Research from The Whiteley Clinic has suggested that 1 in 7 women having varicose vein surgery are currently getting the wrong operation. Even worse, this rises to 1 in 5 women if they have had children. This is because doctors have traditionally been taught that varicose veins only come from the legs, and they are ignoring the contribution from pelvic varicose veins.
Despite most doctors and nurses ignoring the signs of pelvic varicose veins - that is varicose veins of the vulva and vagina, and varicose veins on the inner thighs next to the vulva - internet discussion groups for pregnant women and young Mums are full of women asking about these veins.
Once the pregnancy is over, these veins seem to reduce or even disappear. However they don't. They remain just under the skin, feeding leg varicose vein with blood refluxing from the pelvic varicose veins.
So when a woman with leg varicose veins goes to a normal vein clinic, they usually have a quick scan of the legs. This is often performed by the same doctor who does the surgery rather than a specialist vascular technologist or vascular scientist who specialises only in vein scanning. As a result, only the leg varicose veins are scanned and the pelvic varicose veins are ignored - and therefore not treated.
Research from The Whiteley Clinic and published in the Journal of Vascular Surgery: Venous and Lymphatic Disorders http://www.jvsvenous.org/article/S2213-333X(12)00035-2/abstract has shown that the failure to find and treat pelvic varicose veins is a leading cause of women getting their varicose veins back again - called recurrent varicose veins.
The venous experts at The Whiteley Clinic developed the Transvaginal Duplex Ultrasound Scan to identify these pelvic varicose veins and have shown that this test seems to be the best way to find this problem http://www.ncbi.nlm.nih.gov/pubmed/25324278. The few vein clinics and hospitals that are following the Whiteley Clinic's lead in this area tend to use MRI (MRV), CT Scanning or venograms - all of which measure the size of the vein which is the wrong thing to measure! http://www.ncbi.nlm.nih.gov/pubmed/25457295
So how can we make sure all of these women get the right varicose vein treatment?
Every woman coming to The Whiteley Clinic with leg varicose veins gets scanned and treated by The Whiteley Protocol®. This includes a full leg scan on each side, chasing the cause of any varicose veins back to their origin. In the women where the origin is the pelvic varicose veins they are offered the gold standard - a Transvaginal Duplex Ultrasound scan.
All women with pelvic varicose veins are then offered treatment with Pelvic Vein embolisation. Because the Transvaginal Duplex Ultrasound Scan has shown which exactly which pelvic veins need treatment, the embolisation procedure can be aimed directly at the problem veins. This is not the case when MRI, CT Scanning or Venography is used.
By using the processes developed in The Whiteley Clinic since 2000, we can now make sure that women do not get the wrong treatment for varicose veins anymore and have a lower risk of getting recurrent varicose veins back again in the future.
References:
Whiteley AM, Taylor DC, Whiteley MS.
Pelvic Venous Reflux is a Major Contributory Cause of Recurrent Varicose Veins in more than a Quarter of Women
Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2013 Jan. Vol 1 (1)Pages 100-101 DOI: http://dx.doi.org/10.1016/j.jvsv.2012.10.007
http://www.jvsvenous.org/article/S2213-333X(12)00035-2/abstract- Accessed 12 Jan 2015
Whiteley M, Dos Santos S, Harrison C, Holdstock J, Lopez
Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women.
Phlebology. 2014 Oct 16. pii: 0268355514554638. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/25324278 - Accessed 12 Jan 2015
Dos Santos SJ, Holdstock JM, Harrison CC, Lopez AJ, Whiteley MS.
Ovarian Vein Diameter Cannot Be Used as an Indicator of Ovarian Venous Reflux.
Eur J Vasc Endovasc Surg. 2014 Nov 22. pii: S1078-5884(14)00582-6. doi: 10.1016/j.ejvs.2014.10.013. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/25457295