Conditions We Treat

1. Thread veins

Thread veins (telangiectasia varicose veins) appear as fine clusters of vessels in the skin, usually on the face or legs, and occur due to the weakening of valves in the blood vessels. Unlike varicose veins, thread veins do not bulge and are generally painless, though they can on occasion cause some discomfort.

Microsclerotherapy

Microsclerotherapy is the gold-standard treatment for spider veins and reticular veins and uses a diluted version of the solution (sclerosant) used in sclerotherapy. It is injected using a fine needle into the problem veins and works by sealing the vessel and redirecting blood to the surrounding healthy vessels. The body will then absorb the vein over the following months. 

The procedure takes between 15 – 40 minutes to complete, depending on the size of the area to be treated, and causes minimal discomfort. Some bruising is likely to occur, along with the possibility of temporary brown discoloration of the skin; this occurs in about 25% of cases and fades over time. The veins are likely to look worse for around 6-8 weeks before beginning to disappear and larger reticular veins may temporarily feel hard, lumpy and tender before being absorbed by the body. 

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmhg). You will need to bring it with you on the day of the procedure. 

After the Procedure

  • A compression stocking is applied to the whole leg after treatment. This should be worn full-time for 48 hours. After this time, the stocking and the dressing can be removed, and the legs washed in the shower with lukewarm water. The compression stocking should be applied after that and must be worn during the day for 2 weeks and removed at night when in bed.
  • It is important to walk regularly immediately and, in the days, following the procedure. 
  • Avoid standing still for prolonged periods, and avoid running, cycling, rowing, or any high-intensity leg exercise for 1 week following treatment.
  • When not mobilising, you can rest with your legs up. 
  • It is safer not to drive home after treatment.
  • You will be scheduled for a review appointment with Mr Oluwole 4 weeks after.

Travelling

  • You may travel short distances (under 4 hours) 1 week after the procedure. 
  • It is ideal to avoid flights/train/car travel over 4 hours duration for 3 weeks following the procedure. 
  • It is important to stay hydrated and walk around the cabin regularly whenever flying to minimise your risk of blood clots.

Side Effects

It is not unusual to experience the following during treatment-

Headache: this occurs occasionally, particularly in people predisposed to migraine, and is usually treated with mild painkillers.

Cough: this occurs with higher doses of sclerosant and usually resolves within 30 minutes.

Feeling lightheaded: this is uncommon but can occur with higher doses of sclerosant or in patients with needle phobias.

Possible Issues Following Sclerotherapy

Discomfort/bruising/swelling: It is normal to experience some discomfort and bruising in the areas overlying the treated veins. It is expected that they will be tender when pushed on, and larger veins will feel hard and lumpy. Usually no pain relief is required, but paracetamol and topical anti-inflammatory cream can be used, and it is important to stay active during this time.

Hyperpigmentation: Light-brown staining occurs in about 25% of cases along the course of treated veins. This is related to the iron component of blood being absorbed by the skin, and typically fades over time.

Deep vein thrombosis (DVT): This is extremely rare (<1% of cases), but if it occurs a course of oral anticoagulation drugs (anti-clotting) is prescribed with a follow-up ultrasound. 

Telangiectatic Matting: This is rare, but a small proportion of patients can develop a network of fine new veins around the injection site. The problem is difficult to treat; some cases will resolve on their own over several months, but if the problem persists, an additional session of sclerotherapy can be trialled to target underlying reticular veins, followed by another period of observation over several months.

Recurrent veins: Recurrence rates for the larger varicose veins is up to 20% in the first 5 years following treatment. If this occurs, a repeat ultrasound scan can be performed to determine the nature of recurrence and best treatment option. Spider veins have a higher tendency to recur than varicose veins. Recurrent spider veins can be managed with ‘top-up’ microsclerotherapy sessions.

Very rare complications (<0.5% of cases)

  • Allergic reaction/anaphylaxis.
  • Ulceration.
  • Infection.

