What I discovered from Prof Mark Whiteley at the Whiteley Clinic is that there’s a bigger picture to mine and many women’s varicose veins that almost always goes undiagnosed and left untreated. The crux of it is that my faulty veins, which look so problematic up my legs, don’t suddenly become perfectly functioning at the top of my thigh where they disappear into my body. It seems so obvious once it’s been pointed out, but not one previous doctor has ever discussed that the problem with my ‘incompetent’ veins might start higher up in my body, where they can’t be seen.
After an ultrasound scan, Prof Whiteley, a leading venous consultant and the clinic’s founder, revealed that it’s actually the veins in my pelvis that are at the route of my varicose veins in my legs. It’s an area of research and treatment that Prof Whiteley is leading the way in — and is likely to be one of the reasons (but not the only reason, which we will come to later) that my previous procedures haven’t had a lasting effect. A diagram from the scan shows that the blood in my pelvic veins flow back in the direction of my feet, which Prof Whiteley likens to a leaky bucket. ‘What should be happening is that all the blood from your toes should be going back to your heart,’ he says, but shows me a diagram of all the veins in my pelvic area where that’s not the case. ‘Every place the blood falls out of is like having a hole in a bucket.’
Pelvic Congestion Syndrome, as Prof Whitely christened it, often comes with other side effects – from IBS and bloating to pain during sex – or as in my case could be linked to lower back pain. But it’s often the undiagnosed route of varicose veins in the legs.
‘We found more and more people turning up here who had varicose veins in their legs after treatment elsewhere. They’d had to go back to their doctor, time and time again, because no one was treating their pelvic veins. So we started treating them back in 2000,’ he explains.
Prof Whiteley started using a technique to kill these faulty pelvic veins using platinum coils, something he’s now been doing for 20 years. What’s wrong with good old laser, (which is now the go-to treatment for varicose veins in the legs)? ‘If we put a laser into your pelvis vein… we’re going to burn your uterus, your ovaries and your bowl. We can’t do that. We have to use a cold technology. And the only thing that’s been shown to work is a platinum coil.’
The drawback is that treating these veins has to be done via a catheter in the throat, which psychologically feels a little more intrusive than a laser to the leg. What would happen if I leave my pelvis veins as they are and just laser my legs? ‘It’s a bit like standing in the middle of a waterfall with an umbrella up saying, “I’m not getting wet anymore. I think I’ve turned the water off.” As soon as your umbrella breaks you’re back to square one,’ he explains. If you don’t treat the route cause, you can’t expect a perfect result.
My pelvic veins may well be why my previous treatments failed, but it’s not the only one. During the ultrasound scan of my legs, the sonographer very kindly gave me a tour of my vascular system. ‘Here you can see your great saphenous vein and this is then your small saphenous vein,’ he explained, at which point I had to stop him. In the notes from my operation in 2014 it clearly says that my small saphenous vein has been removed. Perhaps there’s a mistake on the scan? But another blob of jelly and a squeeze of the legs later and it’s confirmed. My small saphenous vein in my left leg, which I went under general anaesthetic to have removed, is still alive and kicking inside my calf.
Despite my shock, Prof Whiteley didn’t look in the slightest bit surprised. He sees sloppy treatment all the time, he says. He also believes that my ‘top consultant vascular surgeon’ at a reputable hospital was unlikely to be an expert in veins, because in the UK most vascular consultants focus on arteries.
But although I discovered that a problematic vein that I thought I’d had removed is still clogging up my system and that my varicose veins don’t end at the top of my leg but run all the way into my pelvis, I emerge from my appointment feeling thoroughly chuffed. There are options ahead – pelvic vein embolisation (those platinum coils into the veins in my pelvis) and a mixture of laser ablation and foam sclerotherapy (via small injections) on my legs. Whatever I decide to do, Prof Whiteley feels confident that by the summer I may want to throw out those maxi skirts.
This week is Vein Health Awareness Week. This theme of this year’s awareness week is #TimeToBeVein – highlighting the urgency of getting your veins checked and treated sooner rather than later, in order to prevent serious, life-altering conditions such as leg ulcers and blood clots later in life. Visit www.thewhiteleyclinic.com for more information