What is it about?

Most doctors treating varicose veins do not treat the incompetent perforating veins. They only treat the main veins and the bulging (varicose veins). However, the risk of getting recurrence after varicose veins surgery is very high. On the other hand, audited results from The Whiteley Clinic show a very low recurrence rate after varicose veins surgery. In this debate, I present the reasons the treating perforator veins as part of the varicose veins operation reduces the recurrence of varicose veins in the future. I also present references to support my view.

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Why is it important?

This is important to both patients as well as for those who fund healthcare - whether it be governments or private medical insurance companies. Many doctors treat varicose veins - and many boast that they are able to treat varicose veins very cheaply. However, if patients get high recurrence rates in the order of 10-30% per year, then cheap treatments do not help patients nor those paying for the treatment. This paper shows that by following The Whiteley Protocol and treating all incompetent perforating veins we have been able to get our recurrence rate down to 3.3% per year - the same as the risk of getting new varicose veins in someone who has never had them before but has varicose veins in the family. In other words, it is impossible to get the recurrence rate lower than this.


Having spent over 20 years of my life trying to get the best possible results for patients with varicose veins, it has become clear to me that finding and treating incompetent perforating veins is a major factor in reducing recurrence. We invented the TRLOP technique in 2001 to treat perforator veins and have shown we can get excellent results. It does take a bit longer and costs a bit more, but this pays dividends in the first few years after surgery when so few patients get a recurrence. Whilst most patients continue to consent to cheap treatments which ignore the treatment of perforating veins, they will continue to get high rates of recurrence after varicose veins surgery. This will mean that patients either do not get the benefit from their varicose veins surgery in the medium to long term or have to have it re-done - costing more and increasing the risks from future interventions.

Professor Mark S Whiteley
The Whiteley Clinic

Read the Original

This page is a summary of: Part One: For the Motion. Venous Perforator Surgery is Proven and Does Reduce Recurrences, European Journal of Vascular and Endovascular Surgery, September 2014, Elsevier,
DOI: 10.1016/j.ejvs.2014.06.044.
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