This week sees the 15th anniversary of the first minimally invasive varicose vein operation in the UK and what a massive difference has occurred.
On 12 March 1999, my colleague Judy Holdstock and I performed the first endovenous procedure in the UK for varicose veins. Using a device called the VNUS closure catheter, we used radiofrequency ablation to close a varicose vein with heat - replacing the painful stripping that has subsequently been shown to cause veins to grow back again in the majority of cases.
Not surprisingly, with the conservative nature of doctors in the UK, whenever we presented our experience at meetings to our peers, we met huge resistance and indeed our early research papers in 1999 to 2002 were rejected by "peer-reviewed" journal.
Now endovenous surgery is not only restricted to radiofrequency ablation but also includes endovenous laser ablation, glue closure (also known as Venaseal) and steam treatment of varicose veins. In addition, we have learned to close pelvic veins with coils, invented the TRLOP procedure to close incompetent perforators and defined the role of foam sclerotherapy within the veins.
Our research and development into these endovenous techniques has changed from being "revolutionary" to now being recognised as the optimal way forward. Indeed the NICE recommendations for the treatment of varicose veins last July have put these endovenous thermoablation techniques as the preferred way to treat veins above foam sclerotherapy and more importantly, vein stripping.
It is a great personal satisfaction to see that over 15 years my own position has gone from maverick to a recognised international expert in this area, and an increasing number of vein surgeons and doctors are using these new techniques to the advantage of all of their patients and also the funders of healthcare as they can be done as walk in, walk out local anaesthetic cases. In good hands, it appears the recurrence rate is far lower than in previous years.
15 years has seen a major transformation in the treatment of varicose veins but by no means is the research and development finished. Indeed, this major change in the way that we treat veins has had unexpected results in the way that we investigate veins and has stimulated research so that our understanding of the whole venous system is improving daily.
With somewhere in the region of 30 to 40% of the population suffering from either varicose veins or "hidden varicose veins" the next 15 years promise to be as exciting as the last 15 years and should see a continued improvement in the assessment and treatment of patients with these vein problems.