J M Holdstock's research while affiliated with Central London Physiotherapy and Sports Injury Clinics and other places

Publications (40)

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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...
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
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...
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Full-text available
Neovascularization after vein stripping is well recognized as a contributory cause of varicose vein recurrence. Treatment is challenging because of segment tortuosity and fibrous web formation. Surgical re-exploration is practiced, but foam sclerotherapy is becoming preferred. We suggest an alternative method using thermoablation with a technique o...
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 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
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
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...
Article
To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids. Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with...
Article
Endovenous laser ablation is a minimally invasive catheter-based procedure for the treatment of varicose veins. The procedure involves injecting tumescent anaesthesia around the catheterised truncal vein, before thermal ablation by the laser. We report a case of a false aneurysm arising from a branch of the inferior epigastric artery, following end...
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Full-text available
Objective: Endovenous thermoablative techniques are gaining popularity in the treatment of varicose veins. Segmental radiofrequency ablation (RFA) has recently been introduced as an option using local anaesthesia. The aim of this study was to compare the post-operative pain profiles of segmental RFA (VNUS ClosureFAST) and endovenous laser ablatio...
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Aims: Reflux in the Anterior Accessory Saphenous Vein (ASSV), formerly "Lateral Thigh Vein", is one of the commonest patterns of recurrent varicose veins. Catheter based thermo-ablation techniques (Endovenous Laser Ablation -EVLA or Radio-Frequency Ablation -RFA) require individual venous trunks to be cannulated and treated separately, increasing t...
Article
Objectives: This is a retrospective study over 12 years reporting the healing rates of leg ulcers at a specialist vein unit. All patients presented with active chronic venous leg ulcers (clinical,aetiological, anatomical and pathological elements [CEAP]: C6) and had previously been advised elsewhere that their ulcers were amenable to conservative...
Article
Deep vein thrombosis (DVT) after varicose vein surgery is well recognised. Less well documented is endovenous heat-induced thrombosis (EHIT), thrombus extension into a deep vein after superficial venous thermoablation. We examined the rates of DVT in our unit after radiofrequency (RFA) and endovenous laser ablation (EVLA) with specific attention to...
Article
Early success treating incompetent perforator veins (IPVs) with radiofrequency ablation (RFA) and the trend to move varicose vein surgery into a walk-in walk-out service led to the design of a specific device enabling RFA of IPVs using local anaesthesia (ClosureRFS stylet). Our aim was to assess one-year outcomes of a clinical series of patients un...
Article
In 2000, we developed a percutaneous method of treating incompetent perforator veins (IPV) using ultrasound-guided radiofrequency ablation (RFA), which we termed TRansluminal Occlusion of Perforator (TRLOP). To audit the five-year outcome of the TRLOP technique as indicated by the rate of IPV closure on duplex ultrasound (DUS). Patients underwent D...
Article
Mounting evidence suggests that pelvic vein reflux is an important contributing factor to recurrent varicose veins. We compared the incidence in our specialist private unit (Unit A) with that of a District General Hospital (Unit B). Results of all female patient lower limb duplex ultrasound (LLDUS) and transvaginal pelvic ultrasound (TVUS) scans pe...
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Full-text available
Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-pro...
Article
To establish a possible mechanism of damage to a laser fibre significant enough to cause a retained segment within a patient. A 21 G needle was used to pierce a VARILASE 810 nm Laser Fibre inserted within a 4F sheath. A tiny pin source of light from the aiming beam emerged from the needle hole in the sheath. Using laser protection protocol, the gen...
Article
This randomized trial was undertaken to investigate the fate of incompetent perforating veins (IPVs) following saphenofemoral ligation and stripping of the great saphenous vein (GSV), with or without subfascial endoscopic perforator surgery (SEPS). Patients with venous reflux (greater than 0.5 s) of the GSV and additional IPVs were allocated random...
Article
Varicose veins that recur after standard high tie and strip are often associated with venous reflux in the thigh, as shown by duplex ultrasonography. The aim of this study was to look for evidence of revascularization in the strip track after great saphenous vein (GSV) stripping. A consecutive series of patients with duplex-proven great saphenous v...
Article
Small saphenous vein (SSV) disconnection and removal are challenging and considered by some authors to have too high a morbidity and failure rate to justify their routine use. Our audited results are at variance with these views. We describe a reliable, ultrasound guided, minimally invasive technique for ligation and stripping of the SSV with an in...
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Despite adequate training in the surgical treatment of varicose veins, recurrence continues to be a problem and a burden to the vascular services. A major cause of recurrence is reported to be neo-vascularisation at the sapheno-femoral junction (SFJ). The aim of this study was to compare the incidence of neo-vascularisation at the SFJ following rad...
Article
A variety of approaches has been described for the treatment of recurrence at the saphenofemoral junction (SFJ) after primary varicose vein surgery most, of them based on dissection through virgin tissue. This observational study describes our clinical experience with the VNUS Closure, a percutaneous catheter-based procedure in which the long saphe...
Article
The VNUS Closure is an endoluminal, percutaneous catheter-based device using a radiofrequency current to cause permanent closure of the long saphenous vein (LSV) as an alternative to high tie and stripping. This study describes our postoperative ultrasound scan surveillance results of VNUS Closure cases over a one year period. Between March and Aug...
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Full-text available
Objective: Trendelenburg's theory was based on the concept of a descending valvular incompetence commencing at the saphenofemoral junction (SFJ) with subsequent distal progression of reflux. The aim of this study was to evaluate the distribution of reflux in patients with superficial venous incompetence in order to assess validity of the above hypo...
Article
Objective Trendelenburg's theory was based on the concept of a descending valvular incompetence com mencing at the saphenofemoral junction (SFJ) with subsequent distal progression of reflux. The aim of this study was to evaluate the distribution of reflux in patients with superficial venous incompetence in order to assess validity of the above hypo...
Article
In an attempt to reduce the morbidity of high tie and strip of the long saphenous vein various extraluminal and intraluminal electrosurgical devices have been employed in the past using monopolar energy to ablate varicose veins. As result of this full-thickness skin burns and saphenous nerve injuries were observed by surgeons using these techniques...
Article
we suspected incompetent perforating veins of having a role in the development of recurrent varicose veins in some patients. The aim was to look for an association between perforators and recurrent varicose veins. a consecutive group of patients presenting with varicose veins were examined using colour duplex ultrasonography by an experienced vascu...

