Need to book a consultation for your varicose veins or artery condition or just looking to discuss your options first? Perhaps you’re interested in scheduling a stocking fitting with our nurse?

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Excessive sweating, also called hyperhidrosis, is usually a problem that mainly affects older teenagers and young adults. It can be embarrassing, causing social anxiety and difficulty with everyday activities, such as handshakes and even holding a pen.

Treatment options range from strong antiperspirants, medications, Botox (a brand name for botulinum toxin, we use Dysport) through to surgical treatments, also called thoracoscopic sympathectomy. We will discuss the best option if you have excessive sweating.

Leg artery disease is also one of the more common arterial vascular conditions. If you have cramping when walking it may indicate leg artery problems, also called intermittent claudication. In more severe cases this can lead to pain, ulcers and gangrene, which needs urgent treatment.

In milder cases of claudication, we will often recommend observation and good risk-factor control of, for example, cholesterol, high blood pressure and diabetes control and stopping smoking. If walking becomes difficult, or when there is pain or ulcers, minimally invasive treatment is effective, for example, angioplasty and stent. Sometimes a patient will need an operation called arterial bypass.

All patients with leg artery narrowing caused by atherosclerosis should be on ‘best medical therapy’, ie, low-dose Aspirin, a statin and good blood pressure control. If you smoke, you need to give up.

Peripheral arterial disease (PAD) refers to diseased leg arteries. When cholesterol builds up in the leg arteries, it may cause narrowing and blockages in the arteries and, as a result, this may cause atherosclerosis. Impaired blood flow down the leg arteries may result in various symptoms and problems emerging.

A degree of PAD is relatively common with ageing. This often does not cause any symptoms and, as a result, does not require any specific treatment, apart from maintaining a healthy lifestyle, exercising, weight control and good control of both high blood pressure and diabetes. Treatment is usually with low-dose Aspirin and a statin to control cholesterol. Stopping smoking is essential. In most cases, PAD does not progress rapidly and management is safe with simple monitoring.

When PAD does start to cause symptoms, a person may experience leg muscle pain with walking. Intermittent claudication is the usual term for this, meaning that it comes on with walking and stops with rest. When claudication becomes a real problem for someone, artery treatment is beneficial.

There are two main treatments for narrowed and blocked leg arteries caused by PAD.

Minimally invasive treatments include angioplasty and stent. These are day-case procedures using local anaesthetic. The aim is to widen a narrowed artery or to re-open a fully blocked artery, usually with a combination of high-pressure balloons and stents.

Bypass surgery is the next step when angioplasty and stent are not possible or have not been successful. This is an operation that puts a new artery in the leg, often using part of a patient’s own surface vein. Hospital stays after bypass surgery will usually be 3-7 days.

Abdominal aortic aneurysm is also known as AAA. It occurs when a part of the main artery in the abdomen, the aorta, grows larger than normal. Other arteries in the body can also develop into aneurysms, such as the aorta in the chest and the leg arteries. Sometimes there is a relationship between these aneurysms and brain aneurysms.

AAAs gradually increase in size over a time frame of many years. As the size increases, the risk of rupture or bursting rises. When a rupture occurs there is often massive bleeding, causing a life-threatening emergency.

The management of small aneurysms, less than 5cm from side-to-side, is usually by regular ultrasound scan observation. When the size of an AAA goes over the 5cm mark, the risk of rupture starts to increase and at that stage discussion about treatment will begin.

There are two types of aortic aneurysm treatment. In younger and fitter patients, open surgical repair will be recommended. This is the best treatment for this group of patients who have many years of life ahead of them.

For older, less fit patients, an aneurysm stent, also called endovascular aortic aneurysm repair (EVAR), is often the best treatment, as long as the shape of the aneurysm is suitable. This is a minimally invasive procedure, with quicker recovery. Afterwards, however, the aneurysm will need close ultrasound scan monitoring.

There is a carotid artery on each side of the neck. These arteries transmit blood from the heart to the brain. When cholesterol builds up inside the artery, it can cause a narrowing or blockage, also called atherosclerosis or plaque.

In most people, this build up of cholesterol does not cause any problems. The best management is to treat any underlying conditions, such as high blood pressure, high cholesterol and diabetes. Stopping smoking is also essential.

In some people, small fragments of cholesterol can break off and pass to the brain or sometimes the eye on that side. When this occurs, a stroke, mini-stroke or visual disturbance may result. A mini-stroke is also called a TIA, which means transient ischaemic attack.

