What is it about?

This review on the best ways to treat varicose veins has been written by Prof Mark Whiteley, a recognised international expert in venous disease. In the review, Mark explains varicose veins and hidden varicose veins, and the medical and cosmetic reasons why they should be treated. He goes through the tests that everyone should have before anyone has treatment, even if it is just for spider veins or thread veins of the legs. He also goes into the tests for pelvic congestion syndrome (varicose veins of the pelvis). Importantly, he describes who should do the scans, and explains why this is important. In the treatment section, Mark goes through the current best treatments that are available and explains that they vary depending on what pattern of vein disease the patient has. Finally, he explains that to get the best results, patients should make sure that they have the right tests and treatments performed by the right team of experts, and should ensure that their doctors are part of a Venous Registry, to make sure that their results are monitored.

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Why is it important?

Most people still think that varicose veins are "only cosmetic" and that "varicose veins always come back after treatment". Neither of these is correct. In this review, Prof Mark Whiteley explains both varicose veins and hidden varicose veins, and how they progress to aching tired legs, swollen ankles, skin staining and leg ulcers if not treated. He goes on to explain how even those leg spider veins and thread veins are usually the sign of underlying hidden varicose veins, and how none should be treated without first of all checking for an underlying cause. Mark explains that the best test for veins is venous duplex ultrasound, and this should be performed by an expert who is specialist in such ultrasound. In particular, he explains why it should never be the doctor who does the treatment. There are so many different treatments available for varicose veins Mark explains that the best treatments are usually a combination of the latest techniques, tailored to the patient's personal pattern of varicose veins. In many, this includes varicose veins of the pelvis, often called pelvic congestion syndrome. Hence, it is important that patients realise that most people with varicose veins or hidden varicose veins have a medical problem that needs treatment, and only those that have spider veins or thread veins with no hired or aching legs, and no other signs or symptoms, actually have cosmetic disease. Moreover, it is important that patients realise that by following the correct investigation and treatment pathways, the risk of veins coming back again in the future is now minimal. Therefore if patients want to have the lowest chance of recurrence after treatment, they need to be careful as to who does their scans and treatments, as this is the major determinant as to whether they are going to get a good result or not. Finally, patients should be aware that doctors who are part of the College of Phlebology Venous Registry, are being monitored at their results continually checked. As such, patients can be confident that doctors who are


This review is very important because so many patients, and indeed doctors, are confused about the latest research and advances in varicose veins, pelvic congestion and venous surgery. It is very hard to dispel the old myths that "varicose veins are only cosmetic" and that "varicose veins always come back". It is particularly difficult when doctors who do not specialise in venous disease still treat patients, often with poor results, which reinforces patients perception of expecting bad outcomes. By starting right at the beginning of venous disease, with the definition of varicose veins and hidden varicose veins, this review with almost 150 references demystifies a lot of the understanding of current practice vein treatments. It is important that both doctors and patients are aware of the current best practices, so that patients are treated by those getting the optimal results, monitored by a Venous Registry, to help overcome the misconceptions of previous generations.

Professor Mark S Whiteley
The Whiteley Clinic

Read the Original

This page is a summary of: Current Best Practice in the Management of Varicose Veins, Clinical Cosmetic and Investigational Dermatology, April 2022, Taylor & Francis,
DOI: 10.2147/ccid.s294990.
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