Returning to Normal

Most people will return to normal activities almost immediately and you can go back to work from the next day.

Follow Up

Mr Oluwole will see you for a follow up session in 4 weeks if needed.

Cost

Initial consultation is £175, and each treatment session is £250. You may need an ultrasound scan assessment prior to treatment.

2. Varicose Veins

Varicose Veins are swollen and twisted veins just under the skin that appear most typically on the legs and feet. There are valves inside our veins which are designed to prevent blood from flowing backwards. When these don’t work properly, blood flows in the reverse direction, collect in the veins, weakens the wall of the veins and make them appear swollen or bulging. It is unclear why most people develop varicose veins (idiopathic), but certain factors can increase your risk- such as pregnancy, having a family history, gender, being overweight or older, and having a job that requires a lot of standing.

For many people, varicose veins are simply a cosmetic concern. For majority of people however, they can also be uncomfortable causing cramps, aches, itching and swollen legs. Sometimes varicose veins can lead to more serious problems like skin eczema, skin discoloration, inflammation (phlebitis), bleeding and leg ulcers.

There is no way to completely prevent varicose veins, but exercising, watching your weight, elevating your legs, constantly changing your standing and sitting position may reduce your risk of developing varicose veins or additional ones.

There are several options for treatment. During your initial consultation, Mr Oluwole will be able to advise on the risks and benefits of each approach to find the best option for you. No treatment is guaranteed to remove all your varicose veins and the risk of recurrence is something to be aware of.

Foam Sclerotherapy

Foam Sclerotherapy is a minimally invasive procedure done under local anaesthetic. A foam solution (sclerosant) is injected into the problem vein with the guidance of ultrasound, which closes off the faulty vessels and reroutes blood to the healthy surrounding veins. The procedure generally takes around 20 – 30 minutes, depending on the number of veins to be treated.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmHg). You will need to bring it with you on the day of the procedure.

You will wear a firm bandage for five following the procedure, and then a compression stocking for an additional 10 days to minimise recurrence and aid healing. Depending on the severity of the varicose veins, you may need further or top-up treatments down the line.

After the Procedure

Following local anaesthetic, sensation should begin to return to the area after several hours, and tingling is quite normal in this time. The majority of patients find over-the-counter painkillers sufficient to deal with any discomfort following the procedure, but if you feel you need something stronger it is recommended you contact your GP or local pharmacy.

After surgery, your legs will be tightly bandaged and will need to be kept dry for five days. If you notice any bleeding, immediately elevate the leg and place a clean towel over the dressing and apply firm pressure for up to 30 minutes or until the bleeding stops. You must not remove the original bandage before the five days, unless in discomfort.

After 5 days, you may shower and bathe as normal, but you must re-apply the compression stocking and continue to wear it for 10 days as this helps support healing and prevents complications.

If there is no bleeding, most patients can gradually return to normal activities. Regular exercise after 5 days should help you to do this, but please only do what feels comfortable and stop if there is any pain. This includes having sex. You may find it difficult to drive while the bandage is on, but if you are able to perform an emergency stop it is safe to do so. You may also return to work from the next day.

Mr Oluwole will see you for a follow-up appointment in about 6 – 8 weeks after the procedure.

Risks

Bruising is uncommon, but possible after foam sclerotherapy. Brown pigmentation of the skin occurs in around 20-30% of patients but usually fades after a few months. A feeling of lumpiness in the area is normal, and usually also fades after a few months. If the varicose veins were particularly large, inflammation in the area may result in a painful red lump developing. This is called superficial thrombophlebitis and can be treated with anti-inflammatories like ibuprofen.

Please visit your local A&E or GP if you have any serious concerns, or experience any of the following: increased redness, persistent swelling, increasing pain and tenderness in the calf region; shortness of breath associated with chest pains or tightness in the chest.