A stroke occurs when an area of the brain dies. This will often cause speech, movement, brain function, and eye deficits. Carotid artery disease causes about 30% of strokes. Other causes of strokes are bleeding and blood clots, which may come from the heart.

An operation called carotid endarterectomy can clean out the segment of disease, to prevent further carotid problems developing. Healthy people with severe narrowing may be benefit from surgery to help reduce the risk of future stroke.

Patients who’ve had a recent stroke with significant narrowing, are the main candidates for carotid endarterectomy, to reduce the risk of recurrent stroke.

Vascular ultrasound is a dynamic way of looking at veins and arteries to provide information about the way blood flows. It uses sound waves to create images of your body.

Most often one of our sonographers will carry out the scan. Sonographers are highly trained and skilled at assessing and performing the ultrasound. Confirmation of the scan results, clinical interpretation and any other recommendations, is the domain of our vascular surgeon, who is trained and credentialed in ultrasound. Dr Evans is also qualified to perform ultrasounds.

Your ultrasound scan will usually be booked before your consultation with the surgeon.

Before your scan we will give you instructions on what to do and what to expect. This includes what to wear. We recommend wearing loose, comfortable clothes with a separate top and trousers/skirt. We provide privacy covers. We’ll also tell you whether you can eat or drink beforehand. Remember, your appointment is for the ultrasound scan only. Our helpful admin staff will give you a separate appointment time with Dr Evans or a specialist nurse.

Your scan may be of your legs, with you standing or lying down, of your abdomen or neck (lying down). For some investigations for women, like for pelvic scans or scans of iliac veins, we may use a transvaginal probe. We will give you all the information before your scan.

Scans take between 30 and 60 minutes. We will tell you how long to expect. Your sonographer will talk to you about any post-scan precautions but you can usually resume normal activities straight away.

Spider veins are visible on the surface of the skin and are often unsightly. Unlike varicose veins, they do not bulge out or if they do, it is just very slightly. They appear as lines or as bursts and have a range of colours from bright red to purple.

‘Spider Veins’ is the general term for the range of skin surface veins that occur. This range goes from the very small, bright red telangiectasias, through to the reddish-purple spiders per se, to the bigger reticular veins. Often, all three of these are present at the same time.

When they occur on the face, they are called facial veins. These are usually the very small telangiectasias.

Often a person will have either visible varicose veins or there will be a suggestion that the deeper surface veins in the legs are not working properly. An ultrasound scan of the leg veins will confirm whether this is the case.

Treatment commonly falls into two categories: sclerotherapy and skin laser. Often a person’s treatment will involve a combination of these.

Sclerotherapy involves the injection of a small amount of irritant into these small veins, which blocks off the veins. It is then reabsorbed by the body.

Laser is a skin treatment that uses a vascular laser. Laser light targets the blood inside the tiny veins, causing them to block off and be reabsorbed by the body.

Varicose veins develop when the one-way valves in your main surface leg veins stop functioning properly, causing blood to flow backward and pool down in the feet. This increased pressure causes the veins to enlarge, swell and often bulge outward, creating visible and sometimes painful varicose veins. Common symptoms include aching, throbbing, heaviness and discomfort, particularly after standing for long periods.

Inside the veins, these valves normally ensure blood flows upwards toward the heart, even when standing. When these valves fail, blood flows downward toward the feet, leading to pooling and increased vein pressure. Over time, this can worsen, potentially causing complications like skin changes, swelling and blood clots.

While varicose veins can be unsightly or uncomfortable, advanced and minimally invasive treatments are available to improve vein health, relieve symptoms and restore your confidence.

Varicose veins often do not cause symptoms in the early stages and may simply appear as visible, unsightly veins.

When symptoms do occur, they are typically related to the increased pressure caused by pooling blood in the legs. Common symptoms include aching, throbbing, itching, burning and cramping. It’s important to note that varicose veins do not cause restless legs syndrome.

As the condition progresses, increased vein pressure may start to affect the skin, leading to issues such as discoloration, thickening, eczema or cellulitis.

In some cases, blood clots can form within the veins, causing surface blood clots, resulting in superficial vein thrombosis (SVT), phlebitis or superficial thrombophlebitis. More serious complications, like deep vein thrombosis (DVT), can occur if clots develop in the deeper veins of the legs, which may lead to lung clots called pulmonary embolism (PE).

Bleeding from veins is another concern, particularly for older adults. Early diagnosis and treatment are key to maintaining vascular health.