Publications by authors named "Mark Whiteley"

62 Publications

Quantification of groin neovascular tissue with three-dimensional ultrasound before and after endovenous laser ablation using the hedgehog technique.

J Vasc Surg Venous Lymphat Disord 2021 May;9(3):785-786

The Whiteley Clinic, Guildford, Surrey, United Kingdom; Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, Surrey, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.jvsv.2020.10.015DOI Listing
May 2021

Clinical dilemma of management: Cardiac arrest after microsclerotherapy for lower limb telangiectasia with liquid 0.3% aethoxysklerol or idiopathic cardiac arrest?

SAGE Open Med Case Rep 2021 9;9:2050313X211000866. Epub 2021 Mar 9.

The Whiteley Clinic, Guildford, UK.

A 48-year-old woman attended to discuss a dilemma. She had suffered a cardiac arrest immediately following microsclerotherapy of leg telangiectasia with 0.3% aethoxysklerol. She had successful defibrillation and been transferred to hospital. In hospital, despite normal cardiac tests, she was diagnosed as having idiopathic cardiac arrest. The exposure to aethoxysklerol was discounted by her cardiologists as a cause of her arrest. Following the hospital protocol, she was strongly advised to have an implantable defibrillator. Cardiac arrest and myocardial infarction are documented after aethoxysklerol injection with proposed mechanisms being anaphylaxis, direct cardiotoxicity or endothelin-1 release. Before consenting to an implantable defibrillator, which may have its own complications in the long term, doctors and the patient need to be certain that this arrest was not due to a reaction to aethoxysklerol.
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http://dx.doi.org/10.1177/2050313X211000866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958149PMC
March 2021

A Double-Ligation Technique to Remove Prominent Frontal Branches of the Superficial Temporal Artery.

Authors:
Mark S Whiteley

Dermatol Surg 2021 Mar 9. Epub 2021 Mar 9.

The Whiteley Clinic, Stirling House, Guildford, Surrey, United Kingdom.

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http://dx.doi.org/10.1097/DSS.0000000000002971DOI Listing
March 2021

Retrograde endovenous laser ablation of the great saphenous vein using the superficial inferior epigastric vein as access vessel illustrated by a case report.

SAGE Open Med Case Rep 2021 12;9:2050313X21994993. Epub 2021 Feb 12.

The Whiteley Clinic, Guildford, Surrey, UK.

Endovenous thermal ablation is a first-line treatment for symptomatic varicose veins due to truncal vein reflux. Ablation of an incompetent great saphenous vein is usually performed from distally, with the vein access at the lowest point of reflux, or just below the knee. Occasionally there are patients in whom the great saphenous vein is difficult to access distally for reasons such as small vein diameter, scar tissue, vasospasm, difficult anatomy or multiple attempts with haematoma formation. In such cases, we access the great saphenous vein in a retrograde fashion by percutaneous cannulation of the superficial inferior epigastric vein, passing the catheter into the great saphenous vein just distal to the saphenofemoral junction and then down the vein to the required distal position. Ablation can then be performed, stopping the ablation in the great saphenous vein just distal to the junction of superficial inferior epigastric vein and great saphenous vein. We present a patient to illustrate our technique.
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http://dx.doi.org/10.1177/2050313X21994993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887672PMC
February 2021

Pattern of thermal damage and tissue carbonisation from endovenous radiofrequency ablation catheter - Using an in vitro porcine liver model.

Phlebology 2020 Dec 13:268355520975539. Epub 2020 Dec 13.

The Whiteley Clinic, Guildford, UK.

Background: Successful endovenous thermoablation relies on transmural vein wall ablation. We investigated the pattern of thermal spread and tissue carbonisation from RadioFrequency-induced ThermoTherapy (RFiTT) at different powers and pull back methods, using a porcine liver model.

Methods: We used a previously validated porcine liver model. Different powers from 5-25 W were used to administer 150 J. We compared continuous and pulsed energy delivery. Length, lateral spread, and total area of thermal damage, together with any tissue carbonisation, was measured using digital analysis software.

Results: All experiments used 150 J total energy. Total thermal damage area was smaller with lower power and pulsed energy. Continuous energy caused more tissue carbonisation than pulsed except at 25 W.

