This is a common description of varicose veins treatment carried out at other clinics. Such an approach leads to inadequate and incomplete assessments. Here’s why.

1. Varicose veins are caused by superficial venous reflux – down flow of blood in the wrong direction in the veins under the pull of gravity. It therefore follows that to accurately diagnose the root cause of varicose veins, gravity must be acting on the veins when the veins are examined. We hear many stories of patients who have had inadequate treatment because they were scanned with ultrasound while lying down. Identifying the presence of reflux, where it is coming from and which veins are affected, can only be accurately assessed by duplex ultrasound when the patient is standing.
2. Furthermore, to accurately identify the varicose veins for adjunctive procedures such as phlebectomy and foam sclerotherapy, skin marking must be performed while the patient is standing.

If you are concerned about your varicose veins, here’s how to contact us

• calling us by telephone – 01935 873951
• using the contact form on the website

• Leg Varicose Veins and Spider Veins
• The Cosmetic Treatment of Leg Veins and Hand Veins
• The Medical Complications of Varicose Veins
• Modern Treatment Options such as Endovenous Laser Treatment and Sclerotherapy
• Treatment under local anaesthetic without surgery on a “walk in, walk out basis”

These Open Events are a marvellous opportunity to meet Dr Gajraj and hear him explain what causes your vein condition and what can be done about it! There will be ample time to ask questions and there will be special offers for those who attend.

These Open Events are free and open to members of the public and healthcare professionals. However, you must book in advance as places are limited and they are offered on a “first come, first served” basis. Book your place now to avoid disappointment. 

These educational events are not a substitute for a full consultation, but those who attend may be eligible for a special concessionary rate for a consultation and duplex ultrasound scan.

Venues, Dates and Times:

Thursday 18th October

• 12.30pm at the Ringwood Health Clinic in Ringwood
• 6pm at the Ringwood Health Clinic in Ringwood

Monday 22nd October

• 6.30pm at the Yeovil Court Hotel

Tuesday 23rd October 

• 6.30pm at the Wessex Royal Hotel

If you would like to attend any of these OPEN EVENTS please contact us to reserve your place. Here’s how to contact us

• calling us by telephone – 01935 873951
• using the contact form on the website
• or e-mail info@melburyclinic.co.uk

These are the 5 most noticeable signs of the Ageing Hand:

1. Prominent Veins: as we get older, the collagen in the veins becomes weaker. As a result, the vein does actually get larger and stretch. One of the very first signs of getting older is that the veins on the back of the hands stick out more.
2. Bony appearance: another fact of getting older is that the amount of supporting collagen in the hands reduces. The bones become more noticeable and the hands look thinner and bonier. A cruel irony is that people who stay thin, who exercise and work out, suffer from prominent veins and a bony appearance than those who are carrying a bit of excess weight.
3. Pigment Spots: age spots are the result of sun exposure. Sun-worshippers or those with outside occupations or hobbies – gardeners for example- tend to get more age spots and at a younger age.
4. Wrinkly skin: wrinkles and thin skin are also a consequence of UV exposure from the sun
5. Arthritis: wear and tear of the joints is an inevitable consequence of the passage of time.

Hand Rejuvenation: The specialists at the Melbury Clinic VeinCare Centre offer a unique hand rejuvenation treatment programme that counteracts 4 of the major signs of the ageing hand. We offer ‘Gentle Sclerotherapy’ to shrink the hand veins to return them to a more youthful size, subcutaneous collagen stimulator injections to reverse the bony appearance and to reduce wrinkle and cryotherapy to remove age spots. The results are shown here. After successful treatment, we can advise on maintenance to keep hands looking younger.

If you would like our free information pack which has details of our hand rejuvenation treatment programme , please send us an email or use our contact form on our website.

We have reached the finals in

Best Place to Work

Our team say that the Melbury Clinic at Holt Mill is a fabulous place to work, developing staff confidence and providing training and career development opportunities. The Melbury Clinic VeinCare Centre is a finalist for the Blackmore Vale Business Awards’ category “Best Place to Work.”

This is what Laura Spicer had to say: “I have never woken up and dreaded going to work – I have never felt so appreciated and listened to at a place of work. In September, I begin my midwifery degree which I would never have had the confidence to apply for and gain a place on without the support of my employer”.

The VeinCare Team know you will do well Laura and we wish you all the best for September.