Citations

... The technique was extremely easy to apply, very reliable both in terms of patient's satisfaction and the clinical results. On the other hand, Whiteley et al., 2017 [21] ; reported neovascularization, the most common cause of recurrence, in three patients (2%) in his study on fifty-eight patients (91 legs), the origin couldn't be confirmed, but all three patients under went previous traditional surgical procedures before presenting to their study for RFA. Therefore, it is highly unlikely it was theconsequence of RFA, especially considering the low neovascular occurrence within the remaining cohort and the previously published data of the lack of neovascularization after RFA in primary varicose veins as shown by Kianifard et al., 2006 [22] . ...
... They revolutionized the treatment by shifting away from hospital-based stripping procedures to office based endovenous procedures. In addition to the obvious benefits of reduced pain and faster recovery times with thermal procedures, the durability of both laser and radiofrequency methods have been proven in long-term follow up studies [1][2][3] . ...
... This gives a clear colour demarcation as to the extent of the thermal ablation laterally away from the catheter, that can be measured. The results from this model have been shown to correlate well with effect seen histologically in great saphenous vein [19] and this in turn correlates well to clinical outcomes at 1 year [20]. ...
... Valve failure and venous reflux is an ascending problem starting from below. 13,14 • Stripping varicose veins out surgically does not permanently remove veins, as most grow back but without valves, during the healing process, causing the same problem to recur. 15,16 Although both health-care professionals and the public are aware of endovenous surgery, particularly with the profusion of websites and adverts on the internet for minimally invasive treatments for varicose veins, few are aware of the major changes in the understanding of varicose veins and their management. ...
... While the authors cannot verify the "true" initial state of the overtreated veins, those that have been undertreated were shown to have persistent reflux at a follow-up TVS almost 100% of the time. 23 Fig . 2 shows the distribution of vessel diameters for both groups. Diameters above and below the purported 8-mm cut-off value can be seen in both groups and, although there is a slight tendency for veins of a smaller diameter to show no reflux on TVS, one can see clearly that there is absolutely no relationship between vein diameter and venous reflux. ...
... In 1999, Boné reported for the first time the closure of an incompetent saphenous veinusingendovenouslyapplied laser light [338]. Radio-frequency treatment of a varicose saphenous vein was described at the same time [339]. Since then, endovenous thermal treatment has developed into a standard treatment method. ...
... No pathological changes were observed in their gynaecological examinations or endocrine evaluations, thus ovarian varices seemed to be the sole suspected factor of their infertility (14). Dos Santos et al. reported good safety outcomes for coil embolization of pelvic veins in 8 patients (15). In our cohort, embolization of ovarian veins enhanced the chance of becoming pregnant, and no changes were observed in female hormone levels. ...
... In 2000, we invented the TRLOP procedure, which we presented nationally and internationally. 110 Under ultrasound control, the IPV was cannulated, and a device passed into the perforator to ablate it. Initially, we used radiofrequency and have subsequently used endovenous laser. ...
... The first group (n = 42) included patients with symptoms and signs of PeVD (CPP, heaviness in hypogastrium, dyspareunia, dysuria, vulvar varicosities). The intensity of pain syndrome was evaluated using a visual analogue scale (VAS) ranging from 0 to 10 scores (where 0 is no pain and 10 is maximum pain) and was graded as mild (1)(2)(3)(4), moderate (5)(6) or severe (7)(8)(9)(10). The second group (n = 38) consisted of patients without clinical manifestations of PeVD, in whom pelvic varicose veins were identified accidentally during a routine gynecological ultrasound examination of the pelvic organs or during examination for chronic venous disease (CVD) of the lower extremities. ...
... However, ovarian vein diameter is a poor predictor of gonadal vein reflux, and dilated pelvic veins can often be incidentally found in asymptomatic women. Therefore, the consensus statement from the Society of Interventional Radiology states that the absolute diameter of the veins should not preclude treatment of PVI in the presence of other findings [15]. ...