Avulsions / Phlebectomy

Unlike Foam Sclerotherapy, which seals the veins but leaves them in place, avulsions involve the physical removal of the varicose veins and offer much faster results. The varicose veins are marked on the skin and a local anaesthetic is injected to minimise discomfort during the procedure. It can also be done under general anaesthetic. Small incisions will be made in the skin, and the varicose veins are then hooked out and removed. Due to the small size of the incisions (less than 1mm), stitches are not necessary, and scarring is extremely minimal. Finally, the site is dressed and bandaged to aid healing, and a compression stocking will need to be worn for a week following to prevent the formation of clots.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmHg). You will need to bring it with you on the day of the procedure.

Risks

There is a minor risk of infection, blood clots, thread veins, and damage to the nerves that provide sensation. This can result in a feeling of numbness in the area, though it resolves itself in most patients within a few months. Please visit your local A&E or GP if you have any serious concerns, or experience any of the following: increased redness, persistent swelling, increasing pain and tenderness in the calf region; shortness of breath associated with chest pains or tightness in the chest.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

Endovenous Radiofrequency Ablation

Endovenous radiofrequency ablation uses heat to seal the faulty vein. The area to be treated will be cleaned and numbed, and then a thin tube called a catheter will be placed inside the affected section of vein with the guidance of ultrasound. A radiofrequency tip will be fed through the catheter to seal up the vein using heat. After the procedure is complete, the catheter and tip will be removed, and a firm bandage will be applied to control any bleeding. A compression stocking will need to be worn afterwards, and the soreness will usually resolve within a few days.

The procedure generally takes an hour to complete, and patients can resume normal activities immediately afterwards, though it is advised that patients do not drive themselves home after the procedure.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmhg). You will need to bring it with you on the day of the procedure.

After the Treatment

The first day

The day after your procedure the local anaesthetic will have worn off so your bandaged leg may feel a little more uncomfortable and may be slightly swollen. You should take painkillers (paracetamol and/or ibuprofen) as prescribed for the first few days if needed. Pain is unpredictable and can vary from patient to patient.

The second day

The bandage should stay on for 48 hours after the procedure. You should then remove the bandage and gauze and wear the compression stockings for 2 weeks, removing it when taking a bath or shower.

The next two weeks

You should wear your compression stockings for the next two weeks: day and night for the first week, and only during the day in the second week.

The stockings may be uncomfortable and difficult to get on and off, but it is important to get them on correctly in order to get the most benefit from them. They are supposed to be tight, and you may need someone to help you put them on and take them off.

You can try using a plastic bag to make it easier: slide your foot into a small plastic bag, grasp the top of the stocking, slide the stocking over the plastic bag and up the leg, and then smooth it out evenly, making sure that the stocking is not twisted or unduly stretched. Pull the plastic bag through the open toes to remove it, and make sure to pull the stockings all the way up so the correct level of compression is applied to each part of your leg.

Don’t allow the stockings to roll down as they can form a tight band and dig into your skin. For the best results you should wear your stockings for the full two weeks, but if they become uncomfortable and painful, you can stop wearing them.

Often it is a natural reaction to limp when your leg is bandaged and a bit sore however as your muscles, bones and joints are not affected by this procedure, we advise you to walk as normally as possible. Walking is important because it keeps blood flowing in the deep veins of your leg and being inactive can increase your risk of Deep Vein Thrombosis (DVT). DVT is a blood clot that develops within a deep vein in the body, usually in the leg. We recommend a minimum of three 20-minute walks each day after the procedure for two weeks to minimise the risk of this occurring.

Please do not throw away the stockings as you may need them later if you get pain.

Most patients recover from radiofrequency ablation and foam sclerotherapy without any problems. It is normal to feel a tightening sensation in your leg after a couple of days, which may last for a few days. It is also common to experience cramping, bruising and swelling. You should take your painkillers as prescribed. 