For reasons of safety,  we believe that vein procedures are best carried out under local anaesthetic on a walk-in walk-out basis. By avoiding general anaesthetics and a prolonged recovery period, there is virtually no risk to the heart and breathing and deep vein thrombosis (DVT) is vanishingly rare. This procedure is safe, effective with very low risk.

We also believe that as well as providing treatments that are safe, it is important to look after the comfort of our patients and to reassure them at every stage of the procedure. For these reasons, one nurse assists the specialist performing the vein procedure, which in this case is endovenous laser (EVLT); another nurse looks after the patient, monitoring blood pressure, oxygen levels and heart rhythm while chatting and offering reassurance.

In total, three members of our specialist team undertake laser treatments for varicose veins always led by one of our vascular surgeons, either Catharine McGuinness of Haroun Gajraj. In the video below, you can watch Catharine performing the procedure entirely through pin pricks in the skin guided by ultrasound. Her assistant ensures that she has instruments and equipment to hand and the second nurse looks after the well-being of the patient.

We understand that most people prefer to have vein treatment under local anaesthesia and we also understand that some may be a little anxious. That’s why we put comfort, safety and reassurance so high on list of our priorities.

For more information about endovenous laser treatments under local anaesthetic, visit The VeinCare website.
http://www.theveincarecentre.co.uk/

1. What is varicose eczema? The term varicose eczema is in fact a misnomer and it is very misleading. This condition is neither an eczema — a skin problem- nor is it caused by varicose veins. The term arose before we fully understood the true nature of the problem. So varicose eczema can develop in the absence of visible varicose veins and unlike skin problems it should not be managed solely by dermatologists. Other misleading synonyms are gravitational eczema and stasis eczema suggesting that gravity somehow preferentially adversely affects some people — clearly ridiculous — or that blood is stagnant in some people — equally ridiculous. Varicose eczema is what we see when the skin is being damaged.
2. What causes varicose eczema? The true nature of varicose eczema is a malfunction of the veins of the legs which causes inflammation and scarring of the skin and underlying fat layer. These changes are seen when biopsies of varicose eczema are looked at under the microscope. A better medical term is Lipodermatosclerosis
3. What is the treatment for varicose eczema? The underlying vein problem should be diagnosed by ultrasound and it should be rectified if possible.
4. What about creams for varicose eczema? Often the skin becomes dry and itchy. Moisturising creams can help. Varicose eczema should not be treated with steroid creams except for very brief periods when itch and pain are very troublesome. Longer term use of steroid creams will help the relieve symptoms and the area will look and feel better, but the use of steroids will thin the skin over time making it more vulnerable to further damage.
5. What about medical stockings? Medical stockings or socks help normalise the function of the leg veins and therefore wearing them will go a long way to improving the varicose eczema. Ideally, they should be put on first thing in the morning before getting out of bed and they should be taken off last thing at night. They are not a long-term solution and most people do not like wearing them.
6. Should everyone with varicose eczema have a scan?  – A duplex ultrasound scan is essential in all cases of varicose eczema. It will detect the exact vein abnormality and the results of the scan will form the basis of the plan for curative treatment.
7. Can varicose eczema be cured? Over half of all cases of varicose eczema are caused by a malfunction in the superficial veins of the leg- veins which lie deep to the skin but superficial to the leg muscles. These problems in the superficial veins can nearly always be cured by non-invasive procedures under local anaesthetic on a walk-in walk out basis — procedures such as laser, radiofrequency, foam sclerotherapy or superglue.
8. Will varicose eczema come back? Varicose eczema is a condition in which the skin is damaged and there may be permanent scarring and changes only visible under the microscope. The area is vulnerable and although the vein condition can be cured, the skin may not completely return to normal.
9. Can I get varicose eczema on my arms? If you have varicose eczema on your leg, it can spread to other parts of the body. The medical term is autoeczematisation.  Once the leg vein problem is treated, the eczema elsewhere gets better.
10. What happens if I ignore varicose eczema? Varicose eczema should be taken seriously. It is a warning sign that the skin is being damaged by inflammation and if neglected and not treated, varicose eczema will progress to a leg ulcer.

Well, I hope you have found this  interesting. For more information about varicose eczema visit our website. If you would like our free information pack which summarises all the information in this video, please send us an email or use our contact form on our website.

There a many methods available to treat leg vein conditions. Vein Specialists need to take into account what is available and patients need more information. Today’s guest blog is by Cornelis Bruijninckx – 

“Nowadays there are numerous ways to treat patients with varicose veins. Although most methods are equally effective, they differ greatly at several levels.

