Varicose Veins Patient Journey at Duchy Hospital

If you want to find freedom from uncomfortable or unsightly veins, our Consultant Vascular Surgeon, Mr Rob Windhaber, and his team are able to help. Our “gold standard” laser treatments provide excellent value and are performed under local anaesthetic on a walk in walk out basis.

There are no waiting lists, no major cuts, and you can return to work after just 24 hours. Endovenous Laser Ablation is the simplest and most effective treatment available for most types of varicose vein.

At Duchy, we are recognised by all the major insurance companies and provide complete peace of mind for self-funding patients with our fully-inclusive Ramsay TotalcareTM packages. Private care doesn’t have to be expensive. For a full list of the varicose vein treatments and what they cost at Duchy Hospital click here.

up close image of facial thread veins

Image - Facial thread/spider veins

How does the process work?

The process begins with a detailed and thorough face to face consultation in the outpatient clinic. This takes about 1 hour and during this assessment you will meet our expert vascular surgeon Rob Windhaber who performs all our vein removal treatments.

Rob will ask you about your vein condition, your medical history, about any medication you are taking and any allergies that you have. He will then examine your legs and perform a detailed ultrasound venous duplex scan on both legs to look at how the veins are working and identify the cause and extent of any vein problem. 


up close image of ankle with blue varicose veins  ankle with gloved hands touching the veins

Images Left to Right - 1. An example of extensive ankle blue veins (Corona Phlebectatica) with visible feeding varices (Varicose Veins) at risk of bleeding, note simple, uncomplicated spider veins have a very low risk of bleeding. 2. An example of a patient with Corona Phlebectatica around the inside ankle due to underlying reflux.  


The most important part of the of the consultation is the discussion that follows this. During this time Rob will explain about your vein problem, listen to all your concerns and talk you through all your options. This will not only include the options to treat your veins but also your options for managing your vein problem conservatively.

At the end of this process you should have all the information you need to decide what is best for you and understand how we can support you with this. After your consultation we will send you a detailed letter including a fixed price quote for any treatment you are considering. If you wish to proceed with treatment this can be arranged through Rob’s secretary Claire Bosustow whose details will also be in the letter.


  up close image of knee with thread veins being injected  three legs with blue varicose veins

Images Left to Right - 1. Mr Rob Windhaber injecting spider veins in a patient who had underlying varicose veins, note that initially the veins disappear as all the blood is displaced by the sclerosant. 2. An example of thread veins caused by reticular veins. Note the visible reticular vein (blue and running in a vertical orientation) on the right-hand picture and how the veins fan from a central focus. 

Can veins be assessed by a video consultation?

We always follow best practice and take our responsibility to you very seriously. Providing the best care to patients with leg vein problems requires a detailed assessment and deep understanding of your health and vein condition. Whilst it is possible to assess facial veins (that do not require a scan) via video link, a proper leg vein assessment cannot be safely carried out in this way. The main reason is that an ultrasound duplex scan of the leg veins is required before the vein problem can be accurately diagnosed.

This can only be done face to face. Without an accurate diagnosis, it is impossible to provide safe and honest advice about what treatment options are available and what the individualised risks and benefits are for each of these treatments is. Valid medical consent is a 2 stage process and relies heavily on the initial outpatient consultation. Whilst video consultations are very convenient to both patients and surgeons, it is our understanding (based on current GMC and Royal College guidelines) that any consent obtained for these leg vein procedures based purely on a video consultation and a scan on the day of treatment would not be legally valid. 


up close image of blue thread veins being injected  up close image of a knee with red thread veins

Images Left to Right - 1. The same patch of spider veins pre-injection as image above. 2. The area a few minutes after injection showing the inflammatory reaction associated with successful treatment. 

Do you offer a “one stop” service for vein treatments? 

Whilst a one stop service is convenient for both patient and surgeon, it does not provide safe care and would not fulfil the GMC and Royal College guidelines for valid consent. This is therefore something that we are unable to offer and all patients are required to have a full, detailed face to face consultation including a scan and cooling off period before booking treatment with us.

What is the best treatment for Varicose Veins?

There is almost universal acceptance amongst Vascular Surgeons and Vein experts that the “gold standard” treatment for varicose veins is Endothermal Ablation. Endothermal Ablation is a term that includes 2 treatment techniques: Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA/ VNUS). These techniques have significant advantages over traditional surgical stripping and cheap alternatives such as Foam.

The UK National Institute of Health and Care Excellence (NICE) has produced clear, independent and evidence based guidelines for surgeons to follow. The NICE Clinical Guidelines (CG168)  state that all patients should be offered endothermal ablation as first line treatment and only those that are not suitable for this technique can be offered foam or as a last resort open vein surgery.

The Duchy Hospital strictly adhere to best clinical practice and all our vein treatments are provided in line with NICE guidance (CG168).


For more information about Consultant Vascular Surgeon, Mr Rob Windhaber, visit his profile or to read more about the varicose veins treatments he provides at Duchy Hospital visit the vascular page.