Vicky

Hey, good evening. Everyone. Welcome to our webinar on varicose veins. Treatment. My name is Vicky, and I'm hosting the session. I'm joined this evening by our presenter 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 either during or after the presentation, please do so using the Q&A icon, which is at the bottom of your screen. This can be done with or without giving you a name. Please note that this session is being recorded. If you do provide your name. If you'd like to book your consultation, we'll provide contact details at the end of this session.

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

Mr Aaron Sweeney

Hello, everyone. Thank you very much for joining us tonight.

My name is Aaron Sweeney, and I'm a vascular surgeon who specialises in varicose vein treatments.

We'll have a little overview of what we'll talk about and what we might just mention. Briefly, my experience is a little bit about what varicose veins are, the different types, a little chat about how consultations occur, and then all the treatment options. We also have a patient testimonial just to give you a little idea of what to expect. But the most important thing is that, at the end, we have a question-and-answer session. So, when we do these webinars, many people have questions, and it's often very interesting. Many people join us tonight with very specific questions, and I'm very happy to spend quite a long time answering them, so I'll try not to bore you too much with little bits and pieces.

So that's why I'm qualified. A while ago, I first saw laser vein treatment after it came here from New York, and that was in the late nineties, in 1999. It looked fabulous, and it's turned out to be quite good here. We perform about a thousand procedures a year, but I perform quite a lot more, and we perform the largest number of laser vein treatments in this hospital and say it's the largest provider. People seem pretty happy with it, and it's more or less the only operation I do here.

So, the first thing is that people are sometimes a bit confused about what varicose veins are.

So, if I tell you to think of your veins like a Christmas tree, you've got one main vein that runs up the centre of your leg; that's called your deep vein, and then there are hundreds of branches. Most of those branches are draining muscle, so there's a little bit of muscle surrounding the vein, and it gives a little squeeze so that everything goes up against gravity back up to your heart to be pumped again. The troublesome veins are the ones that drain your skin, and they look like little blue shoelaces running all over the surface. Again. There are hundreds and hundreds of those; each of them drains a very tiny amount, but maybe a teaspoon or so per minute, and because we have gone from walking all four to standing up straight, certain veins that used to be horizontal suddenly become vertical, and they have real difficulty draining uphill into the main deep vein.

They need a few little valves. Sometimes those valves stop working. There are only a few veins that cause most of this trouble. There are a few useless things. We have a gall bladder and appendix, and one particular vein that runs down the inside of our thigh. We could do without them, but they keep surgeons very busy.

When you have a varicose vein, it tends to swell a little bit. They're not always visible. So sometimes you can have America's vein running from your groyne all the way down to your ankle, which can be 50 or 60 cm, and because it's a centimetre or so under the surface, you don't necessarily see it, but you can get quite a lot of the symptoms, and it can fool you a little bit.

They're usually swollen and large. They usually feel a little bit bumpy. They often give people a bit of an ache or a heavy leg. The first sign of a varicose vein is swelling, then sometimes night cramps, and finally some itchy or dry skin when your skin is just not happy with blood pooling around your ankle.

So, we talked. There's different types of threats. But if you think of that Christmas tree analogy, you have the very tiniest ones, which are kind of like the little pines at the ends of the branches of a Christmas tree. They're generally treated with some sclerotherapy, which is an injection.

It is a little difficult at times. It often takes many treatments to treat those, and they can be quite bruising. So, although they are cosmetic, they do take a great deal of effort on both our parts to make them work.

There are slightly larger veins, which, again, are often just a little bit on the oh, little bit easy to feed on the surface, but generally not dangerous.

They rarely cause any trouble, and again, you probably classify those as cosmetic grade three because they are the more juicy veins, and these often appear in the inside of people's thighs or even on the calf. But that's just the surface. There's normally a vein that's much larger sitting just onto the surface that's feeding those veins.

Grade four is when veins start to cause a bit of trouble. So, you have those hundreds of little, small veins draining your skin, and then one decides not to work, and not only does it not work, but it starts pouring blood back down your leg, so it kind of overwhelms the other veins. They're working overtime, trying their best to get the blood uphill.