You can carry out your normal day to day activities immediately after your treatment and do not need to avoid anything in particular. However, you should avoid strenuous exercise for the first few days and then gradually build up the amount you do. Do not exert yourself initially and be guided by how well you feel. 

You can return to work when you feel well and comfortable. We usually advise taking between two days to one week off work, depending on the type of work you do. If your job involves prolonged standing, driving or if you’ve had both legs treated at the same time you may need to take longer off work.       

We advise that you do not drive for at least 48 hours after your procedure. You should only drive again when you are free of pain and able to perform an emergency stop comfortably. 

Sitting down for long periods with the knees bent increases the risk of DVT (a blood clot deep in the legs). You should avoid flying long haul (any flight over four hours long) for at least four weeks after your procedure. 

There are potential complications with any medical procedure, however only minimal complications have been reported with radiofrequency ablation. Some of the common problems are listed below.

 

Bruising

Some bruising is normal and occasionally the leg will become very bruised. This may occur during the first few days following the procedure but will disappear after a few weeks.

 

Superficial thrombophlebitis

Superficial thrombophlebitis are hard areas of blood clotting which feel like a lump and form in the treated veins. Most patients will experience some lumps- which may be inflamed and uncomfortable- but this is nothing to worry about. If this occurs, anti-inflammatory drugs such as ibuprofen will help. The lumps will eventually subside and disappear, but it may take weeks or several months to do so.

Usually when there is inflammation, the leg will be painful and this pain may last for up to a month. Also, severe twinges of pain may occur in some patients and may persist for some months; again you can take painkillers as prescribed.

Regular daily exercise such as walking, using an exercise bike or wearing your stockings for a few more days may help with the pain. Although this may be uncomfortable try not to rest your leg as this increases the risk of developing blood clots in the deep veins (DVT).

 

Brown pigmentation of the skin

This can occur following superficial thrombophlebitis. It usually fades over time but can be permanent. It is common with Foam Sclerotherapy but can also occur with RFA.

 

Nerve injuries

Some nerves run close to the vein so can get damaged by the procedure. This may cause numbness, tingling and paraesthesia (pins and needles). This reduced sensation may be very noticeable at first but normally diminishes with time.

 

Deep vein thrombosis (DVT)

This is a very rare complication of radiofrequency ablation. To lower this risk the most important advice is to move around when you can and avoid long periods of not moving.

 

Recurrent veins

No treatment for varicose veins can be completely guaranteed against it recurring. Some people can still grow new veins even when all previous veins have been treated correctly. Overall, the risk of recurrence after these procedures is thought to be about 1 in 10 cases.

Radiofrequency ablation significantly reduce the risk of recurrence. Regular exercise, weight control, and wearing light support stockings can all help prevent you from being troubled by varicose veins in the future.

It is important for you to understand that not every visible vein will disappear as a result of your treatment. Your treatment has been for symptoms, not overall appearance. There is usually the bonus of improved cosmetic result, but this is not guaranteed.

Yes, your payment includes a one-off follow up appointment with Mr Oluwole, usually 6 weeks after your treatment. This will be arranged before or soon after your discharge.

Ligation and stripping

Ligation involves the tying off the greater saphenous vein in the leg (which runs from the foot to the groin area) just before it joins the deep veins, and stripping involves the surgical removal of this vein. In both, the vein is accessed through a small incision in the groin or back of the knee and is usually performed when other less invasive treatments are unsuitable or unsuccessful. The area will be firmly bandaged, and a compression stocking will need to be worn for 2-6 weeks post-op.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmhg). You will need to bring it with you on the day of the procedure.

The stockings may be uncomfortable and difficult to get on and off, but it is important to get them on correctly in order to get the most benefit from them. They are supposed to be tight, and you may need someone to help you put them on and take them off.

You can try using a plastic bag to make it easier: slide your foot into a small plastic bag, grasp the top of the stocking, slide the stocking over the plastic bag and up the leg, and then smooth it out evenly, making sure that the stocking is not twisted or unduly stretched. Pull the plastic bag through the open toes to remove it, and make sure to pull the stockings all the way up so the correct level of compression is applied to each part of your leg.

