About Mr. Abu-Own > Biography Qualifications MBChB Bachelor of Medicine, Bachelor of Surgery (Tripoli, 1982) ​ FRCS (Glasgow, 1986) ​ PhD (University College London – UCL, 1995) ​ CCST (Gen Surg; Vasc); 2001 (Intercollegiate – General & Vascular Surgery) Memberships Council Member & Treasurer: Venous Forum of the Royal Society of Medicine ​ Referee: International Journal of Surgery ​ Referee: British Journal of Surgery ​ Vascular Society ​ Royal College of Surgeons GMC Registration 3380400 Mr A. Abu-Own Consultant General & Vascular Surgeon Nuffield Health Ipswich Hospital | East Su ffolk & North Essex NHS Foundation Trust Mr Abdusalam Abu-Own (MBChB, FRCS, PhD, CCST) is a Consultant General and Vascular Surgeon at Nuffield Health Hospital Ipswich. Following qualification from Medical School in Tripoli, Mr Abu-Own trained in General Surgery in Glasgow where he obtained the Surgical Fellowship. He first acquired his international clinical and research reputation while conducting research as part of his PhD at University College London (UCL) and the Middlesex Hospital (now UCL Hospital) Vascular Laboratory in London. His main research interests were Venous Disease, Varicose Veins, Deep Vein Thrombosis and Microcirculation. ​ He then trained in London and East Anglia, where he secured the Certificate of Completion of Surgical Training (CCST) in General and Vascular Surgery in 2001. He was appointed as Consultant in General & Vascular Surgery in Ipswich in March 2002. Mr Abu-Own introduced techniques into Ipswich NHS Hospital, including the Inversion PIN Stripping technique in the management of varicose veins and the Mesh "Plug" technique for hernia repair. He continued to develop his research and clinical interests and believes in actively striving to continually improve standards for patient care.​ As such, he is a council member of the Venous Forum of the Royal Society of Medicine and a referee for the British Journal of Surgery & International Journal of Surgery. His consistent hard work and relentless focus on patient safety, quality and outcomes is well recognised. He has helped develop guidelines and protocols used in ESNEFT and Nuffield Health Ipswich. He is the 'Responsible Officer' for several of these protocols and guidelines related to Thrombosis and Venous Disease. ​ This desire for optimal patient outcomes is also reflected in his private practice at Nuffield Health Ipswich where he is able to routinely utilise the conventional well tested as well as the most modern, minimally invasive treatments. ​ Nuffield Health were awarded Private Hospital Group of the Year for the third consecutive time at both the Health Investor Awards 2019 and LaingBuisson Awards 2019. Mr Abu-Own considers Nuffield Health Ipswich as the ideal place to welcome his private patients looking for the highest standards of personalised service and comfort in a peaceful and calm environment. ​ Mr Abu-Own enjoys teaching and training and was an undergraduate surgical tutor for several years. He continues to take an active role in teaching and training as a clinical and educational supervisor. He is a faculty member of ICENI and course leader for the Basic Surgical Skills (BSS) course at the ICENI Centre.