Conclusion: Reduced thermal damage with lower power or pulsed energy results from cooling due to increased time of treatment. Increasing the power increases tissue carbonisation. Optimal treatment is determined by the highest power used continuously that does not cause tissue carbonisation.
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http://dx.doi.org/10.1177/0268355520975539DOI Listing
December 2020

Comparison of laser power output from the fiber tip during endovenous laser ablation against displayed power and the "first treatment" effect.

J Vasc Surg Venous Lymphat Disord 2020 Dec 2. Epub 2020 Dec 2.

The Whiteley Clinic, Stirling House, Guildford, UK; Faculty of Health and Biomedical Sciences, University of Surrey, Surrey, UK. Electronic address:

Objective: International guidelines recommend endovenous laser ablation as one of the first-line treatments for truncal venous reflux associated with varicose veins. Clinicians use linear endovenous energy density to measure the energy used during treatment. The aim of this study was to investigate the power output from the fiber tip and to see if this changed with use.

Methods: We placed 15 mL of water in a thermally insulated 25-mL beaker. Two thermocouples were placed equidistantly adjacent to the laser fiber tip. A 1470-nm laser was fired at 5W for 2 minutes and the temperature change was measured. Three fibers were used on different days to allow the laser to cool for 24 hours between fibers. Each fiber was tested three times in a row. We also tested the "first treatment" effect by comparing the power output when the fiber was fired immediately after the laser was switched on, compared with treatments when the laser had been switched on for 1 hour. To assess whether this was due to the console being "cold" on the first firing of the day, we repeated the experiment having switched on the laser console 1 hour before firing to "prewarm" the console. However, the diode was not fired during this hour. To measure fiber degradation, three runs of the experiment were performed successively before firing the laser continuously for 20 minutes, then three more runs were conducted, resulting in delivery of approximately 10,000 J.

Results: The actual power output seemed to be lower than the console suggested. The power output from the first fiber used in a succession of three with the same laser had a significantly lower power output than the following two runs (P = .0004 and P < .0001, respectively). When the laser was prewarmed for 1 hour without firing, no change in this output pattern was noted (P = .293). Fiber degradation was not found in any of the fibers that were tested within the maximum recommended for the fiber (10,000 J).

Conclusions: The first use of a fiber in a treatment session has a significantly lower power output from the treatment tip than subsequent uses, even if the machine is prewarmed and the console displays the same power for each. The authors believe that this phenomenon is due to the diode being less efficient when first used after switching it on. Clinicians need to be aware that the true power output at the fiber tip may not be as indicated by the console display and may be variable during a treatment session.
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http://dx.doi.org/10.1016/j.jvsv.2020.10.018DOI Listing
December 2020

Is It Time to Dip More than a Toe in the Water?

Authors:
Mark S Whiteley

EJVES Vasc Forum 2020 27;47. Epub 2020 Feb 27.

The Whiteley Clinic, Guildford, London and Bristol, UK.

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http://dx.doi.org/10.1016/j.ejvsvf.2020.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287396PMC
February 2020

Endovenous Thermal Ablation of Prominent Central Forehead Veins (Supratrochlear Veins).

Dermatol Surg 2020 Oct 2. Epub 2020 Oct 2.

The Whiteley Clinic, Guildford, United Kingdom.

Background: Many patients complain of prominent vertical veins in the center of their forehead, worse when smiling, wrinkling the forehead in bright light, leaning forward, and when vasodilated in heat, when exercising, or with alcohol. Previous attempts to treat these with external laser, sclerotherapy, and phlebectomy have not been successful.

Objective: To describe a new method of treating prominent vertical forehead veins and to report the early results.

Materials And Methods: We used endovenous laser ablation with a 1470 nm diode laser in 15 patients (F:M 12:3; mean age 38.4 years range 24-69). A bare fiber was used once and a 400-μm single ring radial fiber (Biolitec, Vienna, Austria) in all other cases. Tumescence was placed around the vein and a power of 2 to 3 W with a pullback of 7 to 10 seconds per centimeter.

Results: Twelve of the 15 patients (80%) ended up with a good cosmetic result and were satisfied, although 2 needed redo treatment. One patient had minor skin tethering, and 2 (13%) suffered burns-one was the only bare fiber case and the other, the only one where 4 W was used.

Conclusion: We present a novel technique to treat prominent vertical forehead veins, with apparently good early results.
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http://dx.doi.org/10.1097/DSS.0000000000002778DOI Listing
October 2020

Three-year follow-up results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins.

J Vasc Surg Venous Lymphat Disord 2021 03 26;9(2):329-334. Epub 2020 Jun 26.