Don’t allow the stockings to roll down as they can form a tight band and dig into your skin. For the best results you should wear your stockings for the full length of time as advised by Mr Oluwole, but if they become uncomfortable and painful, you can stop wearing them.

Walking and staying mobile after vein surgery is important because it keeps blood flowing in the deep veins of your leg. Being inactive can increase your risk of Deep Vein Thrombosis (DVT). DVT is a blood clot that develops within a deep vein in the body, usually in the leg.

Please do not throw away the stockings as you may need them later if you get pain.

 

Risks

Most patients will go home same day though some may need to stay in hospital overnight. There is, like any surgical procedure, a small risk of infection, and a greater risk of permanent scar formation compared to foam sclerotherapy.

Severe pain is unlikely, but there is a possibility of burning or tingling in the leg (caused by disruption to the saphenous vein) for which over-the-counter painkillers are generally sufficient to resolve. Numbness and discolouration of the skin can sometimes also occur and usually resolves itself within a few months, and patients should continue to wear compression stockings and take frequent walks and low-impact exercise to reduce the risk of post-operative complications.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

3. Peripheral arterial disease/Blocked arteries

Peripheral Arterial Disease (PAD) is a chronic condition caused by fatty deposits (atheroma) in the blood vessels, which cause them to narrow (atherosclerosis) and reduces blood flow to the legs. While many people with PAD have no symptoms, some experience pain or aching in the legs when walking which goes away after resting for a few minutes. This is called intermittent claudication and can affect one or both legs at the same time. Other symptoms can include cramping, numbness, weakness in the legs, a feeling of coldness or colour change, hair loss or shiny skin on the legs, open sores (ulcers) that heal unusually slowly, pain in the legs at night, slow-growing or brittle toenails, and erectile dysfunction in men. If left untreated, it can lead to gangrene or limb loss.

You are more likely to be at risk of PAD if you are a smoker, if you have high blood pressure or cholesterol, are diabetic, runs in family and if you are older. If you suspect you may have PAD it is important to see your doctor.

In most cases, lifestyle changes and/or medication are the first line of treatment for Peripheral Arterial Disease. In more serious cases, you may be referred for revascularisation procedure. During your initial consultation, Mr Akin Oluwole may order tests to assess your condition, and will be able to advise you on your options.

Angioplasty / stenting

During an angioplasty, a catheter is inserted into the affected artery under local anaesthetic. A balloon is then fed through the catheter and inflated to squash the atheroma (fatty deposit) into the vessel wall, which widens it. It is normal to feel some pain during the procedure, but this should go away when the balloon is deflated. It is also common to feel a slight change to your heartbeat while the operation is performed. The whole procedure generally takes between 30 minutes to 2 hours to complete and many patients can go home same day.

A wire mesh tube called a stent may be inserted at the same time as an angioplasty, which helps to keep the artery widened. If you have a stent, you will need to take certain medications afterwards to reduce your risk of blood clots.

Risks

It is common to feel tenderness in the area, and to experience some bruising where the catheter was inserted, though over-the-counter painkillers are generally sufficient to deal with any soreness. There is also a risk of bleeding, damage to the artery (occlusion and dissection). Limb loss, heart attack and stroke is possible but very rare

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

Exercise Therapy

Exercise therapy is an effective initial treatment option for the easing of pain caused by narrowed arteries (claudication). Peripheral Arterial Disease (PAD) can make it difficult to walk and participate in day-to-day activities which can impact quality of life. A supervised regimen of exercise, if available in your area is the best but if not, walking 30-40mins every day and walking through the pain barrier is a highly effective way of reducing the severity of PAD symptoms and improve mobility and independence.

It is recommended that patients also make other lifestyle changes- such as quitting smoking- in addition to undergoing endovascular treatment for the best overall outcome.