Research & Publications > Research > Book Chapters Anchor 1 Compression Treatment for Venous Disease of the Lower Limb A. Abu-Own. In: Fegan’s Compression Sclerotherapy for Varicose Veins. Edited by Shami SK and TR Cheatle. 2003; 39-46. Springler-Verlag Compression Treatment in Venous Disease Abu-Own A, Sarin S. In: Microcirculation in Venous Disease. PD Coleridge Smith (Editor), Medical Intelligence Unit (R.G. Landes Company), Austin; 1994: 145-173 Research Interests PhD Published Abstracts Book Chapters Peer-Reviewed Papers Scientific Society Papers Research in Progress

Hernia Repair > Resources > Hernia Repair > Groin Hernias Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. 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Payment Information > Payment Options Patients can often feel intimidated by the financial aspect involved with receiving their treatment in the independent sector. Many worry that it will be a long, complicated process with unexpected bills. We're here to help guide you through our simple and transparent process so that there are no surprises. Explore our convenient payment options: Private Medical Insurance Pay for Myself Medical Insurance Your treatment could be covered by your current insurer and we work with all of the major providers. Medical Insurance If you are paying for your treatment with medical insurance, then it is important that you liaise closely with your insurance provider throughout the process. You should be aware of the terms and conditions of your policy and let us know if there are any limitations. ​ Mr Abu-Own works with the following private medical insurance providers: When you attend Nuffield Health Ipswich hospital for treatment please make sure you bring the following: ​ Medical insurance registration documents Completed claim form / proof of pre-authorisation by medical insurer. ​ Make sure that your claim form has been signed by your GP and if required by your insurance policy provider. In order to meet the admission requirements of many insurance companies, we may need you to provide the date when your symptoms first developed and the date you subsequently visited your GP. We understand that it's sometimes difficult to schedule an appropriate time to see your local GP, especially with long waiting times. You may wish to look into the Nuffield Health private GP service which offers a rapid access GP service if you don't want to wait. Please note that if you do not have all of your insurance details with you when you first come into hospital for treatment, then you may be asked to settle your account in full before leaving. ​ We have an arrangement with many insurance companies which allows us to send your invoice directly to them. If you do however receive an invoice for treatment at the end of your stay, then you should forward this to your insurance company. Please Note Mr Abu-Own is compliant with the schedule of fees of all major insurance companies. This means that you will not be charged any excess fees on account of Mr Abu-Own on top of what your insurance company pays. However, for procedures requiring anaesthesia, we can not be responsible for anaesthetists who do not comply with the fee structure. Mr Abu-Own requests a fee-compliant anaesthetist; but this cannot be guaranteed. Please contact us if you need help verifying that you are covered by your insurance Paying for Myself We offer an all-inclusive pre-agreed procedure price, including aftercare for greater peace of mind. If you want to spread the cost of treatment, 0% finance options are available. Paying for myself If you are funding your treatment yourself, you are entitled to self-refer without having to see your GP. However, Mr Abu-Own recommends that you get a referral from your GP first if possible. We understand that it's sometimes difficult to schedule an appropriate time to see your local GP, especially with long waiting times. You may wish to look into the Nuffield Health private GP service which offers a rapid access GP service if you don't want to wait. During your initial consultation, Mr Abu-Own will discuss your condition and treatment plan with you. Depending on your condition he may carry out a Doppler test or Duplex Ultrasound scan to help with diagnosis and recommend the best treatment; this is charged for separately. Occasionally, you may need further investigations to be carried out in the imaging or other department. Subsequently, a further follow up appointment may be required to discuss the outcome and further management. ​ Once the initial assessment by Mr Abu-Own is completed, our partners at the Nuffield Health Ipswich booking office will offer you an all-inclusive price* for any procedure required. For peace of mind, this covers all of your treatment costs, including pre-assessment and aftercare, so that you don’t have to worry about unexpected bills. ​ If you're happy with your treatment plan and the all-inclusive procedure price and are ready to proceed, Mr Abu-Own's Secretary (Vicky Handy) will contact you to agree a date for the operation. Nuffield Health will also arrange with you a convenient date for pre-assessment, usually 1-2 weeks prior to the treatment date. This includes an assessment of your general health and fitness for surgery by carrying out various tests and investigations. Following the procedure, Mr Abu-Own routinely sees patients at least once for a follow-up outpatient appointment. This is included in the all-inclusive procedure price. ​ During the COVID-19 pandemic, there may be times where it may not be possible for Mr Abu-Own to have a consultation with you in person. Depending on current guidelines by Nuffield Health (which are continually subject to change) and your individual circumstances, it may be that Mr Abu-Own offers you a virtual consultation (phone or video). For self-funding patients, these are charged at a cheaper rate than face-to-face consultations. Please contact Mr Abu-Owns’ team for more information. For futher information, please contact Ipswich Nuffield Bookings on 01473 279123 and ask to speak to the self-pay enquiry team. Alternatively, you can send us a message and we'll get back to you via your chosen contact method. Personal Medical Loans Getting access to the best possible healthcare may be more accessible than you think. You can get the treatment you need now and pay back later. Nuffield Health recommend Chrysalis Finance as the ideal way to pay back the cost of your medical treatment. They are the only ethical provider who focus solely in the healthcare arena. You pay back over 6 or 10 interest-free monthly instalments at representative 0% APR with no added costs, deposits or admin fees. Longer term payment plans are available at 9.9% APR.** ​ For more information, please get in touch . *Initial consultation(s), diagnostic scans/tests and investigations required to establish a diagnosis are not part of the procedure price. For more details, please see Nuffield Health's terms and conditions . **Rates correct at time of publication: March 2020. Terms and conditions apply. We or Nuffield Health do not receive any commission for introducing customers to credit.