Imperial College, London, UK.

Objective: Cyanoacrylate closure of refluxing saphenous veins has demonstrated excellent safety and effectiveness results in feasibility and pivotal studies. This article provides the 36-month follow-up results of a prospective, multicenter, nonrandomized cohort study.

Methods: A total of 70 patients were enrolled in a prospective, multicenter study conducted at seven centers in four European countries and underwent treatment of a solitary refluxing great saphenous vein with endovenous cyanoacrylate embolization without the use of tumescent anesthesia or postprocedure compression stockings. The primary effectiveness end point was freedom from recanalization (closure rate) of the great saphenous vein at 6 months. Safety was assessed by occurrence of adverse events after the procedure and during the 6-month follow-up period. Quality of life and clinical improvement parameters were measured before and after the procedure and through a 12-month follow-up period. Anatomic success and clinical improvement were assessed through 36 months after the procedure.

Results: Of 70 treated patients, 64 (91%) were available for the 3-year follow-up. The closure rates by Kaplan-Meier life table methods at 6-, 12-, 24-, and 36-month time points were 91.4%, 90.0%, 88.5%, and 88.5%, respectively. Through 36 months, the improvement in change of the mean venous clinical severity score over time was statistically significant by dropping from 4.3 at baseline to 0.9 at the 36-month follow-up (P < .001).

Conclusions: The 3-year follow-up results of the prospective, multicenter eSCOPE study demonstrated the continued anatomic and clinical effectiveness of cyanoacrylate embolization over an extended follow-up period.
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http://dx.doi.org/10.1016/j.jvsv.2020.05.019DOI Listing
March 2021

Do we need another modality for truncal vein ablation?

Authors:
Mark S Whiteley

Phlebology 2020 Oct 15;35(9):736-737. Epub 2020 Jun 15.

The Whiteley Clinic, Guildford, Surrey, UK.

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http://dx.doi.org/10.1177/0268355520932785DOI Listing
October 2020

High intensity focused ultrasound (HIFU) for the treatment of varicose veins and venous leg ulcers - a new non-invasive procedure and a potentially disruptive technology.

Authors:
Mark S Whiteley

Curr Med Res Opin 2020 03 6;36(3):509-512. Epub 2019 Dec 6.

The Whiteley Clinic, Stirling House, Guildford, Surrey Faculty of Health and Biomedical Sciences, University of Surrey, Guildford, Surrey.

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http://dx.doi.org/10.1080/03007995.2019.1699518DOI Listing
March 2020

Is Size Important? The French Experience.

Authors:
Mark S Whiteley

Eur J Vasc Endovasc Surg 2019 07;58(1):104

The Whiteley Clinic, Guildford, UK. Electronic address:

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http://dx.doi.org/10.1016/j.ejvs.2019.04.032DOI Listing
July 2019

Having a voice and raising the profile of lower limb healthcare!

Br J Community Nurs 2019 Mar;24(Sup3):S39-S40

Consultant Venous Surgeon and Consultant Phlebologist, Executive Chairman of The Whiteley Clinic, Visiting Professor University of Surrey, Founder of The College of Phlebology.

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http://dx.doi.org/10.12968/bjcn.2019.24.Sup3.S39DOI Listing
March 2019

Histopathologic differences in the endovenous laser ablation between jacketed and radial fibers, in an ex vivo dominant extrafascial tributary of the great saphenous vein in an in vitro model, using histology and immunohistochemistry.

J Vasc Surg Venous Lymphat Disord 2019 03;7(2):234-245

Research Department, The Whiteley Clinic, Guildford, Surrey, United Kingdom; Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom. Electronic address:

Objective: The study aimed to investigate the biologic effects of the 1470-nm endovenous laser (EVL), with a jacketed fiber and a radial fiber, during EVL ablation of an ex vivo dominant extrafascial tributary of the great saphenous vein in our in vitro model by histology and immunohistochemistry.

Methods: Ten segments of the dominant extrafascial tributary of the great saphenous vein were harvested by a consultant vascular surgeon from patients during routine varicose vein surgery. Six segments were treated using an ex vivo model of our design by a 1470-nm EVL with a jacketed fiber. The other four segments were also treated by a 1470-nm EVL but with a radial-firing fiber. Each segment was split into five sections and treated at five different linear endovenous energy densities (LEEDs) at 10 W: 0, 20, 40, 60, and 80 J/cm. The veins were incubated and subsections collected at 6 and 24 hours after treatment. Subsections were immersed in buffered formalin and taken for histologic and immunohistochemical analysis. Histopathologic analysis was then performed.