Medical Therapy

The use of certain medications in combination with exercise therapy and other lifestyle changes can reduce the need for more invasive treatments. These include statins, which reduce the amount of cholesterol in your blood; anti-hypertensives that reduce your blood pressure; antiplatelets such as aspirin or clopidogrel; and a drug called naftidrofuryl oxalate which can improve the blood flow in your body.

Mr Akin Oluwole will formulate a treatment plan with you that is tailored to your situation, considering all of the available options.

Bypass Surgery

When other treatment options are unsuitable or have not been successful, a bypass graft may be performed. A synthetic vessel or a healthy vein from your leg or arm can be grafted (attached) to the diseased artery, which allows the blood to bypass the blockage. This is performed under general or spinal anaesthetic and takes between 2 – 4 hours. For most patients, this surgery will decrease pain, decrease the future risk of amputation of the limb, and improve mobility- particularly when this is complemented with lifestyle changes, such as quitting smoking or improving your diet.

Most people will need to recover in hospital for 3 to 5 days after bypass surgery. You should be able to resume normal activities after around 4 to 6 weeks. You will have a follow-up appointment with Mr Oluwole to check the progress of your recovery and to discuss any queries you may have.

Risks

As with any major surgical operation, there is a risk of complications. These include irregular heartbeat, infection of the wound and graft, thrombosis (blood clots), stroke, heart attack and bleeding. Pre-existing conditions such as diabetes or cardiovascular disease (CVD) can increase your chances of developing complications.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

4. Aneurysms

An aneurysm is simply a weakening and bulging of the aortic wall. The aorta is the main blood vessel that runs from the heart down through the chest and tummy. An aortic aneurysm can be dangerous if not detected early. It can get bigger over time and can burst leading to catastrophic life-threatening bleeding. Most of the time there are no symptoms until it ruptures (bursts), but some people may experience abdominal or back pain.

If you are diagnosed with an aneurysm, there are several options available. Most aneurysms are at low risk of rupturing, particularly if it is small to medium in size (between 3 – 5.4cm across). Yearly monitoring with ultrasound scan and lifestyle changes (such as stopping smoking, well controlled blood pressure , well controlled diabetes and eating healthily) is recommended.

For aneurysms identified as at risk of bursting, the vessel may be strengthened via surgery to prevent this happening.

Endovascular Aneurysm Repair (EVAR)

During this surgery, a small graft made of a fabric-covered tube is inserted via a small cut in the groin area, and fed up through the vessel to repair the aneurysm. This is performed under general anaesthetic, and most patients will spend just 1 overnight stay in hospital.

Endovascular aneurysm repair is less invasive than open aneurysm repair, but the long-term outcome is usually the same. You will likely need regular check-up scans to make sure the graft remains in place and is still working properly.

Risks

As with any surgical procedure, there is a risk of bleeding and infection, and a risk of blood clots, further procedures, endoleak, stroke and heart attack. Other factors can increase your risk- such as the shape of the aneurysm, and whether you have any other conditions, like kidney or lung disease.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

Open Aneurysm Repair

If endovascular aneurysm repair is not appropriate or suitable, then there is the option for an open aneurysm repair. The aneurysm is accessed through a cut in the abdomen, and the graft- a fabric covered tube- is sutured in place directly to replace the diseased section of artery. This is a much more invasive surgery and therefore takes longer to recover from, but usually continues to work for the rest of your life.

Most patients will spend 7-10 days in hospital, and it may take about three months to return to normal levels of activity.

Risks

As with any surgical procedure, there is a risk of bleeding and infection, and a risk of blood clots, stroke, heart attack and death 1%. Other factors can increase your risk- such as the shape of the aneurysm, and whether you have any other conditions, like kidney, heart or lung disease.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

5. Carotid Surgery for Stroke Prevention

Fatty deposits can build up in the carotid arteries in the neck, narrowing the vessels and increasing your risk of stroke; this is called carotid artery disease, or carotid artery stenosis. Often there are no symptoms until the condition progresses to the point of causing a stroke or transient ischemic attack (TIA).