Get in Touch > Contact Us ENQUIRIES Have a question? We're here to help. Call us on 01473 279180 or send us your question using the link below and we'll get back to you. MAKE AN ENQUIRY APPOINTMENTS Fast track your treatment now by requesting an appointment with Mr. Abu-Own today. Fill in the form in the link below and we'll get in touch. BOOK AN APPOINTMENT FEEDBACK We take great pride in delivering the best experience possible for all of our patients. Please follow the steps in the link below to help us continuously improve the experience we provide. LEAVE FEEDBACK Practice Locations Nuffield Health Ipswich Nuffield Health Ipswich 01473 279 100 (Reception) 01473 279 180 (Secretary) 01473 277 595 (Inpatient Queries) 01473 279 181 (Secretary Fax) vicky.handy@nuffieldhealth.com Foxhall Road, Ipswich, IP4 5SW Mon - Thurs: 6.45am - 8pm ​​Friday: 7am - 6pm ​Saturday: 9am - 2pm nuffieldhealth.com/ipswichhospital NHS Ipswich NHS Foundation Trust Ipswich 01473 712 233 (Switchboard) 01473 704 781 (PALS*) 0800 328 7624 (PALS Freephone) 01473 712 233 (PALS urgent after hours line) Heath Road, Ipswich, IP4 5PD PALS Hours Mon - Fri: 9am - 4pm (Not on Bank Holidays)​​ Switchboard Hours 24 hours esneft.nhs.uk *PALS = Patient Advice and Liasion Service NHS Colchester NHS Foundation Trust Colchester 01206 747474 (Switchboard) 01206 742683 / 746488 (PALS*) 0800 783 7328 (PALS Freephone) 01206 747474 (PALS urgent after hours line) ​Turner Road, Colchester, CO4 5JL PALS Hours Mon - Fri: 9am - 4pm (Not on Bank Holidays)​​ Switchboard Hours 24 hours esneft.nhs.uk *PALS = Patient Advice and Liasion Service

Research & Publications > Research > Research in Progress Anchor 1 Rare presentations of iliac vein thrombosis T Jaipersad, Abu-Own A. | Presented East Eng Vasc Socity, Jul 2005 Stump appendicitis: a review and case presentation Jaffer O, Abu-Own A. | Submitted to Annals of the R C of Edin Extra skeletal Ewing Sarcoma of the Scalp Salhab, Abu-Own A. Appendicitis audit Salhab M, A Paul, Ferdousi and Abu-Own A. Suggested preoperative classification for recurrent Varicose veins (VVs) and operative approach Abu-Own A, Cheatle TR, Farah J and Shami SK. | Paper in preparation; abstract presented in UIP, Rome Management of Acute Appendicitis Audit Salhab M, Ferdous, A Abu-Own Endovascular Repair of Renal Artery to Inferior Vena Cava Fistula Axisa B, Whitear P, Picken G, Parry J, Cameron A & Abu-Own A. | Presented at the East Eng Surgeons Meeting Anorectal abscess and fistula caused by an ingested chicken bone. American Journal of Gastroenterology D Cash, M Sadat, A Abu-Own. | Vol 99 Issue 8. Page 1617. Aug 2004 Research Interests PhD Published Abstracts Book Chapters Peer-Reviewed Papers Scientific Society Papers Research in Progress

Compression Stockings > Resources > DVT > Compression Stockings Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. Deep Vein Thrombosis General Information Graduated Compression Stockings Thrombosis and Travel Paying for Your Treatment MAKE AN ENQUIRY BOOK AN APPOINTMENT

Hernia Repair > Resources > Hernia Repair > Abdominal Wall Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. Hernia Repair Groin Hernia Repair Abdominal Wall Hernia Repair Aftercare Paying for Your Treatment MAKE AN ENQUIRY BOOK AN APPOINTMENT

Varicose Veins > Resources > Varicose Veins > RFA Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. Varicose Veins General Information Radiofrequency Ablation Foam Sclerotherapy Surgery Paying for Your Treatment MAKE AN ENQUIRY BOOK AN APPOINTMENT

Deep Vein Thrombosis > Resources > DVT > General Info Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. Deep Vein Thrombosis General Information Graduated Compression Stockings Thrombosis and Travel Paying for Your Treatment MAKE AN ENQUIRY BOOK AN APPOINTMENT

Varicose Veins > Resources > Varicose Veins > Surgery Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. Varicose Veins General Information Radiofrequency Ablation Foam Sclerotherapy Surgery Paying for Your Treatment MAKE AN ENQUIRY BOOK AN APPOINTMENT