Results: Treatment with the radial fiber led to a pattern of damage that was more homogeneous than with the jacketed fiber, with no carbonization of tissue present. Significant transmural damage and necrosis were observed at LEEDs of 60 and 80 J/cm in both treatment groups. At the same LEEDs, p53 and caspase 3 analysis showed that transmural cell wall vein death (necrosis or apoptosis) occurred by 6 hours after treatment with both fibers.

Conclusions: There was a significant difference in the effects of treatment with a jacketed fiber and a radial fiber in EVL ablation in vitro. Although both fibers caused transmural vein wall cell death at similar LEEDs, the pattern of damage with the radial fiber was more homogeneous. There was no overtreatment of tissue in terms of carbonization after treatment with the radial fiber. Treatment with the jacketed fiber showed carbonization of tissue at the same LEEDs.
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http://dx.doi.org/10.1016/j.jvsv.2018.09.017DOI Listing
March 2019

Addressing social isolation in lower-limb management.

Br J Community Nurs 2018 Dec;23(Sup12):S38-S39

Consultant Venous Surgeon, Consultant Phlebologist, Whiteley Clinics, London.

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http://dx.doi.org/10.12968/bjcn.2018.23.Sup12.S38DOI Listing
December 2018

Response to "Commentary on pelvic venous reflux in males with varicose veins and recurrent varicose veins".

Phlebology 2019 02 4;34(1):70-71. Epub 2018 Nov 4.

1 The Whiteley Clinic, Guildford, Surrey, UK.

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http://dx.doi.org/10.1177/0268355518811033DOI Listing
February 2019

Symptomatic recurrent varicose veins due to primary avalvular varicose anomalies (PAVA): A previously unreported cause of recurrence.

SAGE Open Med Case Rep 2018 17;6:2050313X18777166. Epub 2018 May 17.

The Whiteley Clinic, Guildford, UK.

A 56-year-old woman presented in 2006 with symptomatic primary varicose veins in her right leg. Venous duplex ultrasonography at that time showed what appeared to be "neovascular tissue" around the saphenofemoral junction. However, there had been no previous trauma or surgery in this area. This appearance has subsequently been described as primary avalvular varicose anomalies. She underwent endovenous treatment at that time. In 2018, she presented with symptomatic recurrent varicose veins of the same leg. Venous duplex ultrasonography showed successful ablation of the great saphenous and anterior accessory saphenous veins. All of the recurrent venous reflux was arising from the primary avalvular varicose anomalies. This report shows that primary avalvular varicose anomalies is a previously unreported cause of recurrent varicose veins and leads us to suggest that if found, treatment of the primary avalvular varicose anomalies should be considered at the primary procedure.
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http://dx.doi.org/10.1177/2050313X18777166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960849PMC
May 2018

Response to "Pelvic venous reflux in male: Varicocele?"

Phlebology 2018 07 9;33(6):432-433. Epub 2018 Jan 9.

1 The Whiteley Clinic, Stirling House, Surrey, UK.

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http://dx.doi.org/10.1177/0268355517752169DOI Listing
July 2018

Varicose vein appearance caused by perforating vein incompetence detected after intense cycling.

SAGE Open Med Case Rep 2017 11;5:2050313X17747490. Epub 2017 Dec 11.

The Whiteley Clinic, Guildford, UK.

The role of incompetent perforating veins in the aetiology of varicose veins is not well understood. Anecdotally, competitive cyclists appeared to be more prone to varicose veins than the general population. We present a case of a 63-year-old amateur competitive cyclist who acutely developed a painful varicosity of her left calf while straining during a hill climb in 106-mile cycle race. Duplex ultrasonography has shown an underlying incompetent perforating vein, feeding the varicosity directly through the underlying muscle. With no other significant venous reflux in either leg, we believe this case shows a clear causative association between the stresses put across the lower leg during competitive cycling and developing a varicose vein via an incompetent perforating vein. We believe this should lead to further investigations as to any link between cycling, perforator vein incompetence and the development of varicose veins.
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http://dx.doi.org/10.1177/2050313X17747490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734563PMC
December 2017

Diagnosis of stenosis within the popliteal-femoral venous segment upon clinical presentation with a venous ulcer and subsequent successful treatment with venoplasty.