They differ at the level of the principle of the treatment: firstly eliminating the reflux in the superficial venous trunks (great and/or small saphenous vein) or firstly removing (or closing) the visible secondary varicose veins? The last method results, apart from relief in complaints, immediately in an aesthetically satisfying outcome, and in many cases the causative reflux in the superficial trunk will diminish or vanish in time. On the other hand a combined ablation of the refluxing superficial venous trunk and removal of the secondary varicosities might constitute a more durable procedure. This ablation of the refluxing superficial venous trunk might be reached by ultrasound guided stripping of the trunk or catheter-based techniques.  Catheter-based techniques may use endovenous thermal destruction (applying laser or radiofrequency energy), mechanochemical destruction (combination of rotating wire tip and injection of sclerosing agent) or deposition of a glue to occlude the venous trunk. The thermal technique requires several injections of an anaesthetic over the length of the trunk to be treated. The last two techniques are painless, apart from the punction that is needed to introduce the endovenous catheter, although the mechanicochemical ablation may give rise at times to well tolerable pinch feelings. Lastly there is the well-known ‘old’ technique of sclerosing of varicose veins, which saw a revival by the introduction of  the so-called foam sclerotherapy, meaning injection of a liquid sclerosans that has been upgraded to a foam by intense mixing of the liquid with air (or CO₂ from a bottle). This foam is far more effective in sclerosing larger veins than the liquid form.

Physicians with the necessary experience in treating patients with all these methods know in which patients and under which circumstances which technique would be best suited. However, they are limited in the use of these techniques by reimbursement regulations of health care insurance companies and/or the governments. That is why in most of the European countries most patients with varicose veins are treated with old-fashioned in-hospital venous stripping except in the Netherlands and the UK where endovenous thermal techniques have been favoured the last decade. However additive foam sclerotherapy, which is indicated for treatment of wrinkled refluxing venous trunks or refluxing perforating veins, has been excluded from reimbursement in both countries. Mechanicochemical ablation recently has been admitted for reimbursement in the Netherlands, however the more expensive glue technique still is excluded as is the primary removal of the secondary varicosities.

In conclusion, venous specialists should be familiar with (nearly) all treatment strategies for varicose veins and with the local reimbursement regulations that limit use of the various techniques.“

Cornelis M.A. Bruijninckx is a Vascular Surgeon and Vein Specialist based in Rotterdam

It is crucial to consider each component of the ultrasound system in order to achieve each of these goals and, ultimately, streamline the Phlebology practice.

A comprehensive understanding of the various types and functions of ultrasound probes offered with the ultrasound system is the vascular technologist’s- and by extension the Phlebology practice’s- primary step to success. Ultrasound probes act as an arrow in the diagnostic process, allowing the technologist to change the frequency of the sound-waves in order to penetrate at different depths into the body for optimal image acquisition. The standard linear array transducer should be lightweight and vary from 7-12 MHz in frequency, which corresponds to a penetration depth of one to seven centimetre, respectively. If the Phlebology practice has a disproportionate demographic of obese patients, it would be advantageous to purchase a curved array transducer, which ranges in frequency from 2-6 MHz, permitting a penetration depth as high as 16 centimetres.

The secondary core concept that the vascular technologist must familiarise themselves with is the basic controls of the ultrasound system. Basic controls include overall gain, time gain compensation, focus, and auto tissue optimisation. The overall gain control function allows the vascular technologist to adjust the brightness of the image uniformly. Time gain compensation (TGC) adjusts gray shades in a particular section, allowing optimal images at varying centimetre depths. Focus allows enhancement of visualisation at the depth of interest. Finally, auto tissue optimisation (ATO) allows adjustment of the gray shade contrast of the overall image. It is recommended to seek ultrasound manufactures offering tissue harmonic imaging as a standard option, which will enhance and optimise the body tissue while simultaneously decreasing artefact.

Beyond the basic controls, varying settings of ultrasound imaging must be considered. Grayscale imaging, or B-mode, is a setting that will uniformly provide superior penetration. Dynamic range compression will assist in producing a clear image with high contrast and fewer shades of gray. It is important that grayscale imaging has equivalent sensitivity in order to visualise the vessel walls with clarity. If optimised correctly, this setting should produce an image that is pleasing to the eye- not too smooth, too soft, or too gritty. The ultrasound system also provides different gray shade maps for the vascular technologist to select for optimal imaging at any given point during the ultrasound exam. When a gray shade map is selected, the system automatically adjusts for overall gain, dynamic range, and time gain compensation. The next setting that requires consideration is colour flow. Color flow should never attenuate the grayscale image after utilisation. An experienced vascular technologist will ensure that colour flow is well-balanced, finding the middle group between excess and deficiency. In order to pinpoint the perfect amount of colour, the ultrasound system should have colour flow mapping options with easy-to-adjust colour scale settings ranging from eight to fifteen. This feature is particularly imperative when dealing with veins, which are characterised by low blood speed and require minuscule adjustment in order to achieve diagnostic accuracy.