Travelling > Resources > DVT > Travelling Medical Disclaimer Whilst every effort has been made to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and Mr A. Abu-Own recommends consultation with a doctor or healthcare professional. The information provided is intended to support patients, not to provide personal medical advice. Please see our Terms and Conditions for more information. ​ Foreword by Mr. Abu-Own I am particularly interested in the investigation and treatment of varicose veins (VVs) and venous ulcers. ​ I believe varicose vein surgery should only be undertaken by experienced, appropriately trained vascular surgeons. I also believe that careful preoperative assessment and investigations are essential to achieving a satisfactory outcome. In the management of venous disease (my area of research interest), I introduced some ideas and techniques to Ipswich Hospital. For example, the Inversion “Pin” Stripping technique. I acquired this technique from the Middlesex Hospital London (John Scurr and Phillip Coleridge-Smith) where I carried out my PhD research. My experience has indicated that this technique causes less bleeding/bruising compared to the old conventional stripping techniques. I offer my patients with VVs minimally invasive treatment options, including radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy, in addition to conventional surgery, if considered appropriate. ​ I am also interested in research into the causes and management of recurrent varicose veins and presented a paper on the subject in the International Union of Phlebology Congress in Rome: ​Abu-Own A, Cheatle TR, Farah J and Shami SK. Suggested preoperative classification for recurrent Varicose Veins (VVs) and operative approach. International Union of Phlebology Congress, Rome Sep 2001. This page has been designed to provide patients with some useful information about varicose veins, the different treatment options that I offer and what to expect throughout the treatment journey. I very much look forward to welcoming patients to my outpatient clinic for an assessment where we can discuss things further. What are varicose veins? Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted. They are very common and do not cause medical problems in most people. There are two main systems of veins in the legs: ​ 1. Deep veins: The leg muscles squeeze the deep veins during walking, carrying most of the blood back up the legs to the heart. 2. Superficial veins: These occur under the skin which are functionally less important and can form varicose veins. ​ All of these veins contain one-way valves to ensure that the blood flows towards the heart. Failure of these valves allows blood to flow backwards down the veins and results in an overload of pressure when standing. This excess pressure leads to widening of the veins so that they do not close properly. Blood then flows back into the leg along these veins and causes varicose veins to develop. Raised pressure in these veins also encourages the development of spider veins and discoloured areas which look like bruises. How common are varicose veins? Varicose veins are extremely common. Studies suggest that varicose veins are found in about 3 in 10 people. National Health Service waiting lists suggest that there is still considerable unmet need. Most people with varicose veins do not have an underlying disease and they usually occur for no apparent reason. Varicose veins do not cause symptoms or complications in most cases, although some people find them unsightly. If treatment is advised, or wanted for cosmetic reasons, a procedure to seal them off is used. What causes varicose veins? Varicose veins often run in families and there may be a hereditary component. Women are more likely to suffer from varicose veins and up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills and hormone replacement therapy (HRT) can all affect the disease. Pregnancy: It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus can put pressure on the main vein bringing blood back to the heart from the legs, causing blood to pool in the legs and varicose veins to develop. