How The Whiteley Clinic has changed Vein Surgery in the UK

12th March 1999 – First “Keyhole” vein operation in UK:

Mark Whiteley and Judy Holdstock performed the UK’s first Keyhole surgery operation for varicose veins. They performed it under general anaesthesia VNUS Closure®.

April 1999 – First “Keyhole” vein operation presented to National Meeting:

Mark Whiteley presented the first case to The Venous Forum, the UK Venous Society, at the Annual Meeting in Leeds.

2000 – Invented TRLOP to treat Incompetent Perforating Veins (IPVs)

In 2000, Mark Whiteley and Judy Holdstock invented a new way to treat IPVs. Before this time, patients needed general anaesthetic and large incisions – until 1985 when Hauer invented SEPS (Sub-fascial Perforating Vein surgery). This endoscopic technique needed general anaesthetic and a 1 – 3cm incision – and the dissection caused a lot of post-operative pain.

TRLOP – TransLuminal Occlusion of Perforating veins – is a pinhole technique. The incision is 2mm long and the device in introduced through a needle under ultrasound control. The device then heats the IPV and closes it permanently. This is performed with local anaesthetic only.

This was presented nationally in 2001:
Reference:
Vascular Surgical Society of Great Britain & Ireland - Brighton, Nov 2001. Surgical technique and preliminary results of perforator vein closure – TRLOP. (Transluminal Occlusion of perforators). Kianifard B, Browning L, Holdstock J M, Whiteley MS.

May 2001 – We prove an association between Incompetent Perforating Veins and Recurrent Varicose veins

Even today, most surgeons don’t treat Incompetent Perforating Veins (IPVs). However, in May 2001 we published our research showing a clear association between IPVs and recurrent varicose veins. This suggests very strongly that leaving IPVs alone at varicose vein surgery (as most other units do) will increase the risk of recurrent varicose veins in the future.
Reference:
Incompetent perforating veins are associated with recurrent varicose veins. Rutherford EE, Kianifard B, Cook SJ, Holdstock JM, Whiteley MS. Eur J Vasc Endovasc Surg. 2001 May;21(5):458-60.

2002 – We showed that the theories of how Varicose Veins occur are upside down

Most UK doctors are taught that varicose veins occur when the “top valve” (the valve at the Sapheno-Femoral junction) gives way. This then allows blood to put pressure on the next valve below, causing that to give way, and so on like a domino effect, until all the valves have gone. This has caused doctors to think that extra pressure in the pelvis causes varicose veins – such as constipation, being fat, being pregnant etc.

However our research showed that the top valve (at the Sapheno-femoral junction) was indeed the LAST to give way. This showed all of the previous theories to be upside down, and showed why at old operations of tying the top of the vein did not work. It also explained why there actually isn’t a link with weight, constipation etc. and varicose veins.
Reference:
The Saphenofemoral Valve: Gate Keeper Turned into Rear Guard. Fassiadis N, Holdstock JM, Whiteley MS. Phlebology 2002; 17: 29

September 2002 – We showed a new way to operate on Recurrent Varicose Veins

We published our experience showing that recurrent varicose veins could be treated effectively by using the “keyhole” (actually pinhole) techniques that we had introduced to the UK – without the general anaesthesia and large incisions that are generally used.
Reference:
A novel approach to the treatment of recurrent varicose veins. Fassiadis N, Kianifard B, Holdstock JM, Whiteley MS. Int Angiol. 2002 Sep;21(3):275-6.

November 2004 – National Prize for work on Incompetent Perforating Veins (IPVs)

A researcher working at, and funded by, The Whiteley Clinic, [performing a project conceived and supervised by Mark Whiteley, won The Venous Forum Prize at The Vascular Surgical Society of GB & I (VSSGBI) held at Harrogate. The work showed that, contrary to what is taught and practised in the UK, incompetent perforating veins do NOT close after treatment of the Great Saphenous vein. Thus the conclusion supported work from The Whiteley Clinic showing that incompetent perforating veins do need to be treated and not just left – as they usually are in the UK.

This work was awarded an MD Thesis from the University of Surrey and was published in 2007:
Reference:
Randomized clinical trial of the effect of adding subfascial endoscopic perforator surgery to standard great saphenous vein stripping.
Kianifard B, Holdstock J, Allen C, Smith C, Price B, Whiteley MS. Br J Surg. 2007 Sep;94(9):1075-80.

January 2005 – Regional Prize for proving The Great Saphenous Vein grows back after stripping

Research by Mark Whiteley at The Whiteley Clinic showed for the first time, that after high tie and strip, veins could be seen to grow back along the strip tract. We showed that at 1 year, 23% of veins had partially or completely grown back and were showing pathological reflux again. This won the Prize of the Best Paper at the South West Thames Vascular Group in Wimbledon.