Mark Whiteley
Endovenous Thermal Ablation (EVTA) of varicose veins is now the recommended first-line treatment. This project aims to understand the mechanism of EVTA, ensuring the best results, regardless of which device is used - and to help design new devices for the future.
EVTA is usually endovenous laser ablation (EVLA) or Radiofrequency Ablation (RFA). However, there are now new methods such as Steam Vein Sclerosis (SVS) or Endovenous Microwave Ablation (EMWA). There are a great many different devices - and many doctors and hospitals get poor results even when using the same devices as others who get better results.
By understanding the science between the devices, how they work and how they interact with the vein wall, we can optimise all treatments to get the best outcomes for patients.
Since I did the first Endovenous procedure in the UK in March 1999, I have been studying how these devices work and their effect on the vein wall.
Even now we see patients from other doctors and clinics who have had the right treatment with a good device, but a poor outcome - usually recurrence of their treated veins.
By studying the science behind EVTA, we can check which devices work, how to use them optimally, and tricks and tips for when they might not perform as expected.
All of our results get incorporated into The Whiteley Protocol, to ensure that our patients get the best long term results that are possible to achieve.
The Whiteley Clinic
This was one of the first reports in the world outlining the ultrasound changes found after endovenous thermal ablation of varicose veins
This was one of the first descriptions of how varicose veins that had recurred after open surgery can be treated with endovenous thermal ablation
Further proof that understanding endovenous thermal ablation (APTA) allows us to treat patients with complex vein problems unable to have open surgery
Further evidence that stripping varicose veins causes most varicose veins to grow back after 5-8 years - unlike with endovenous thermal ablation (EVTA)
Our porcine liver model measured endovenous thermal ablation in the laboratory. We showed that the standard recommended settings of one device were inadequate
We reviewed the available literature reporting the outcomes of endovenous laser ablation (EVLA) which justified our recommended energy settings (LEED)
We showed the correlation between our in-vitro porcine liver model and the histology of ex-vivo treated great saphenous veins validating our porcine liver model
This was the first report of the long-term outcomes endovenous thermal ablation (EVTA) confirming our theories about our settings to treat varicose veins
This review of patients one year after treatment confirmed our previous work using the porcine liver model - the settings we developed worked perfectly
As part of the understanding of the interaction of laser energy and veins, we show that veins of any size can be treated by altering technique
A study using histology and immunohistochemistry to see the effect of endovenous laser 1920nm on vein wall - to compare with our database of other treatments
Using our ex-vivo endovenous laser treatment of veins we compared laser fibres that have jacket tips v those that fire radially and show the differences in vein
An invited commentary on a meta-analysis that tried to show that wavelength and power were irrelevant in endovenous laser treatment!
An invited commentary on a large study of patients with veins treated by sclerotherapy - but a skewed sample as the veins were very small
Our prize-winning discovery that endovenous laser machines do not produce the power that they indicate - and the first treatment is lower than subsequent ones
Using our porcine liver model we were able to show the optimal settings for treatment using RFiTT (Radiofrequency Induced ThermoTherapy) - a form of RFA
A case report showing how to access difficult Great Saphenous Veins for endogenous thermal ablation (EVTA) using a retrograde approach
A demonstration of the "Hedgehog" technique (developed from our TRLOP technique) to treat neovascular tissue in the groin with endovenous laser ablation
EVLA with 1940 nm has no advantage over 1470 nm at powers used for varicose veins. It may have advantages for small aesthetic veins.
Major changes that are current in the management of varicose veins, to help doctors as well as other interested parties understand the current best practices.
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 clini
Research paper showing that when varicose veins are treated with endovenous laser, there is no blood in the vein, contrary to many in-vitro models.
