Publications by authors named "Mark Whiteley"

68 Publications

Aneurysm of the Giacomini vein.

J Vasc Surg Venous Lymphat Disord 2022 May;10(3):765-766

The Whiteley Clinic, Guildford, UK. Electronic address:

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http://dx.doi.org/10.1016/j.jvsv.2022.02.007DOI Listing
May 2022

Current Best Practice in the Management of Varicose Veins.

Clin Cosmet Investig Dermatol 2022 6;15:567-583. Epub 2022 Apr 6.

The Whiteley Clinic, Guildford, GU2 7RF, UK.

This article outlines the current best practice in the management of varicose veins. "Varicose veins" traditionally means bulging veins, usually seen on the legs, when standing. It is now a general term used to describe these bulging veins, and also underlying incompetent veins that reflux and cause the surface varicose veins. Importantly, "varicose veins" is often used for superficial venous reflux even in the absence of visible bulging veins. These can be simply called "hidden varicose veins". Varicose veins usually deteriorate, progressing to discomfort, swollen ankles, skin damage, leg ulcers, superficial venous thrombosis and venous bleeds. Patients with varicose veins and symptoms or signs have a significant advantage in having treatment over conservative treatment with compression stockings or venotropic drugs. Small varicose veins or telangiectasia without symptoms or signs can be treated for cosmetic reasons. However, most have underlying venous reflux from saphenous, perforator or local "feeding veins" and so investigation with venous duplex should be mandatory before treatment. Best practice for investigating leg varicose veins is venous duplex ultrasound in the erect position, performed by a specialist trained in ultrasonography optimally not the doctor who performs the treatment. Pelvic vein reflux is best investigated with transvaginal duplex ultrasound (TVS), performed using the Holdstock-Harrison protocol. In men or women unable to have TVS, venography or cross-sectional imaging is needed. Best practice for treating truncal vein incompetence is endovenous thermal ablation. Increasing evidence suggests that significant incompetent perforating veins should be found and treated by thermal ablation using the transluminal occlusion of perforator (TRLOP) approach, and that incompetent pelvic veins refluxing into symptomatic varicose veins in the genital region or leg should be treated by coil embolisation. Bulging varicosities should be treated by phlebectomy at the time of truncal vein ablation. Monitoring and reporting outcomes is essential for doctors and patients; hence, participation in a venous registry should probably be mandatory.
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http://dx.doi.org/10.2147/CCID.S294990DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8995160PMC
April 2022

Endovenous Laser Ablation (EVLA) for Treatment of Varicose Veins: A Comparison of EVLA with 1470 nm and 1940 nm Lasers.

Authors:
Mark S Whiteley

Surg Technol Int 2022 May;40:281-286

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

Introduction: Endovenous laser ablation (EVLA) using 1470 nm, which targets water as its chromophore, has become the standard endovenous thermal treatment for incompetent truncal veins. Recently, there has been growing interest in the use of 1940 nm, due to the greater absorption by water. This increased absorption has led to claims that, with the longer wavelength, less power is needed to achieve the same biological effect during treatment, resulting in fewer adverse post-operative sequelae.

Methods: Review of the current literature comparing 1940 nm and 1470 nm EVLA, which includes both laboratory-based and clinical studies. Reports on the use of 1920 nm were combined with those on 1940 nm.

Results: Increased absorption of the longer wavelength by water results in more thermal damage closer to the EVLA device. Thus, there may be an advantage to using the longer wavelength in EVLA of thin-walled veins at low power. However, in saphenous veins, which have thicker walls, there is little evidence that this different energy distribution in the vein wall makes any clinical difference. Reduced pain is likely to be due to reduced power during treatment. This is likely to result in more long-term failures of ablation using 1940 nm.