So initially, it starts with swelling. Then the skin becomes quite unhappy, so it starts to get itchy, and then finally, the skin gets really annoyed and starts to scar, and that sometimes appears as red or sore skin. Other times, it starts to get itchy.

But either way, it's a sign that things have moved on a little bit from just a little bit of swelling. So, grade four is when the skin starts to get a little bit sore or changes colour, and I think I'm going to show you a little bit more now. Yeah, that's why we'll move quickly if the skin is left inflamed. Eventually, you can end up with an ulcer. But I would say that that takes ages to happen. Many people who have an ulcer realise that, in retrospect, their skin was a little sore and a little itchy. They thought it was eczema. They weren't quite sure what was going on, and then finally mine. A little bit of trauma occurred, and then, next thing, there's an ulcer, which lasts for many, many months.

So, when you come and see me, I like to see you myself, and then I do a duplex ultrasound scan of your veins in the clinic. I think using an ultrasound is a bit like doctors using a stethoscope. It's always attached to my hand, and I think it's wonderful because it allows me to see everything inside your leg. And so, you don't have to guess. In the olden days, when people were stripping veins, they just guessed where they came from. That's the reason it was a pretty hit. And miss, as to whether you had a good operation or a bad operation, when you see me, I will tell you all the different options available to you. Not just EVLT. There are other things that we can do, and if you think you might want to have something done, we will send you an assessment right away. So that's really checking your blood pressure and double-checking that I haven't missed anything.

And then finally, we send you, are you head of home, and then, at some stage later, we give you a call just to see what you think. We deliberately try not to pressure you, so you can. I think it's much easier if you get a phone call a few days later. You can then say yes or no, or I'm going to think about things. So very, very few people ever book a date right away.

Most of the surgery is done on a day-to-day basis. It's a walk-in, walk-out procedure. It's a little bit like going to the dentist. I think it's about as stressful as that because you start to think I'm going to hurt you. And then, normally, within about two minutes of me starting to do anything to you, you relax a little bit, and I think most people tell me it's nothing close to a bad day at the dentist.

So, most treatments I do under local anaesthesia don't mean that they all have to be under local, and plenty of people say that I'd rather be asleep. That's fine. Almost everyone with varicose veins can have endovenous laser treatment or one of the minimally invasive techniques. I almost never strip veins. I cannot recall the last time I've done that; it might have been 20 odd years ago. So, most people have a little laser put in, and they walk in. If somebody is with them, the total time in the hospital is about an hour and a half. The total time for any varicose vein. Treatment is about 20 min, maybe 30 min. So, it's a relatively quick procedure that's pretty efficient. We don't have people hanging around all day.

So, this is just kind of an idea of what endovenous laser treatment is. So, the picture is a little bit confusing, maybe, but think of it as the inside of somebody's right leg. So, what you have is the main artery and vein running down the groyne right the way towards the knee, and the main troublesome vein runs from the groyne right the way to the knee, and what you see there is us threading up a little catheter up the inside. I call it a wire, so think of it as a wire being threaded up the inside of a vein. We always use an ultrasound to make sure we're in the correct spot, as you have to do with so many. It's a fairly straightforward procedure.

So sometimes people say, Well, when I look at the Internet, I can find loads of different treatments. So, I tell you, there are really three. One is stripping veins, which has long ago been found to be substandard, and then the two main treatments that are available are endothermal ablation and chemical ablation, which are nice words for heat and some chemicals being injected into your vein. The heat treatment is that you thread the laser up or wire up the inside of your vein and laser the inside lining of the vein, which is a fancy way of burning something. You try your best not to damage anything else, and when you do, you damage just the inside of the vein. Your body is amazing at working out that the vein suddenly is not working, and it dissolves it, and that dissolving process takes about six weeks or so, and you kind of know about it for the 1st week or 2, because it feels like you have exercised too much or pulled a muscle.