SAGE Open Med Case Rep 2017 3;5:2050313X17740512. Epub 2017 Nov 3.

The Whiteley Clinic, Surrey, UK.

This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right leg, duplex ultrasonography showed proximal incompetence of the small saphenous vein, and dilation of the anterior accessory saphenous vein, which remained competent. Incidentally, two venous collaterals connected onto the distal region of both these segments, emerging from a scarred, atrophic popliteal-femoral segment. An interventional radiologist performed venoplasty to this popliteal-femoral venous segment. Intervention was successful and 10 weeks post procedure ulceration healed. Popliteal-femoral venous stenosis may be associated with venous ulceration in some cases and may be successfully treated with balloon venoplasty intervention.
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http://dx.doi.org/10.1177/2050313X17740512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672999PMC
November 2017

Anatomical abnormalities of the pelvic venous system and their implications for endovascular management of pelvic venous reflux.

Phlebology 2018 Sep 23;33(8):567-574. Epub 2017 Oct 23.

1 The Whiteley Clinic, Guildford, UK.

Background Pelvic venous reflux is often treated with pelvic vein embolisation; however, atypical pelvic venous anatomy may provide therapeutic challenges. Methods We retrospectively reviewed seven patient files and reported symptoms, diagnostic imaging, aberrant anatomy and means by which the interventional radiologist successfully completed the procedure. Any follow-up data were included if available. Results Four anatomical abnormalities were found: internal iliac veins draining into the contralateral common iliac vein, duplicated inferior vena cava, reverse-angle renal veins with atypical left ovarian vein drainage and direct drainage of the internal iliac vein to the inferior vena cava. All patients were successfully treated with pelvic vein embolisation. Conclusion Abnormal embryologic development may cause variable pelvic venous anatomy. Knowledge of this will enable interventional radiologists to successfully treat such patients.
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http://dx.doi.org/10.1177/0268355517735727DOI Listing
September 2018

Pelvic vein embolisation of gonadal and internal iliac veins can be performed safely and with good technical results in an ambulatory vein clinic, under local anaesthetic alone - Results from two years' experience.

Phlebology 2018 Sep 9;33(8):575-579. Epub 2017 Oct 9.

1 The Whiteley Clinic, Guildford, UK.

Objectives Pelvic vein embolisation is increasing in venous practice for the treatment of conditions associated with pelvic venous reflux. In July 2014, we introduced a local anaesthetic "walk-in walk-out" pelvic vein embolisation service situated in a vein clinic, remote from a hospital. Methods Prospective audit of all patients undergoing pelvic vein embolisation for pelvic venous reflux. All patients had serum urea and electrolytes tested before procedure. Embolisation coils used were interlock embolisation coils (Boston Scientific, USA) as they can be repositioned after deployment and before release. We noted (1) complications during or post-procedure (2) successful abolition of pelvic venous reflux on transvaginal duplex scanning (3) number of veins (territories) treated and number of coils used. Results In 24 months, 121 patients underwent pelvic vein embolisation. Three males were excluded as transvaginal duplex scanning was impossible and six females excluded due to lack of complete data. None of these nine had any complications. Of 112 females analysed, mean age 45 years (24-71), 104 were for leg varices, 48 vulval varices and 20 for pelvic congestion syndrome (some had more than one indication). There were no deaths or serious complications to 30 days. Two procedures were abandoned, one completed subsequently and one was technically successful on review. One more had transient bradycardia and one had a coil removed by snare during the procedure. The mean number of venous territories treated was 2.9 and a mean of 3.3 coils was used per territory. Conclusion Pelvic vein embolisation under local anaesthetic is safe and technically effective in a remote out-patient facility outside of a hospital.
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http://dx.doi.org/10.1177/0268355517734952DOI Listing
September 2018

A description of the 'smile sign' and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins.

Phlebology 2018 Sep 28;33(8):534-539. Epub 2017 Sep 28.