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. ​ Other predisposing factors include ageing, standing for long periods of time, obesity and leg injury. What problems do varicose veins cause? Many people have no symptoms at all from their varicose veins, except for the fact that they are noticeable and their appearance can be embarrassing for many people. Other than cosmetic embarrassment, the most common symptoms of varicose veins are aching, discomfort and heaviness of the legs, which are usually worse at the end of the day. Sometimes the ankle can swell, too. These symptoms are not medically serious, but can be treated if they are sufficiently troublesome. Although varicose veins can get worse over the years, this often happens very slowly. In a few people the high pressure in the veins causes damage to the skin near the ankle, which can become brown in colour. This is called lipodermatosclerosis (hardened, sclerosed, brown discoloured skin). Varicose eczema (an itchy, dry, red skin rash) can also develop. If these skin changes are allowed to progress, or if the skin becomes injured, a venous ulcer may develop, which can be quite troublesome. Skin changes are therefore a good reason for going to see your GP and for referral to a specialist. Mr A. Abu-Own recommends patients with VVs to seek early assessment for their VVs, as he considers the development of skin changes to be an advanced stage of varicose veins disease. ​ Other problems which varicose veins can occasionally produce: ​ Phlebitis: Phlebitis (sometimes called thrombophlebitis) means inflammation of the veins, and is often accompanied by some thrombosis (clotting of blood) inside the affected veins, which become hard painful and tender. This is not the same as deep vein thrombosis (DVT) and is not usually dangerous, but is considered as an indication for treating the VVs. Bleeding: The risk of bleeding as a result of knocking varicose veins worries many people, but this is rare. The bleeding should be treated prompltly by elevating the leg and application of a firm pressure bandage. Bleeding varicose veins are considered an absolute indication (mandatory) for referral to a specialist for assessment and definitive treatment of the VVs to prevent risk of further bleeding. Deep Vein Thrombosis: Varicose veins are considered an additional causative factor for the development of DVT in some patients. Moreover, DVT may lead to development of secondary varicose veins. What tests are used to investigate varicose veins? Most varicose veins originate from leaking valves at groin level or behind the knee. It is important to accurately locate the site of the valve leaks. During your assessment at your outpatient appointment, the doctor will use a small probe to assess your veins - this is called continuous wave Doppler. The probe can detect the direction of blood flow which is audible, both in the skin veins and in the deep veins. It indicates where the veins have come from and helps in the planning of any operation that might be required. An ultrasound scan (duplex) may be performed. This will allow detailed examination of your deep veins, particularly if there is a past history of deep vein thrombosis (DVT). Assessment of varicose veins behind the knee and recurrent varicose veins will also require duplex scanning.​ ​ Once the initial assessment is complete, all treatments will require duplex ultrasound scanning as part of the selection process and for the monitoring of the treatment itself. ​ Other scans which are occasionally used include MRI and CT. Do I need treatment? Very large numbers of varicose veins procedures are performed each year in the UK for medical and cosmetic reasons. The highest priority is to treat those who have developed symptoms or complications. For example: Those with bleeding from varicose veins (usually around the ankle) are considered high priority and should be seen by a specialist immediately. Pain, aching, discomfort, heaviness, fatigue, throbbing, swelling or itching caused by varicose veins. Superficial thrombophlebitis (appearing as hard, painful veins) Development of skin changes (e.g. discolouration, lipodermatosclerosis, eczema) are indicative of chronic venous insufficiency (failed valves leading to persistent blood pooling in the legs) and therefore warrant intervention. Skin changes are considered a warning sign (precursor) to develop an ulcer. Development of a venous leg ulcer or a healed venous ulcer are very important indications for treatment of varicose veins. Mr Abu-Own recommends patients with VVs to seek early assessment for their VVs. He considers the development of skin changes to be an advanced stage of varicose vein disease. What does treatment involve? There are different options. Self-help methods.Avoid prolonged standing or sitting still. Try to put your feet up frequently (sit or lie down and raise the feet above the level of your hips). You can, for example, use extra pillows under your feet on a bed or footrest). This helps to reduce blood