The final setting that requires consideration is pulsed-wave Doppler. This setting is used to identify the location of blood flow, quantify blood flow, assess patency, and measure resistance. In order to optimise the pulsed-wave Doppler waveform, the vascular technologist must familiarise themselves with tools that include, but are not limited to, pulsed-wave Doppler frequency, compression, and the reject button. Adjusting pulsed-wave Doppler frequency can increase or decrease the spectrum strength of the waveform. Adjusting the compression can increase or decrease the brightness of the waveform. Finally, utilising the reject button sharpens the spectrum of the waveform image while removing low-level gray echoes.

In conclusion, the secret to having a successful Phlebology practice is not all the bells and whistles that the ultrasound manufactures will inevitably attempt to sell you. While these optional features may increase convenience, the actual secret is a comprehensive understanding of how to optimise every ultrasound image using the standard tools that are offered by every manufacturer. The aforementioned consideration of proper probe selection, mastery of basic controls, and utilisation of proper imaging settings leads to effective image optimisation, which subsequently leads to a streamlined Phlebology practice.

Written by:

Julie Cardoso

Julie A. Cardoso RVT, RPhS, RDCS

Eduard Marmut

Eduard Marmut Universal Ultrasound Management www.universalultrasoundmanagement.com

Maintaining the security of your data is a priority at The Melbury Clinic VeinCare Centre, and we are committed to respecting your privacy rights.  We pledge to handle your data fairly and legally at all times. The Melbury Clinic is also dedicated to being transparent about what data we collect about you and how we use it.

The EU’s General Data Protection Regulation (GDPR) is the culmination of four years of efforts to update data protection for the 21st century, in which people regularly grant permissions to use their personal information.

In the UK, the EU’s GDPR will replace the Data Protection Act 1998, which was brought into law as a way to implement the 1995 EU Data Protection Directive. GDPR seeks to give people more control over how organisations use their data, and it also ensures data protection law is harmonised  across the EU.

In line with new legislation, we have updated our privacy policy to provide you with information about:

• how we use your data and personal information;
• what personal data we collect;
• how we ensure your privacy is maintained;
• your legal rights relating to your personal data and
• how to make a complaint.

You can download our privacy policy here.

If you would like our free information pack which summarises all the important information about what services we provide on varicose veins, superficial venous reflux and leg ulcers, please send us an email or use our contact form on our website.

Would you like to stay up to date with all the latest on varicose veins and their treatments? Subscribe and don’t miss out. You can change your mind at anytime and we promise never to share your email address.  Subscribe by clicking here

This answers the question that many patients ask: “If I have a leg ulcer, should I have my veins treated now, or should I wait until the ulcer is healed?”

You can read the study for yourself in full. But in summary, this is how the study was conducted. In a trial conducted at 20 centres in the United Kingdom, the investigators randomly assigned 450 patients with venous leg ulcers to receive compression therapy and undergo early endovenous ablation of superficial venous reflux within 2 weeks after randomization (early-intervention group) or to receive compression therapy alone, with consideration of endovenous ablation deferred until after the ulcer was healed or until 6 months after randomization if the ulcer was unhealed (deferred-intervention group). The primary outcome was the time to ulcer healing. The results were as follows: Early endovenous ablation of superficial venous reflux resulted in faster healing of venous leg ulcers and more time free from ulcers than deferred endovenous ablation.

So what does this mean? Quite simply, if you have a leg ulcer, don’t wait, get a duplex ultrasound scan performed and if you have reflux, get it treated promptly. That way, your leg ulcer will heal more quickly and your chance of getting another will be reduced.

If you would like our free information pack which summarises all important information about varicose veins, superficial venous reflux and leg ulcers, please send us an email or use our contact form on our website.

Would you like to stay up to date with all the latest on varicose veins and their treatments? Subscribe and don’t miss out. You can change your mind at anytime and we promise never to share your email address.  Subscribe by clicking here