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Mark Steven Whiteley

Mark Steven Whiteley
The Whiteley Clinic

Professor

About

226
Publications
20,534
Reads
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3,517
Citations
Additional affiliations
April 2013 - present
University of Surrey
Position
  • Visiting Professor
April 1998 - June 2005
Royal Surrey County NHS Foundation Trust
Position
  • Consultant Vascular Surgeon
August 1995 - present
Oxford University Hospitals NHS Trust
Position
  • John Radcliffe Hospital
Education
September 1981 - June 1986
National Health Service
Field of study
  • Medical Student

Publications

Publications (226)
Article
Introduction: Endovenous laser ablation (EVLA) using 1470 nm, which targets water as its chromophore, has become the standard endovenous thermal treatment for incompetent truncal veins. Recently, there has been growing interest in the use of 1940 nm, due to the greater absorption by water. This increased absorption has led to claims that, with the...
Article
Full-text available
Current endovenous laser ablation (EVLA) practice favours 1470 nm, as water is a major chromophore for this wavelength. Water has a greater affinity for 1940 nm, leading to claims that lower powers or linear endovenous energy densities (LEEDs) are needed. We compared the thermal spread and carbonisation of EVLA using these two wavelengths, in the p...
Article
Full-text available
Mark Steven Whiteley The Whiteley Clinic, Guildford, GU2 7RF, UKCorrespondence: Mark Steven Whiteley, The Whiteley Clinic, 1 Stirling House, Stirling Road, Guildford, GU2 7RF, UK, Tel +44 330 058 1850, Email mark@thewhiteleyclinic.co.ukAbstract: This article outlines the current best practice in the management of varicose veins. “Varicose veins” tr...
Article
Patients with prominent or cosmetically embarrassing facial veins may often seek an aesthetic opinion for removal. The authors present a methodology to approach classifying facial veins by describing the veins in terms of position, colour, size and flat or bulging appearance. Tiny telangiectasia (also known as thread or spider veins) or smaller dis...
Article
Full-text available
A 70-year-old man presented to our vein clinic with intermittent and recurrent left testicular and groin pain, clinically resembling epididymo-orchitis. He had never had any genitourinary problems until contracting a severe flu-like illness in January 2020, strongly suspected to have been Covid-19. He had failed to respond on four separate occasion...
Article
Full-text available
A 48-year-old woman attended to discuss a dilemma. She had suffered a cardiac arrest immediately following microsclerotherapy of leg telangiectasia with 0.3% aethoxysklerol. She had successful defibrillation and been transferred to hospital. In hospital, despite normal cardiac tests, she was diagnosed as having idiopathic cardiac arrest. The exposu...
Article
Full-text available
Endovenous thermal ablation is a first-line treatment for symptomatic varicose veins due to truncal vein reflux. Ablation of an incompetent great saphenous vein is usually performed from distally, with the vein access at the lowest point of reflux, or just below the knee. Occasionally there are patients in whom the great saphenous vein is difficult...
Article
Background Successful endovenous thermoablation relies on transmural vein wall ablation. We investigated the pattern of thermal spread and tissue carbonisation from RadioFrequency-induced ThermoTherapy (RFiTT) at different powers and pull back methods, using a porcine liver model. Methods We used a previously validated in-vitro porcine liver model...
Article
Objective: International guidelines recommend Endovenous laser ablation (EVLA) as one of the first line treatments of truncal venous reflux associated with varicose veins. Clinicians use Linear Endovenous Energy Density (LEED) to measure energy used during treatment. The aim of this study was to investigate power output from the fiber tip and to se...
Book
Many people have problems with their legs - from aching/tired legs and swollen ankles to varicose veins, from lumps appearing to skin discolouration and leg ulcers to name a few. Sometimes symptoms and signs are obviously due to veins - and other times people might be unaware of hidden varicose veins. However with 30-40% of the adult population hav...
Article
Background: Many patients complain of prominent vertical veins in the center of their forehead, worse when smiling, wrinkling the forehead in bright light, leaning forward, and when vasodilated in heat, when exercising, or with alcohol. Previous attempts to treat these with external laser, sclerotherapy, and phlebectomy have not been successful. O...
Article
Objective Cyanoacrylate closure (CAC) of refluxing saphenous veins has demonstrated excellent safety and effectiveness results in feasibility and pivotal studies. This article provides the 36-month follow-up results of the prospective multi-center non-randomized cohort study. Methods A total of 70 patients were enrolled in a prospective multicente...
Book
Pelvic Congestion Syndrome – Chronic Pelvic Pain and Pelvic Venous Disorders: Pelvic congestion syndrome is one of the most misunderstood and least well-known medical conditions today. Because doctors most do not look for it, nor treat it: 1 in 3 (30%) of women with chronic pelvic pain get misdiagnosed and no treatment 1 in 6 (16.7%) of women and...