It's rarely completely pain-free, but it's usually pretty manageable. Most people walk the dog, for example. The next day, there are a few different types of treatment. So, this is the end of Venus laser treatment, as that's the end of Venus within a vein laser treatment. There's a treatment called radio frequency ablation, which is just as good, but that uses electricity as opposed to a laser, which is again a good treatment. The chemical techniques usually involve injecting something, and that's foam. Sclerotherapy is the most common thing. So, do any of you remember watching those old Mr Muscle ads where the phone goes around the U-bend in the kitchen sink?

I think people got a bit of an idea from that, because the foam sphere of therapy is just that you make a bit of foam up. You inject it into a vein. It kind of pushes all the blood out. Then you get the chemical sitting right up against the wall of the vein, giving it a chemical burn. There's another machine called claravane, which kind of combines the 2, and then some people have even injected super glue up the inside of veins. We don't do that here. And for the most part, we do everything alone, and that's because we think it's quite good. People seem pretty happy with this, and, more importantly, it is very safe. The home sphere of therapy often produces some marks in the leg and can be a bit lumpy afterwards, so although we do use that preferred first treatment, our first choice is a laser. So that's just kind of a pretty simple leg. So that's a left leg. If you look at the before picture, that's a few veins on the underside of the calf. That's the normal thing that people come to see us with, and if you remember what I said earlier, there's a vein running down the inside of the thigh. Usually, someone who's not working can't see it, but it's a branch of that vein that comes up on the surface. So, we pop a laser up if you don't bother removing any of the little veins, and if you do, you make little incisions called phlebectomies. But if you didn't do that, what happens normally is that the vein of the thigh disappears. That kind of turns off the tap and reduces the pressure in those veins in your calf, and then, a few weeks later, they're normally quite reduced, and then, about six weeks later, they look okay. If you look carefully, you sometimes see a few blue things. So that's kind of a reasonable outcome. And many people just want that because they want a pretty no-nonsense treatment with minimal complications and aren't particularly post about getting rid of every single vein.

So, I hope, just to summarise, that you think of them as a Christmas tree. Almost everyone is perfect. You'll just have one or two things that are just branches that are not working correctly. They're pretty. Standard is the one that comes from the top of your groyne, and another one that comes from the back of your knee. Sometimes people say, Oh, they must be important. If they're big, nope, they're big because they're not working. Others say, Well, if I have that done on the blood, find a different way to get up your leg.

The answer to that is, well, actually, it's already done that. And if you think about varicose veins, they're not only not doing their job; they're doing the complete opposite. So often, instead of draining a teaspoon a minute uphill, they're sending back down a cup full or more, and that's what overwhelms the other veins. So, when you get rid of the vein, in fact, all the other veins in your leg have a bit of a holiday because they only have to do their own job.

Sometimes people say, Well, if you have your veins done? Won't they always come back? No recurrence rates—pretty tiny. Following a laser treatment. It's about 1%, which sounds amazing. And if that's the case, you can massage those figures depending on how super honest you are. When you laser-cut a vein, it's very unlikely to return.

What people sometimes really want to know is, if I have a vain operation, how likely am I to be back? Well, about 1% of people come back within a year to 18 months as normally a small little vein nearby that's appeared, and that can be treated relatively easily and depending on your age. If you come to me as a 20-year-old with varicose veins, I think even if I do, Fab Job, you still have about a 10% chance of another vein appearing. That's usually on the other leg, and it depends on how you classify it. Many would say it's just a new vein; others would say it's a recurrent vein. But to you, what it means is that you can come back, or you might need to come back and have another thing done years down the line, which contrasts hugely with stripping, where 50% of people had a recurrence. That was because when you pull that vein out, your body tries to heal the trauma caused, and in that healing process, loads of new veins appear, and if any of those new veins reconnect with the deeper vein or the central tree trunk, then you get new veins. So that's why people were told years ago don't have any veins done before you have your family, because they just come back, and that's kind of slightly true. If you had a particularly brutal operation done and everything joined back, and then you got pregnant, all of a sudden you got loads more veins. So, there is some truth. But that is one of the nicest things about most of these minimally invasive treatments. They tend to have very low recurrence rates and very low complication rates. There's not. It's not 0, but it's pretty close to that, and most people walk in, walk out two weeks later, and have forgotten about their operation until they look down at their leg and see it's still bruised, and I think it takes about six to eight weeks for you to look down and see that your leg is actually sorted.

