Ask the expert - Varicose Veins

Professor Andrew Bradbury is the Sampson Gamgee Professor of Vascular Surgery at the University of Birmingham and a Consultant Vascular and Endovascular Surgeon at Heart of England NHS Foundation Trust. He is also currently President of the Venous Forum of the Royal Society of Medicine.

Professor Bradbury treats many hundreds of patients with varicose veins each year both in the NHS and the private sector. As an academic vascular surgeon he has undertaken research into the treatment of varicose veins for over 20 years, published many papers in peer-reviewed scientific surgical journals, and lectured and taught on the subject all over the world.

For the last 10 years, Professor Bradbury has been developing Ultrasound Guided Foam Sclerotherapy (UGFS) for the treatment of varicose veins and has recently published his results in the Journal of Vascular Surgery, the British Journal of Surgery and the European Journal of Vascular and Endovascular Surgery.

Why do patients seek treatment for varicose veins?
Patients seek treatment for varicose veins for three main reasons:

  • Dissatisfaction with the appearance of the leg
  • Symptoms such as pain, heaviness and itching
  • Complications such as bleeding, deep vein thrombosis (DVT), varicose eczema and ulceration

Are there different types of varicose veins?
Yes. There are three main types of varicose veins and it is not unusual for all three to be present in the same patient.

  • Trunk veins: these lie in the fat layer underneath the skin, are lumpy-bumpy, and usually more than 4mm across. 
  • Reticular veins: these lie within the deeper layers of the skin, are less lumpy-bumpy, and are usually less than 4mm across.
  • Spider (aka thread) veins: these lie in the upper layers of the skin, are not lumpy-bumpy, and are usually less than 1-2mm across.  

Is it likely that I will need surgery for my varicose veins?
No. Almost all patients with trunk, reticular and spider veins can be treated as an out-patient under local anaesthetic using:

  • Ultrasound Guided Foam Sclerotherapy (UGFS) for trunk and large reticular veins
  • VeinLite Transilluminated Sclerotherapy (VTMS) for thread and small reticular veins

Very occasionally, when patients present with enormous trunk varicose veins in both legs, surgery might still be the best treatment.

How do I know which treatment is best for me?
Varicose veins that are visible to the naked eye are often only the ‘tip of the iceberg’, and that unless the underlying invisible trunk varicose veins are also dealt with then treatment is often unsuccessful. For this reason, Professor Bradbury performs a colour duplex ultrasound scan on all patients presenting to him with varicose veins. Duplex ultrasound is a completely safe and painless examination (similar to that undergone by ladies when they are pregnant) that provides accurate and detailed images of all the veins and arteries of the leg.  This important information allows Professor Bradbury to formulate a bespoke treatment plan for each individual patient.

Will treatment be painful?
No, UGFS and VTMS are performed under local anaesthetic and are virtually painless.

Is any special preparation required for these minimally invasive treatments?
No. You can wear your normal clothes; take all your usual tablets and medicines (including warfarin) and eat normally beforehand; and you do not need to shave your legs (unless you want to gentlemen!).

What sort of recovery period is there?
Virtually none; it really is ‘walk in, walk out’. The procedure takes around 30 to 40 minutes. There is very little discomfort following the procedure and much less bruising than after surgical ‘stripping’.  Your leg will be bandaged for a few days afterwards and you will need to wear a compression stocking for a few weeks.  During that time there are few restrictions on activities; however, we do suggest no long haul flying for 4-6 weeks afterwards.

Are there any risks?
As with any treatment for VV there is a very small risk of DVT.  Professor Bradbury has only seen 4 DVTs in the course of treating several thousand legs with UGFS and VTMS; a risk of less than 0.2%.  Professor Bradbury has not encountered any other significant complications.

Will my varicose veins (ulcers) come back?
Professor Bradbury’s published research shows that the risk of developing further VV following UGFS is lower than after surgery and that, if patients do grow new veins, then treatment by means of further injections is very straightforward and effective.  Patients undergoing treatment for ulcers usually enjoy rapid healing and a low recurrence rate.

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