon, and night, whereas I am and quite often. It's actually quite difficult to look at your legs properly because the bit you see is usually the bit down in the front, but you can't see the back of your leg very, very well.

Vicky 

Okay, lovely. Thank you everyone for your questions. Another few questions that we didn't quite get around to we recommend. The best thing to do is to make an appointment to see Mr Sweeney.

As a thank you for joining this session. We're going to be offering 50% off the value of your initial consultation. There's a voucher code to use there. A call back from your dedicated private patient advisor and an email to follow with the recording treatment information and your loyalty reward points and updates on news and future events.

We'd be grateful if you could complete the survey on this session to help us shape our future events. If you'd like to discuss varicose vein treatment further or book your consultation. Our private patient team can take your call until 8.30pm this evening, or between 8am and 6pm Monday to Friday, using the number on the screen. Our next webinar is on hip and knee surgery, which you can sign up for via our website.

On behalf of Mr Sweeney and our expert team here at Benenden Hospital. I'd like to say thank you very much for joining us today, and we hope to hear from you very soon. Thank you very much.