The next thing we're going to do is just give a little bit about some patient experience to stop me from talking for too long.

Jo Crossey 

My name is Joe Crossey. I'm 58 years old. It was making my legs more uncomfortable. As the years went on, I felt very heavy and tired, especially in the hot weather. It could swell, and I was 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, especially when it was a beautifully new hospital. 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 22nd of January, and I had my consultation with Ben on the 31st of January, so 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, also talked me through it. But obviously, when you're in consultation, there's a lot of information to take in. So, I came home and read the leaflet. I also looked online for him, and he gave 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'm 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. So, 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 five days and then take those off. I couldn't drive for five days, obviously because they said it was for insurance purposes if I had to stop quickly or if I was in an accident. Insurance might not be so 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, and wearing a support bandage if you need to, and I did that a few times because the weather was quite warm post-surgery. So, I made use of those devices and advice, and it certainly has.

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, so it certainly boosted my confidence in terms of that, and yes, getting back to running after having two grandchildren.

If anybody were thinking about having the varicose veins done, I would recommend Benenden Hospital. Their technology and the processes they use. It's just a laser. Treatment is the way forward in terms of not making you lie in bed, getting you up, and getting you mobile.

Certainly, Benenden Hospital is highly recommended, as far as I'm concerned.

Vicky

Okay, thank you very much, Mr Sweeney, for that very interesting presentation. We're now going to take some questions. It took quite a bit of time. So please ask your questions. I'm using the icon at the bottom of your screen.

So first up tonight is Julie, and Julie says, Many thanks for the session tonight. Is there a limit as to how many times you can have treatment, particularly sclerotherapy?

Mr Aaron Sweeney

I would say. Sclerotherapy is usually a cosmetic treatment for smaller thread veins, and I would say that it always takes multiple treatments to get rid of thread veins. So sometimes people come to me, and they think maybe it'll just be one session. That's very unusual. So, I always caution people about thread, vein treatment, or cosmetic thread. Vein treatment is often a pretty long process that takes multiple separate treatment sessions. What you might say, though, is that if I came back two or three years later for an exam, could I keep on having that done? Yes, you can. With regards to varicose veins? Well, it depends. Usually, when the operation is done correctly the first time, you're rarely back. But if you come back, I will scan you to make sure that the big vein and the deep vein are normal. Once that's normal, you can get rid of all the other veins. It's very rare for people, though, to have more than two or three separate operations on varicose veins on one leg that used to happen. It doesn't really happen that much anymore. So, the sclerotherapy. Yeah, you can have multiple sessions. And I caution you: you often need multiple sessions, so it can be quite. I tell people it's a bit like watching paint dry and having thread veins treated. It takes multiple treatments, and there is a cost implication because of that.

Vicky

Thank you, Julie. I hope that's helpful. Next up is from Stephen. Stephen asks, Would you treat both legs on the same day?

Mr Aaron Sweeney

Not usually, actually. And there's a reason for that in terms of complications from varicose vein surgery? There aren't that many. There's only one thing that I ever get concerned about, and that's a thing called deep vein thrombosis, which can occur after any procedure. It can certainly occur after a dose of COVID. And, for example, your risk of getting a DBT. Which is a clot in the big vein in your leg. It's about one per 100 pregnancies, or if you break your leg skiing, it's one in 10. People get a DVT with varicose vein surgery. It's pretty rare, but it's not 0. So, I quote you a risk of around one in 1,000, but that is extremely low when we do one leg at a time, and I think that's to do with mobility. After the procedure, some people choose to have both sides done. I just tell them there's a slightly higher DVT risk. Secondly, if I do it under local anaesthesia, there's a limit on how much local anaesthesia I can give you in one day, and while I can do one leg with these sometimes, if your legs are a little bit complicated, I advise you not to have both on the same day because I probably won't have enough local anaesthesia to do it. If you have a general anaesthetic, yeah, you can have both sides done. But 95 or more people choose a local anaesthetic. So, to answer your question, you can have both sides done on the same day, but nearly always I do it. One leg at a time.