pooling in the veins. Use a moisturising cream or ointment to protect the skin in the affected area if it is dry, flaky or itchy. ​ Radiofrequency ablation and endovenous laser ablation. These minimally invasive methods involve passing a probe into one of the longer varicose veins, using ultrasound to guide the position. The radiofrequency or laser energy makes the vein heat up, which seals it. Surgery. Traditional surgery may still be the best option for your VVs. Mr Abu-Own will discuss with you if you should consider having surgery for your VVs. Mr Abu-Own's preferred surgical technique is the inversion PIN stripping technique, combined with mini-phlebectomies. Foam sclerotherapy. This technique is used if heat or lasers do not work. It uses a chemical mixed with air to make foam. The foam is injected into the veins, pushing the blood away and making the veins go into spasm. After treatment, a combination of a bandage and a compression stocking are applied. The treated veins may feel hard and swollen for a while before they shrink down. More than one treatment may be needed. ​ Conventional Sclerotherapy. The vein is injected with a chemical that can close and seal (sclerose) it. Mostly replaced by foam sclerotherapy nowadays. Support tights and compression stockings. These counter the extra pressure in the veins. They may help to ease symptoms such as ache, although there is little proof as to how well they work. They may be difficult to put on, particularly by people who have arthritis in their hands. Current guidelines do not recommend that they be used routinely unless treatments to seal the veins are not suitable or do not work. If you do need compression stockings, below-knee class 1 (light, e.g. travel socks) or class 2 (medium) are usually the most suitable. Ideally, they should be put on first thing in the morning, before you get out of bed, and then taken off when going to bed at night. Compression stockings are available on prescription or you can buy them. Note: if you have arterial disease in the legs, you will need a medical assessment of your circulation to decide if compression stockings are suitable (see above). Not sure what to do with your varicose veins? Many patients with varicose veins are confused as to what to do about them. This is unsurprising as there are several options including doing nothing, conservative treatments such as stockings, having an operation and several new non-surgical treatments like radiofrequency ablation, EVLA and foam sclerotherapy. You may wish to do nothing if you are not bothered by the appearance of your veins and they are not causing significant symptoms. There is no medical need to treat most varicose veins. ​ Compression stockings may be an option for those with symptoms but who are not worried about the appearance of their legs and are willing to wear stockings for the rest of their lives. However, use of stockings as a treatment option for VVs is no longer supported by NICE (National Institute for Health and Care Excellence). ​ Surgery continues to be a definitive treatment suitable for patients with extensive varicose veins on both legs who want all treatment carried out in one session, those who wish to have a general anaesthetic or those who don't like injections. ​ If you want to avoid surgery and general anaesthesia and to get back to normal activities quicker, you may want to consider having one of the minimally invasive procedures. These include the catheter endothermal ablation techniques (RFA and EVLA) and foam sclerotherapy: ​ Radiofrequency Ablation (RFA)is good for those with a long wide straight segment of vein which requires treating. Approximately 70% of patients are suitable for RFA. This is Mr Abu-Own's preferred catheter endothermal ablation technique. Mr Abu-Own usually combines RFA with phlebectomies so that the whole treatment can be completed in one session. Endovenous Laser Ablation (EVLA). The method and results of treatment are almost identical to RFA. Foam Sclerotherapy is especially good for those with less extensive veins who are willing to accept the possible need for several sessions of treatment and the possibility of the veins recurring in the future where further treatment would become necessary. It is the least invasive option, but less effective compared to surgery and the ablation techniques. 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