Conclusion: There is a difference in the distribution of thermal damage in the vein wall between EVLA at 1470 nm and 1940 nm. However, there is little evidence of any clinically significant difference when used in incompetent saphenous veins. Clinical studies looking for a difference need to report the size and wall thickness of the treated vein, the power used as well as the energy per centimetre (LEED), and long-term ablation rates in addition to early post-operative pain, induration, paraesthesia and ecchymosis. Also, power loss in different laser / fibre systems and technical differences, such as those that might allow blood to remain in the vein being treated, need to be considered.
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http://dx.doi.org/10.52198/22.STI.40.CV1565DOI Listing
May 2022

No significant difference between 1940 and 1470 nm in endovenous laser ablation using an in vitro porcine liver model.

Lasers Med Sci 2022 Apr 23;37(3):1899-1906. Epub 2021 Oct 23.

The Whiteley Clinic, Stirling House, Stirling Road, Guildford, GU2 7RF, Surrey, UK.

Current endovenous laser ablation (EVLA) practice favours 1470 nm, as water is a major chromophore for this wavelength. Water has a greater affinity for 1940 nm, leading to claims that lower powers or linear endovenous energy densities (LEEDs) are needed. We compared the thermal spread and carbonisation of EVLA using these two wavelengths, in the porcine liver model. Using the previously validated porcine liver model, we performed 5 treatments, at each power: 2 W, 4 W, 6 W, 8 W and 10 W using a standard pullback of 8 s/cm. This gave LEEDs for each wavelength of 16, 32, 48, 64 and 80 J/cm. Digital images were given random codes and analysed by two blinded observers. Thermal spread was measured using "SketchandCalc" online software and graded carbonisation from 0 (none) to 3 (black carbon tract). There was no significant difference in thermal spread between the two wavelengths at 6 W, 8 W and 10 W. At 2 W, the 1470-nm laser had a significantly increased thermal spread over the 1940 nm. Significantly more carbonisation was found with the 1940-nm laser compared to 1470 nm. In this model, there was no significant difference in thermal spread at powers of 6 W and more. At 2 W and potentially 4 W, 1470 nm showed spread than 1940 nm, due to increased absorption at the device/tissue interface. At powers and LEEDs used for saphenous ablation, we found no evidence to support reduced power or LEED when using 1940 nm. However, 1940 nm may be more advantageous than 1470 nm when ablating small thin-walled veins, near to the skin.
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http://dx.doi.org/10.1007/s10103-021-03449-0DOI Listing
April 2022

Pelvic venous pain due to pelvic congestion syndrome is becoming a primary diagnosis.

Authors:
Mark S Whiteley

J Vasc Surg Venous Lymphat Disord 2021 11;9(6):1425

Research Department, The Whiteley Clinic, Guildford, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.jvsv.2021.05.003DOI Listing
November 2021

Testicular vein thrombosis mimicking epididymo-orchitis after suspected Covid-19 infection.

SAGE Open Med Case Rep 2021 4;9:2050313X211022425. Epub 2021 Jun 4.

The Whiteley Clinic, Guildford, UK.

A 70-year-old man presented to our vein clinic with intermittent and recurrent left testicular and groin pain, clinically resembling epididymo-orchitis. He had never had any genitourinary problems until contracting a severe flu-like illness in January 2020, strongly suspected to have been Covid-19. He had failed to respond on four separate occasions to antibiotics prescribed by his GP and had only responded on these occasions to aspirin. Duplex ultrasonography at our clinic showed thrombosis of the left testicular vein with venous collateral formation. The testicle itself showed mild oedema, but a reduced arterial flow supporting the pain to be secondary to thrombosis. Covid-19 is known to be associated with venous thromboembolic disease, but usually in patients sick enough to be hospitalised and particularly in those requiring intensive care. This man appears to have had a left testicular vein thrombosis secondary to relatively mild Covid-19 infection, as he did not require hospitalisation.
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http://dx.doi.org/10.1177/2050313X211022425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182169PMC
June 2021

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 05;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 08;47(8):1152-1153

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

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http://dx.doi.org/10.1097/DSS.0000000000002971DOI Listing
August 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 2021 Jul 13;36(6):489-495. 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
July 2021

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 2021 07 2;9(4):1051-1056. 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
July 2021

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 2021 03;47(3):e97-e100

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
March 2021

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
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