Vicky

Thank you, Steven. I hope that's answered your question.

And next up, we've got an anonymous attendee, and they've asked. I'm due to go on holiday in seven weeks, and we'd like to get my veins done beforehand. Would it be possible to recover in time and have my legs on display?

Mr Aaron Sweeney

It depends, so. But that's what they have to answer. Nearly always, I tell people that they can go away whenever they like. Plenty of people fly in and see me, then fly out back to where they came from the next day. There's no particular risk associated with flying, and D-v-t's. So, from a medical point of view, you could have some done and go on holiday. I suggest that a few days later, the slight problem you have is that your leg will be bruised and a bit sore. I did actually work out that it's a mile of walking from Gatwick Car Park to the terminal. So that's a bit tough with the bandage on your leg. I think if you wait until the bandage is gone, you probably get a week or two. Your leg looks quite bruised, so most people don't go for a swim in a local pool for the first two weeks because they're a little embarrassed by the bruising.

That's usually gone in about three weeks, so I think you could pass your leg off as a normal leg. three weeks after having something done again. I'd caution you about going on holidays because you'd be a little sore. You get a bit worried that you've ruined everyone else's holiday and that you're going to be hopping, I would say. three weeks is the quickest. I'd go on a proper half-family holiday. I have to have my veins done.

I think when you get to six weeks, you can nearly always pass it off as a normal leg, and you don't have to explain to everyone what you've done a few weeks before. So, I think six weeks. Most people wouldn't know you've had anything done for people who are getting married. I normally tell them at least 12 weeks, because I know it's six weeks. Everything will be fine, and then you don't have any panicking, and you have six weeks beforehand where nobody worries. Yes, the answer to your question is, yes, you could have it done however you like. It just depends on whether you want to spend your holiday telling people that you've had your veins done. That would be the first three weeks. I think if you wait a little longer than that, you'd probably be fine, but in terms of bruising and marks, I think it takes quite a few weeks, as in about 6, before you could pass that leg off as a normal leg, and nobody would give you a second glance.

Vicky

Okay, how does the heat affect it?

Mr Aaron Sweeney

I think it's fine, and people worry often about DVTs on airplanes. If I tell you your risk of a DVT on the plane is one per one million flights, it is a lot less than you think, and I, for example, don't wear flight socks. The reason is that I think fully fitting flight socks are far more troublesome than if you didn't wear them at all, and if I were going to America, I might wear flight socks just to stop my ankles swelling, because everyone's ankles swell when you sit in the plane for a long time, but they're not compulsory, and I think the risk to you of a DVT on a plane is really, very small.

Vicky

Okay, lovely. I hope that's answered your question. And enjoy your holidays wherever you're going.

Next is from Marion, and Marion asks, Do you have to be referred by a GP?

Mr Aaron Sweeney

No, I kind of feel that if you manage to get to see your GP, that's great, but often times people are quite frustrated. I have absolutely no problem with people just turning up without ever seeing a GP. I think most people are able to diagnose varicose vein just by looking at their own legs. And I don't think they need a formal referral for that. Some of your insurance companies, if you're insured, would like you to have at least discussed with them an online GP consultation. But to be honest, I think many NHS GPs are working a bit hard at the moment, and sometimes they put veins as a very low priority.

Varicose veins are a very low priority in the NHS. I think that's normal for people who've never had varicose vein problems. Think of them as purely cosmetic. I would say to you that almost everyone I operate on has a problem with varicose veins. In the normal course of events, people have them for maybe 10 years, and it's usually people who have other things to deal with—life, family, whatever. They don't want to take time off to fix their own legs. But it's often about 10 years, and then something happens like eczema or pain, a bit of phlebitis, or something troublesome. That's the usual reason why people pop along. I don't think you need a GP referral to tell you that your veins are giving you a lot of grief. It's usually pretty obvious. And I'm happy with that.

Vicky

Okay, that's helpful, Marion.

I think we've covered this already, but it might be worth asking again. I'm from Pfizer. Would you recommend waiting after having a family or having it done before?

