Varicose vein surgery is one of 17 procedures the NHS may limit under plans to cut treatments deemed ‘unnecessary’, as revealed last weekend.
The proposal is that such procedures will only be offered when there is good reason.
But new research suggests that when it comes to patients with leg ulcers, treating varicose veins can make a real difference.
Each year around 750,000 Britons develop a leg ulcer that can take many mont hs — even years — to heal.
Did you know? Around 80 per cent of leg ulcers are caused by venous disease — vein problems
‘Leg ulcers may sound trivial but they can be extremely painful and debilitating,’ says Alun Davies, a professor of vascular surgery and honorary consultant at Imperial College Healthcare NHS Trust. ‘In some cases, a leg ulcer can even lead to sepsis and death.’
About 80 per cent of leg ulcers are caused by venous disease — problems with the veins — and the majority are due to varicose veins, where faulty valves allow blood to pool in the veins in the leg, causing the vein to swell. This in turn can damage the skin.
Until now, compression bandages have been used to treat ulcers by encouraging blood up the legs, and with antibiotics if infections develop.
‘Although many leg ulcers will heal with compression, without addressing the underlying cause, around 60 per cent [of patients] will have another ulcer,’ says Professor Davies.
But the results of a new study he has been leading suggest there is a speedier approach that can stop the ulcers recurring.
The investigation looked at whether treating the varicose veins of patients with leg ulcers at an early stage could speed up healing. All 450 patients involved in the research were given compression stockings to wear, and half of them also received one of four treatments for varicose veins within two weeks.
Ouch! As well as being unsightly, varicose veins can also be painful for sufferers
These techniques included foam sclerotherapy — which uses an injectable foam to destroy the faulty vein — and a form of ablation, which uses heat or lasers to destroy the affected vein.
These treatments were once widely available on the NHS but are now only given if the varicose veins are causing significant problems such as pain or ulcers.
Results, published in the New England Journal of Medicine, showed those who had their varicose veins treated within two weeks found their ulcer healed in 56 days, compared with 82 days in the group treated with bandages and received delayed vein treatment.
After six months, healing rates were 85.6 per cent in the group that received rapid treatment, compared with 76.3 per cent in the other group — a significant improvement of 12 per cent.
Among the first to benefit was Henrik Ritzen, a 43-year-old chef who developed varicose veins and then a leg ulcer after working 60-hour weeks, most of which he spent on his feet. The varicose veins began ten years ago, initially on his left shin and ankle, but soon worsened.
‘My dad has varicose veins quite badly, so I knew I was at risk, and being on my feet wasn’t helping,’ says Henrik, who lives in London with his wife, May, 39, a make-up artist, and daughter, Inka, three.
‘The GP gave me compression stockings and told me to put my feet up whenever I could,’ he says. Then in 2011, Henrik developed a purple-brown bruise inside his left ankle.
‘My GP said it was a venous ulcer caused by the varicose veins and referred me to a vascular surgeon who performed a laser operation to destroy a section of the veins a few weeks later. The ulcer healed, but six months later it flared up again,’ he says.
The ulcer quickly doubled to the size of a golf ball. Henrik was given compression bandages but the ulcer refused to heal and became infected.
‘My GP then said I needed surgery again to remove more of the veins,’ he explains. ‘I was treated within two weeks.’
Henrik had treatment as part of the Imperial trial, and within weeks his ulcer healed, and has shown no sign of returning.
‘My leg no longer aches — now I’m doing everything I can to avoid getting another ulcer,’ says Henrik. ‘I work a 40-hour week and sit down for part of the day. I wear compression stockings sometimes, watch my weight and exercise.’
‘We have shown that by intervening early you improve the healing of leg ulcers, and help a patient recover quicker,’ says Professor Davies. ‘We recommend patients are referred to a vascular clinic upon diagnosis with an ulcer, to see if they would be suitable for early treatment.’
Ian Franklin, president-elect of the Royal Society of Medicine’s Venous Forum, says: ‘One of our concerns has been that patients with venous ulcers were being treated with bandages, but the underlying cause wasn’t treated.
‘This study shows that early treatment of the underlying issue significantly speeds up healing.’
Professor Davies adds: ‘The million-dollar question is how much could we save the NHS by treating leg ulcers like this earlier? My estimate would be about a 30 to 40 per cent saving. Not only that, it could vastly improve quality of life for patients.’