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Varicose vein treatment options

Lack of availability of varicose vein surgery under the NHS

Varicose vein treatment options

Many patients looking for information on varicose veins are trying to find which of the alternative treatments for varicose veins might suit them best. The options are:

• Conventional surgery
• Foam sclerotherapy
• VNUS radiofrequency ablation
• Endovenous laser treatment.

Which operation is best?

A few years ago nearly all patients had conventional surgery. Some patients had injection sclerotherapy with a liquid (sodium tetradecyl sulphate), but in the UK these were a minority and some surgeons did not offer injection treatment at all. The only other alternatives were to put up with it or wear an elastic stocking for the rest of one’s life.

In the last few years three important new treatments have become available, foam sclerotherapy, radiofrequency closure by VNUS and endovenous laser treatment. The introduction of choice is good but can leave patients confused.

If you have a consultation with me I shall tell you which alternatives are suitable and make a recommendation. I offer conventional surgery, foam sclerotherapy and VNUS Closure Fast. You can find detailed information about all these on my Advice Sheets. I do not offer laser. I have no first hand experience of it. There are plenty of good reports but it is my understanding that it is more painful than VNUS without seeming to offer any advantages over VNUS.

If you have already surfed the net you will have found sites promoting foam sclerotherapy, VNUS and endovenous laser treatment. Not all sites will offer a balanced view of the options nor discuss all the relevant complications. The shortcomings of the mass of information on the web are demonstrated by Scurr in a recent paper, “www.Accurate information for varicose vein patients.com?”.

If you want to know more about what vascular surgeons throughout the UK are doing, look at the survey I recently conducted with vascular surgical trainee, Miss Rebecca Winterborn.

The problem is also availability

Nearly every statement about the provision of varicose vein treatments has to be qualified. For NHS patients in the Brighton and Mid-Sussex area the only two options at present are conventional surgery and foam sclerotherapy. They may be denied these which leaves only compression stockings. For a fuller discussion of the local situation see below.

For a national view look at a recent article by Mr Michael Horrocks, former President of the Vascular Society, “Uncomplicated varicose vein surgery in the UK - a postcode lottery?”. This survey demonstrated the variation in the ability of surgeons to offer varicose vein treatments in different parts of England. This is another ‘post code lottery’.

In the private sector things are not simple either. If you are insured contact your provider at the outset. Only after the consultation, and after the scan which is done during the consultation can I advise what is appropriate. Some insurers such as BUPA and WPA will no longer cover foam sclerotherapy. Many experts in the field regard this as nonsensical as the treatment is effective, cheaper than the alternatives and generally very safe. Go to the Foam Sclerotherapy Advice Sheet for more details on safety. If I tell you VNUS is a suitable option, check, with your insurer that there will not be a shortfall as costs tend to be higher. We try to keep these down by doing it all as an Out-Patient procedure under local anaesthesia. On arrival at the hospital you go to Out-Patients, receive the treatment, have a cup of coffee afterwards and some patients walk home! It is not at all like being admitted for an operation. Go to the VNUS Advice Sheet for more details.

Lack of availability of varicose vein surgery under the NHS

The great problem for NHS patients with varicose veins is that from 1 May 2007 the three Primary Care Trusts in this area (West Sussex, Brighton and Hove, East Sussex Downs and Weald) agreed between themselves that they would only permit funding for varicose vein treatments under special circumstances.

I and my vascular surgical colleagues in Brighton strongly disagree with this stance. The PCT’s take the view that treatment of varicose veins is a ‘Low Priority Procedure’ and that there are insufficient funds to pay for it. The PCT’s hold the purse strings.

The majority of patients with varicose veins, about 60% in my clinic, have no complications. Nevertheless they may have very significant symptoms with aching discomfort that can seriously interfere with work and pleasure. Most of these people are now denied treatment even though their symptoms are likely to go on for decades. The other 40% have complications such as skin damage, eczema, phlebitis, bleeding or ulceration. My experience so far is that if you live in the area covered by Brighton and Hove City PCT your prospects of receiving approval are fair, if you are covered by West Sussex your chances are very poor even if you have skin complications. If you live in the area covered by East Sussex Downs and Weald PCT you have some chance of approval but not much.

Please understand decisions about your care are taken by a person in an office who has never seen you, is not a doctor and may have no specialised knowledge of the field. Your case may be referred to an ‘Exceptional Cases Review Panel’ and I know nothing about the composition of these committees.

My view

The whole process of applying for funding is extremely bureaucratic and wasteful. I suspect that with some of the newer treatments we could treat patients for less money than is spent on these applications, taking into account all the time, the paperwork, the Review Panels, the salaries and the pensions of all the staff involved. It sometimes takes months to obtain a verdict from the PCT and although the government besieges the hospitals with targets, as you may guess there is no target for this one!

I and my colleagues in vascular surgery in Brighton and Hayward Heath continue to press for a change in policy. Currently the prospects for change are poor but we shall not give up.