Mr Aaron Sweeney

I'd had it done before. The reason is, you might ask yourself, Why do veins give you ladies in particular a load of grief?

The answer is that you, unfortunately or fortunately, have a hormone called progesterone. Progesterone gets really high just before you. A baby is delivered. Progesterone. Among other things, it dilates things to allow the baby to pop out. It also dilates your veins.

That's why, if you have varicose veins, your last trimester tends to be a bit miserable because you've got a very high level of progesterone. Everything's dilated, and your legs are just full of veins. Once the baby comes, the progesterone level drops, and your veins can reduce dramatically, or sometimes stay the same, to answer your question. If you have varicose veins and you're thinking of having a family, I will have to treat them first, because then you don't have all this trouble with big, dilated veins. So, I don't want to repeat myself. But previously, when people had their veins stripped, sometimes the pregnancy then induced loads of new veins, which was a definite problem. But I think that's kind of 20 years out of date nowadays. I would tell people to just get rid of their veins. There's absolutely no reason to wait 10 years, have three kids, and go through three miserable pregnancies when you could have been sorted relatively easily before.

Vicky

Okay, thank you, Faisa. I hope that's helpful for you.

Next up, another anonymous question. Thank you so much for this seminar. Thank you for attending. I had scar therapy done last year, which was very successful. Two weeks ago, I had breast cosmetic surgery under general anaesthesia. I've noticed that my vein, which is being treated, has come back. Any explanation for this?

Mr Aaron Sweeney

Well, it depends. So, I would say if you depend on what you haven't sclerotherapy before, if it's for large veins and it comes back well, it hasn't fully included the vein. If it's for thread veins, just to say sclerotherapy for thread veins, you do get rid of the veins that you actually treat. However, if you are prone to the threat of veins that always recur, you will always require multiple treatments. But I'm not 100% sure what your vein was like beforehand. If it were a large vein treated with, for example, bone, that would have a slightly higher recurrence rate than lasering and doing small phlebectomies, but I can't think of it. There is an obvious reason why it should pop back after another operation, but I am not sure of that.

Vicky

Thank you. Next question. I'm 77 years old, and I'm finding more and more veins occurring in the groin. My left leg has the most obvious vein shining through the calf. Would your surgery help?

Mr Aaron Sweeney

Again, maybe it depends. If you've had an operation before, you might require some additional procedures. So, it's difficult to tell you. But when veins appear in the groin and you've never had an operation before, quite often, you've got another underlying vein just sitting underneath. That's the source of everything.

Vicky

Thank you. Yeah. Next question. I do a lot of exercise, running, spinning, and 90-minute walks. If I have EVLT, how long can you get back to these activities?

Mr Aaron Sweeney

Not the next day you will go to a spinning class, perhaps two weeks after you have it done. You won't be as good as you were beforehand. If you run on Tarmac, I think it takes about three weeks to feel happy enough to go out for a proper run.

So, people who do lots of cycling tell me that at two weeks they felt happy enough to go out, but they certainly weren't at full speed. I think it takes three or four weeks following a procedure for you to be back. To full speed.

Vicky

Okay, lovely. I hope that's helped.

The next question is from John. I had a blood clot in the superficial veins in the right leg. Last year, after a long flight, it cleared up. But does that present any issues with the treatment?

Mr Aaron Sweeney

No, not really. You might ask, Why would that happen? And if you have a varicose vein and you sit in a car or on an aeroplane, you kind of crease your leg in two places, and that tends to fill your veins up. So, it's interesting. Varicose veins tend to reduce a little bit when you're walking and get a type of syphon effect. But the two things that get them going are sitting, for example, in a car, or, interestingly, cycling, because you're at a slight angle, and that slight angle preferentially shoves some blood up into the surface. So, your veins, if you think of them as tiny little things the size of a shoelace, should really only be the size of a thread. So, if they're big, they've been stretched, rather like a balloon stretching. They're not going to go pop, but they do. Eventually, the wall starts to get damaged, and that produces a clot. So that's superficial thrombosis. It's up on the surface. Thrombosis is a clot, and phlebitis is inflammation of the vein. So that's one of the indications to have your veins done quite often. That's the thing that precipitates someone coming to see me to sort out the rest of their veins.