Article
Objective: The study aimed to investigate the biologic effects of the 1470-nm endovenous laser (EVL), with a jacketed fiber and a radial fiber, during EVL ablation of an ex vivo dominant extrafascial tributary of the great saphenous vein in our in vitro model by histology and immunohistochemistry. Methods: Ten segments of the dominant extrafasci...
Book
Full-text available
Most venous leg ulcers can be cured. Not healed temporarily but dressings and compression, only to recur again in the future, but cured. If the patient can walk, then in most cases, the compression stocking can be thrown away, and the patient return to a normal life. So why is this revolutionary? Because most patients are not given the chance o...
Article
Being able to work well as a team is crucial to the success of any business. But what if your colleague is also your partner? If done well, going into business with your partner could be a resounding success, but if done badly, it could put a strain on the relationship. In this section, three couples describe their experiences of working together i...
Article
Full-text available
A 56-year-old woman presented in 2006 with symptomatic primary varicose veins in her right leg. Venous duplex ultrasonography at that time showed what appeared to be “neovascular tissue” around the saphenofemoral junction. However, there had been no previous trauma or surgery in this area. This appearance has subsequently been described as primary...
Article
Full-text available
Objectives To analyse the biological effects of a 1920 nm endovenous laser (EVL) on extra-fascial great saphenous vein (GSV) in vitro. Methods A 10 cm length of a large tributary bypassing a hypoplastic segment of the GSV (sometimes called an “extra-fascial GSV”) was obtained during routine varicose vein surgery. The length was treated in five sec...
Chapter
Visible varicose veins affect approximately 10–15% of the adult population, with a similar percentage of people suffering from superficial venous incompetence (also known as chronic venous incompetence or superficial venous reflux) which is essentially the same disease but without visible varicosities [1–3].
Book
First of a series of books with chapters written by internationally renowned experts in Phlebology and Venous Surgery. Chapters: - Endovenous Thermal Ablation of Varicose Veins and Examination of the Use and Failings of Linear Endovenous Energy Density (LEED). Mark S Whiteley. - Radiofrequency Thermal Ablation of Varicose Veins. Kate J Williams, Ia...
Chapter
Linear Endovenous Energy Density (LEED) is the usual measure of how much energy is used to treat veins using Endovenous Thermal Ablation - endovenous laser or radiofrequency. This chapter explains how LEED is calculated and shows that quoting a LEED is inadequate, as many different settings can result in the same LEED - some that are clearly inappr...
Chapter
Radiofrequency-induced Thermotherapy (RFiTT) is an endovenous technique treating varicose veins. When it was first launched, the manufacturers recommended using a high power and fast pullback. However, this resulted in sub-optimal results with the device requiring removal during the procedure to be cleaned and some veins reopening after treatment....
Chapter
Endovenous thermal ablation for varicose veins has become the recommended primary treatment for varicose veins with truncal reflux. However, there is little long-term data available for this relatively new technique. This chapter reports the 10-year data for a series of patients treated with radiofrequency ablation of varicose veins from truncal or...
Chapter
The instructions for use of endovenous laser ablation for the treatment of varicose veins usually includes commencement of treatment 2 cm back from the saphenofemoral junction. However, this can lead to a "stump" that can result in a clot called an endovenous heat induced thrombosis (EHIT). The bubble trapped technique is a technique developed by t...
Chapter
Endovenous thermoablation has now become the recommended first-line treatment for varicose veins. When performed under local anaesthetic (tumescence) as a "walk in, walk-out" procedure, it was initially performed as a series of procedures with one vein being treated at each visit. With increasing experience and increasing research, the number of ve...
Chapter
Ambulatory surgery for varicose veins has now become a standard model of care, reducing costs and allowing varicose vein clinics to become "office-based". Many techniques have been discussed in the past to try to improve the patient experience, reducing pain and anxiety during local anaesthetic ambulatory surgery. This chapter, based on randomised...
Chapter
Despite evidence in the 1980s and 1990s showing that most venous leg ulcers are due to superficial venous reflux which can be treated by varicose vein techniques, most nurses and doctors still condemn patients to long-term compression rather than curative surgery. With the advent of local anaesthetic, "walk-in, walkout" ambulatory surgery for varic...
Article
Full-text available
The role of incompetent perforating veins in the aetiology of varicose veins is not well understood. Anecdotally, competitive cyclists appeared to be more prone to varicose veins than the general population. We present a case of a 63-year-old amateur competitive cyclist who acutely developed a painful varicosity of her left calf while straining dur...
Article
Full-text available
This case study reports the diagnosis and treatment of a lower limb venous ulcer with abnormal underlying venous pathology. One male patient presented with bilateral varicose veins and a right lower limb ulcer. Upon investigation, full-leg duplex ultrasonography revealed total incompetence of the great saphenous vein in the left leg. In the right l...