1 The Whiteley Clinic, Guildford, Surrey, UK.

Aims To report on great saphenous vein diameter distribution of patients undergoing endovenous laser ablation for lower limb varicose veins and the ablation technique for large diameter veins. Methods We collected retrospective data of 1929 (943 left leg and 986 right leg) clinically incompetent great saphenous vein diameters treated with endovenous laser ablation over five years and six months. The technical success of procedure, complications and occlusion rate at short-term follow-up are reported. Upon compression, larger diameter veins may constrict asymmetrically rather than concentrically around the laser fibre (the 'smile sign'), requiring multiple passes of the laser into each dilated segment to achieve complete ablation. Results Of 1929 great saphenous veins, 334 (17.31%) had a diameter equal to or over 15 mm, which has been recommended as the upper limit for endovenous laser ablation by some clinicians. All were successfully treated and occluded upon short-term follow-up. Conclusion We suggest that incompetent great saphenous veins that need treatment can always be treated with endovenous laser ablation, and open surgery should never be recommended on vein diameter alone.
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http://dx.doi.org/10.1177/0268355517734480DOI Listing
September 2018

One-year results of the use of endovenous radiofrequency ablation utilising an optimised radiofrequency-induced thermotherapy protocol for the treatment of truncal superficial venous reflux.

Phlebology 2018 Jun 20;33(5):298-302. Epub 2017 Mar 20.

1 The Whiteley Clinic, Guildford, UK.

Background In previous in vitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of superficial venous reflux in truncal veins. Methods Sixty-three patients were treated with radiofrequency-induced thermotherapy using the optimised protocol and were followed up after one year (mean 16.3 months). Thirty-five patients returned for audit, giving a response rate of 56%. Duplex ultrasonography was employed to check for truncal reflux and compared to initial scans. Results In the 35 patients studied, there were 48 legs, with 64 truncal veins treated by radiofrequency-induced thermotherapy (34 great saphenous, 15 small saphenous and 15 anterior accessory saphenous veins). One year post-treatment, complete closure of all previously refluxing truncal veins was demonstrated on ultrasound, giving a success rate of 100%. Conclusions Using a previously reported optimised, low power/slow pullback radiofrequency-induced thermotherapy protocol, we have shown it is possible to achieve a 100% ablation at one year. This compares favourably with results reported at one year post-procedure using the high power/fast pullback protocols that are currently recommended for this device.
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http://dx.doi.org/10.1177/0268355517696611DOI Listing
June 2018

Pelvic venous reflux in males with varicose veins and recurrent varicose veins.

Phlebology 2018 Jul 31;33(6):382-387. Epub 2017 Aug 31.

1 The Whiteley Clinic, Guildford, Surrey, UK.

Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurrent lower limb varicose veins. Methods Full lower limb duplex ultrasonography revealed significant pelvic contribution in eight males presenting with bilateral lower limb varicose veins. Testicular and internal iliac veins were examined with either one or a combination of computed tomography, magnetic resonance venography, testicular, transabdominal or transrectal duplex ultrasonography. Subsequently, all patients received pelvic vein embolisation, prior to leg varicose vein treatment. Results Pelvic vein reflux was found in 23 of the 32 truncal pelvic veins and these were treated by pelvic vein embolisation. Four patients have since completed their leg varicose vein treatment and four are undergoing leg varicose vein treatments currently. Conclusion Pelvic vein reflux contributes towards lower limb venous insufficiency in some males with leg varicose veins. Despite the challenges, we suggest that pelvic vein reflux should probably be investigated and pelvic vein embolisation considered in such patients.
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http://dx.doi.org/10.1177/0268355517728667DOI Listing
July 2018

Suprapubic varicose vein formation during pregnancy following pre-pregnancy pelvic vein embolisation with coils, without any residual pelvic venous reflux or obstruction.

SAGE Open Med Case Rep 2017 8;5:2050313X17724712. Epub 2017 Aug 8.

The Whiteley Clinic, Guildford, UK.

Suprapubic varicose veins are usually indicative of unilateral iliac vein occlusion and venous collateralisation. We report two cases of suprapubic varicose veins following pelvic vein embolisation and subsequent pregnancy; both presented without residual pelvic venous reflux or pelvic venous obstruction. In both cases, there was no significant flow in the suprapubic veins indicating that they were not acting as a collateral post-pregnancy. One patient had this venous abnormality treated successfully with TRansluminal Occlusion of Perforators, followed by foam sclerotherapy to the main part of the suprapubic vein. This patient has since completed the reminder of her lower limb varicose vein treatment. We suggest that pregnancy may have caused prolonged intermittent compression of the left common iliac vein, and that this, together with the physiological impact of previous embolisation procedures, obstructed venous drainage from the left leg resulting in collateral vein formation within the 9-month gestation period.
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http://dx.doi.org/10.1177/2050313X17724712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5557157PMC
August 2017