Vicky 

Okay, I hope that was helpful for you, John.

Next up is Patricia, and Patricia asks, I have a toe wound that is getting slowly better. Is it still possible to have the other leg treated while it's still healing?

Mr Aaron Sweeney

Yes, that is the answer. The thing that I would always look for is to make sure that you're mobile. I don't want to give you two limbs that are giving you grief.

So, if you walk in and you're pretty mobile, I'm happy to do the other side, and the mobility thing is to make sure that you don't get a DVT. So, if someone, for example, had a fractured ankle, had a big operation, and was in a cast,.

I wouldn't dream of doing an operation on the left leg unless it was absolutely necessary. So, it's all to do with being mobile and walking in and out, and that gets you back to normal quite quickly. So small a wound on the toe. If you had your ingrown toenail done or something, Minor. That's no problem at all, typically.

Vicky

And we've got one more question. They say thank you for your session. You're very welcome. I've had surgery on both legs in 1,986, again in 1997, on one leg, and again in 98 in the other leg. I'm 72 now, and my legs are a dreadful mess with lumpy veins, and my feet are awful behind me. Do you think I'm a lost cause? Or is there any help to improve them?

Mr Aaron Sweeney

Yeah, you'd be surprised sometimes if your first operation weren’t particularly good, or they didn't get all the veins. What often happens is that you get recurrence, and then more and more recurrences, and sometimes especially before the use of ultrasound was routine. You kind of guessed what veins have occurred. So, people have often had three or four useless operations, and then when they come, I scan them, and I show you, when I scan you, that quite often they still have a vein that's sitting there. It may have been tied off the groin, but it wasn't removed correctly, and sometimes you can do a remarkable amount with a laser on patients like that.

I would say that if you have loads of small veins in your legs, what normally happens is that I can reduce them, but I really get rid of everything completely. So, what I like is when people come to me with first-time veins, because I know they're fairly straightforward to sort when they come as recurrent veins, or especially if you've had multiple previous operations.

I'm usually very clear with you when I scan you about whether I can fix you or not. Most times, I can. It's very rare for me to say no, and I just try to give you a reasonable expectation of what to expect. So occasionally people come to me and say I just can't wear sandals. I've had multiple operations. My feet are a mess of little veins, and for those people, I quite often say I can get rid of most things and make your legs feel good. I can stop the eczema, etc. But I cannot get rid of all the smaller veins to such an extent that you'd be happy wearing flip-flops. So, I think it's very important that I, when I see you, give you a reasonable idea of what to expect, and I certainly don't over-advertise that because I don't want anyone to be unhappy afterwards. So, I do manage your expectations, and I'm very clear with you on that, so if I thought that wasn't going to work and there was no danger to you, I might say there's not much point in trying to do that. If your whole thing is that you want to wear sandals,.

I hope that's kind of clear.

Vicky

Lovely sounds good. Late entrant question here. Is there a need to wear compression on the leg after the operation?

Mr Aaron Sweeney

Not really so. I put a compression bandage on you, which is like soft velcro, and that's because nobody wears compression stockings if they can avoid them.

That's usually the thing you're given. First of all, when you go and see somebody tell you to wear compression stockings, I think it's ridiculous. Nobody ever wears them, and after operations in warm climates, absolutely nobody wears them. So, I think there's a kind of reflex that everyone should wear compression stockings. I just think that's just a UK thing. I don't think they work very well. They rarely fit. So, I put a bandage myself on, which says, like salt, Velcro, and that's on for a few days. It varies from three days to maybe five or six days. and you take that off yourself. And essentially, you leave everything open to the air. And I think stockings are just a source of misery for most people with very little benefit, Jim, so they don't really prevent DVTs, prevent DVTs or clots in the leg, or get you back to normal quickly by moving.

So, anything that stops you from getting up and about, like a badly fitting compression stocking, is not particularly useful.

Vicky

Okay, so I think that's a no for compression stockings. Thank you very much.

So, thank you. Everyone, thank you for your questions.

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Mr Aaron Sweeney

Thanks.