Article
Background Pelvic venous reflux is often treated with pelvic vein embolisation; however, atypical pelvic venous anatomy may provide therapeutic challenges. Methods We retrospectively reviewed seven patient files and reported symptoms, diagnostic imaging, aberrant anatomy and means by which the interventional radiologist successfully completed the...
Article
Objectives Pelvic vein embolisation is increasing in venous practice for the treatment of conditions associated with pelvic venous reflux. In July 2014, we introduced a local anaesthetic “walk-in walk-out” pelvic vein embolisation service situated in a vein clinic, remote from a hospital. Methods Prospective audit of all patients undergoing pelvic...
Article
Aims To report on great saphenous vein diameter distribution of patients undergoing endovenous laser ablation for lower limb varicose veins and the ablation technique for large diameter veins. Methods We collected retrospective data of 1929 (943 left leg and 986 right leg) clinically incompetent great saphenous vein diameters treated with endoveno...
Article
Objectives To report on a male cohort with pelvic vein reflux and associated primary and recurrent lower limb varicose veins. Methods Full lower limb duplex ultrasonography revealed significant pelvic contribution in eight males presenting with bilateral lower limb varicose veins. Testicular and internal iliac veins were examined with either one o...
Article
Full-text available
Suprapubic varicose veins are usually indicative of unilateral iliac vein occlusion and venous collateralisation. We report two cases of suprapubic varicose veins following pelvic vein embolisation and subsequent pregnancy; both presented without residual pelvic venous reflux or pelvic venous obstruction. In both cases, there was no significant flo...
Article
Objectives Endovenous thermal ablation (EVTA) of varicose veins was introduced in the late 1990s with radiofrequency ablation (RFA) using the VNUS Closure device. The results of the original VNUS Closure device for the abolition of truncal venous reflux at 15 years are reported. Methods A prospective audit of a group of patients treated with VNUS...
Article
Full-text available
A 40-year-old woman with a history of alopecia areata related to stress or hormonal changes was treated for bilateral primary symptomatic varicose veins (CEAP clinical score C2S) of pelvic origin, using a staged procedure. Her first procedure entailed pelvic vein embolisation of three pelvic veins using 14 coils and including foam sclerotherapy of...
Article
Skin laxity continues to be a concern for people as they age and experience anatomical changes. While cosmetic surgery remains the gold standard and most effective type of procedure in the long term, non-surgical alternatives come with less downtime, allowing patients to return to normal activities more quickly, and are less daunting for those who...
Article
Background During sclerotherapy, it has been recommended to confirm intravenous placement of the needle by aspirating blood into the sclerosant syringe. This may inactivate some, or all of the sclerosant. Aims To quantify the volume of human blood needed to completely inactivate 1 ml of sodium tetradecyl sulphate, and comparing fresh blood and blo...
Article
Background: Nonthermal, tumescentless devices are the next generation of minimally invasive devices to treat varicose veins. We aimed to investigate the effects of mechanochemical ablation (MOCA) using ClariVein (Vascular Insights, Quincy, Mass) on ex vivo great saphenous vein with histology and immunofluorescent staining. Methods: Extrafascial...
Article
Background In previous in vitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of su...
Article
Aims: To investigate the thermal spread achieved in porcine liver when using an optimised radiofrequency ablation protocol and correlate findings with the effects seen in ex vivo great saphenous vein (GSV), in order to justify clinical use with the new treatment protocol. Material and methods: Porcine liver and GSV sections were treated with radiof...
Article
Full-text available
Objectives Pelvic congestion syndrome (PCS) is associated with pelvic vein reflux (PVR), occasionally secondary to venous compression. Its symptoms, usually intra-pelvic, are alleviated following the abolition of this reflux by pelvic vein embolisation (PVE). The objective of this report is to present two cases of left hip pain, erroneously diagnos...
Article
Full-text available
Objectives: The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins. Methods: We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis)...
Article
Objective/Background Traditionally, sclerotherapy has been thought to work by the cytotoxic effect of the sclerosant upon the endothelium alone. However, studies have shown that sclerotherapy is more successful in smaller veins than in larger veins. This could be explained by the penetration of the sclerosant, or its effect, into the media. This st...
Article
Background Pelvic venous reflux has been proven to contribute to the development of primary and recurrent varicose veins, vulval/labial varicose veins and pelvic congestion syndrome. It is associated with lower limb varicose veins in 20% of patients who have a history of at least one prior vaginal delivery. Pelvic vein embolisation is known to be a...
Article
Pelvic congestion syndrome accounts for approximately 16% to 31% of patients suffering from chronic pelvic pain, and it is the second most frequent cause of pelvic pain after endometriosis. It is a poorly understood disease, and various treatments have been suggested in the past. Hormonal treatment, which suppresses ovarian function, demonstrated v...