The main symptoms of a TIA can be remembered with the word FAST:
Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have dropped.
Arms – the person may not be able to lift both arms and keep them raised because of weakness or numbness in 1 arm.
Speech – their speech may be slurred or garbled, or the person may not be able to talk at all, despite appearing to be awake; they may also have problems understanding what you’re saying to them.
Time – it’s time to call 999 immediately if you see any of these signs or symptoms.

Carotid artery disease is usually diagnosed after brain imaging following a stroke or TIA; or it may be picked up during unrelated tests.

There are two options for treatment, and Mr Oluwole will be able to advise on the best course of action for you.

Carotid Endarterectomy

During this surgery, a cut will be made in the neck just below the corner of your jaw to allow access to the carotid artery and then a small cut will be made in the carotid artery to manually remove the build-up. This can be done under local or general anaesthetic. The surgeon may put in a shunt, which allows blood to go around the surgery site and continue flowing from the heart to the brain during the operation, and a drainage tube to drain any blood from the area at the end of the operation. After the blockage is removed, the artery and the skin are stitched closed. The drainage tube is usually removed the day after surgery.

Most patients are able to go home 1-2 days after the procedure and can return to work 2-4 weeks after. Following surgery, the risk of stroke is significantly reduced, and lifestyle changes- such as stopping smoking and eating healthily- will help maximise this benefit.

Risks

There is a risk of heart attack, and a risk of stroke- which is higher if you have had a stroke previously. Pain, numbness and bleeding at the wound site are common. There is also a risk of nerve damage, though this generally resolves itself within a few months, and a risk of re-narrowing of the carotid artery (restenosis) which would require further surgery to treat.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

Carotid stenting

Carotid artery stenting is a less invasive treatment for carotid artery disease and involves using a metal mesh tube to widen the artery. It is usually performed under local anaesthetic and can be a good alternative for patients that are unsuitable for surgery- for instance, due to previous nerve damage in the area or arteries that are difficult to reach surgically. First, a flexible tube called a catheter is inserted into the vessel through a cut in the groin area and fed up through the body to the affected section. A balloon at the end of the catheter is inflated to widen the artery, and the stent is then put in place to keep the vessel open.

Most patients can return home the next day. The risk of stroke is slightly higher after carotid stenting compared to a carotid endarterectomy, but the long-term reduction in stroke risk is largely the same for the two procedures. You may also need to take medication to reduce the risk of blood clots following the insertion of a stent.

Risks

Bleeding and bruising are common at the site where the catheter is inserted. There is also a risk of infection, and a risk of damage to the arteries during the procedure, both of which will be minimised as far as possible by the surgical team. The risk of stroke is slightly elevated during and after the procedure- but will be lower than if the condition was left untreated. There is also a possibility your arteries may narrow again (restenosis), requiring further treatment.

During your initial consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

6. Hyperhidrosis/Excessive Sweating

Hyperhidrosis, or excessive sweating, is a condition where the body produces more sweat than is needed to keep the body cool. This may be due to a variety of reasons- such as medication or a family history- and can cause embarrassment as well as disruption to daily activities.

Botox Injection

One treatment available for hyperhidrosis is botox injection. Botulinum toxin (usually referred to as ‘botox’) is injected into the underarm area, and the toxin works by blocking the signal from the nerves. This effectively prevents the sweat glands from producing sweat and lasts between 3- 6 months.

Risks

There are relatively few risks associated with botox injections for hyperhidrosis in the underarms and it is highly effective in treating hyperhidrosis in this area. There is small possibility of pain or tenderness from the use of injections, and some patients may experience flu-like symptoms for the first 24 hours.

During your initial consultation, Mr Oluwole will discuss the procedure and any risks in detail with you.