Article
In July 2013, the National Institute of Health and Clinical Excellence (NICE) recommended "endothermal" ablation (meaning endovenous thermal ablation) is the first line treatment for truncal venous reflux in varicose veins. The initial endovenous thermoablation devices were radiofrequency ablation and endovenous laser ablation. More recently, Glue...
Article
The aim of this study was to investigate the outcomes of radiofrequency advanced electrolysis (RAE) for the treatment of xanthelasma palpebrarum (XP) and report the outcomes of treatment at 18 months. Fifty patients presenting to an aesthetic clinic with XP between 2011 and 2013 were identified. All patients underwent clinical examination and treat...
Article
Pelvic venous reflux is known to be associated with lower limb varicose veins in 20% of women with a history of at least one previous vaginal delivery. Pelvic vein embolisation with coils has been shown to be a successful treatment in the short term. The objective of this study was to ascertain the long-term outcomes of pelvic vein embolisation for...
Article
Leg ulcers are known to have a profound effect on patients' quality of life; however, the influence of different treatment approaches is unclear. This review aims to evaluate the comparative impact of conservative treatments and superficial venous surgery, for venous leg ulcers, on patients' Quality of Life. Three electronic databases (PsycInfo, Me...
Article
Background High levels of anxiety during surgery are associated with poorer post-surgical outcomes. This prospective, non-blinded randomized controlled trial aimed to compare the effectiveness of four intraoperative distraction interventions for anxiety and pain management during minimally invasive venous surgery under local anaesthetic.Methods407...
Article
Aims and objectivesTo gain insight into the experience of living with varicose veins and undergoing minimally invasive surgery under local anaesthesia in a private clinic. Background Minimally invasive surgery under local anaesthesia is replacing traditional surgical stripping for the treatment for varicose veins. Conscious surgery has previously b...
Article
Previous research into pelvic venous reflux has suggested that the size of the ovarian veins indicates the presence or absence of reflux. It is already known that vessel diameter is not an indicator of reflux in the great saphenous vein. However, to this day, physicians still use vein size to plan treatment of refluxing ovarian veins. The authors a...
Article
Objectives: To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women. Methods: A retrospective study of patients treated in 2011 and 2012 was performed in a specialised vein clinic. Diagnostic transvaginal duplex ultrasonography in women presenting with symp...
Article
The longevity of foam made using sodium tetradecyl sulphate and gas (air or a CO2:O2 mixture) is increased significantly if silicone-free syringes are used over the normal syringes containing silicone oil lubrication. However, the plungers in silicone-free syringes start sticking after several passages when making foam for sclerotherapy, preventing...
Article
Objective The objective of this study was to report a phenomenon in patients with primary varicose veins that resembles neovascular tissue in postsurgical recurrences—primary avalvular varicose anomalies (PAVA). Methods Between March 2012 and July 2013, 756 patients (122 men, 634 women) with primary varicose veins (mean age, 53 years; range, 18-89...
Article
Results: A total of 109 patients with recurrent varicose veins in 172 legs were analyzed (mean age, 53.9 years; female-to-male ratio, 97:12). Patients were divided into four groups: group 1, all patients; group 2, female patients; group 3, female patients with children; and group 4, female patients with children who had not had hysterectomy. Pelvic...
Article
Objective: To develop a reproducible method of using radiofrequency-induced thermotherapy with adequate thermal spread to ablate the whole vein wall in a truncal vein but avoiding carbonisation, device sticking and high impedance "cut outs" reducing interruptions during endovenous treatments. Methods: Porcine liver was treated with radiofrequenc...
Article
Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive pr...
Article
Clinical Relevance Foam sclerotherapy is performed widely around the world in different environments, at different temperatures, at different altitudes, and with different ratios of sclerosant to gas, using different gases (air or carbon dioxide–oxygen mixtures) and different syringes. The most commonly used technique is the Tessari method of makin...
Article
Objective: The use of foam and liquid sclerotherapy for the treatment of varicose veins and underlying venous reflux is widespread. A novel device, the ClariVein Occlusion Catheter (Vascular Insights LLC, Madison, Conn), has been the subject of several clinical trials in humans. We report the initial histologic results obtained with use of the dev...
Article
Background There are various methods advocated for the treatment of verruca plantaris. However, many verrucas do not respond to simple treatment.Objective This study presents our results using Nd: YAG laser ablation therapy for such recalcitrant cases.Methods We performed a retrospective audit by sending a questionnaire to all patients with recalci...
Article
Objective: We have previously reported strip-tract revascularization 1 year following high saphenous ligation and inversion stripping. This study reports the 5-8 year results in the same cohort. Methods: Between 2000 and 2003, 72 patients presented with primary varicose veins and had undergone high saphenous ligation and inversion stripping plus...