The following information deals with the operation for varicose veins.
The damaged valves in the veins cannot be cured so the best way to cure the problem is to remove the affected veins. The aim of surgery is to take pressure off the skin veins in the leg, by tying and dividing (and often removing) the principal skin veins in the leg
Removal of varicose veins does not affect blood flow as other veins, and especially the deep veins, do this job. The operation is particularly suitable for people with:
Ulceration or the risk of ulceration due to their varicose veins.
When the veins have caused bleeding through the skin. It’s frightening and can happen again.
Phlebitis (inflammation of the veins and overlying skin), large varicose veins, and pain in the veins.
The aim of the operation is to reduce the pressure in the skin veins to normal. This prevents existing varicose veins from enlarging further and new varicose veins from growing. In patients with lesions on the ankles or previous ulcers, reducing the pressure prevents the lesions from getting worse and usually reduces the risk of further ulcers. For this group, adding support stockings will further protect the skin around the ankles.
Before treatment
A number of tests must be performed before varicose veins surgery. There are two types: those that can be used to assess whether you qualify for varicose vein surgery, and some immediate preoperative tests. Tests have already been done to see if you qualify for the surgery. These always include the examination with a hand-held Doppler and can include an ultrasound examination. Immediate preoperative tests include: blood tests and EKGs for some, as well as paperwork filling out. These immediate preoperative tests are usually done shortly before your surgery during a pre-admission hospital visit.
Come to the hospital
Varicose vein operations are often performed as day cases. If you’re fit, a family member is bringing you home and staying with you overnight, you will likely qualify. People with more complex surgeries and people who live alone stay in the hospital overnight. You should bring any medication you are currently taking with you. You will be taken to your bed by one of the nurses who will also fill out your medical record.
The surgeon who will perform your surgery will visit you immediately before the procedure. He will mark your veins with a waterproof pen and agree which veins will be removed. You should make sure that all of your varicose veins are marked. The doctor who gives you the anesthetic will also visit you and explain the anesthetic to you.
The treatment
Varicose vein operations are performed under general anesthesia. There is a tiny needle in the back of your hand. The anesthetic will be injected through the needle and you will be asleep within seconds. A local anesthetic is applied around the groin incision and the incision on the back of the knee (if used) while you sleep. When you wake up, the incisions should be numb. Sometimes a drop will be placed in a vein in your arm (usually your wrist) to give you some fluid during and after the surgery.
The operation
Operation varies a little from case to case depending on where the leaking valves are. Usually you have an oblique cut about 4-6 cm long in the skin fold of the groin. This incision is used to tie off the top of the faulty cutaneous vein (long saphenous vein) to stop blood flow – this is known as ligation. A wire is then inserted into the vein and passed at knee level. A second incision is made at knee level and the vein (with the wire running through it) is pulled out. This process is known as stripping. The ligation and removal of the long saphenous vein addresses the cause of the varicose veins and should prevent their recurrence.
Less often, if the main vein at the back of the knee has a leaky valve, it will need to be ligated as well. This is done through a horizontal incision about 3 cm long on the back of the knee. The vein is then removed as before. The short saphenous vein is rarely pulled away from the leg because it is near a nerve and has a skin feel that can be damaged.
Finally, in most cases, the visible varicose veins are removed from the leg through tiny incisions about 2-3 mm in length. The incisions are spaced about 3 to 5 cm apart along the line of the varicose vein. If the varicose veins are large, a large number of tiny cuts can occur. The larger incisions are closed with a stitch that lies under the skin and does not need to be removed. The smaller cuts aren’t sewn because they heal well. At the end of the operation, the leg is firmly bandaged from the toe to the groin.
After treatment
Usually after the operation you will be taken to the recovery area of the theater where you will wake up. When you are fully awake (usually 20 to 30 minutes) you will be taken back to the ward. Most people describe the leg as stabbing or burning when they wake up. It is unusual for the leg to be painful. After this type of surgery, you are very unlikely to feel sick and you should be able to eat and drink again within a few hours.
Some of the smaller cuts can bleed easily for the first 24-48 hours. For this reason, it is best to cover the leg with bandages or stockings for the first 48 hours. After this time, the stockings can support the bruises, making the leg more comfortable. They can be worn for up to 10 days, but usually won’t help beyond that time. Although the incisions are very visible at first, they become practically invisible within 9 to 12 months. There is usually severe bruising in the leg, especially on the inside of the thigh. These bruises usually last 3-4 weeks. By removing the skin veins, the blood returns to the heart through the deep veins more efficiently than before the operation.
Go home
Most people describe the leg as sore and uncomfortable when they get home. The symptoms increase steadily from the second postoperative day and are usually on the 8th-10th Worst postoperative day. The symptoms usually go away 12 to 14 days after surgery. Occasionally, usually with phlebitis, the leg is painful. The pain can last up to three weeks in this situation.
It is recommended that you exercise regularly every day, e.g. For example, go for a walk or use an exercise bike to gradually return to normal activity. Resting after surgery increases the risk of developing blood clots in the deep veins (deep vein thrombosis, or DVT). Regular exercise reduces this risk, but makes the leg more uncomfortable.
Driving: You can drive within 48 hours of the operation as long as the leg is not too uncomfortable.
Bathing: You can bathe or shower within 48 hours of using it. Sometimes bathing or showering immediately after surgery can cause bleeding from the smaller incisions.
Work: If this applies to you, you should be able to return to work within 1-3 weeks of the operation depending on your occupation. Your GP will let you know when you see him / her about your medical record.
Lifting: There are no restrictions in this area.
Medication: You will usually be sent home with some pain relievers. You will be informed of their use before leaving the hospital.
Complications
Complications after varicose vein surgery are rare.
Breast infections: These can happen after this type of surgery, especially in smokers, and may require treatment with antibiotics and physical therapy.
Wound infection: wounds sometimes become infected and may need antibiotic treatment. Serious infections are rare.
Fluid leak from wound: Occasionally the groin incision may leak blood stained or clear fluid. This usually this lasts a few days when it is bloodstained. Sometimes, clear fluid collects under the groin incision. It may be contained beneath the skin or it may leak through the incision (this is known as a lymphocele). This occurs infrequently mainly following re-operation on the groin. If there is leakage from the groin, it may take up to 6 weeks to settle.
Nerve injuries: These are uncommon occurring in about 1 in 20 cases. Two skin nerves are particularly at risk: the first picks up sensation from the top of the foot, and the second from the outer border of the foot. Other unnamed nerves may also sometimes be damaged leading to reduced sensation anywhere in the leg. The reduced sensation may be very noticeable at first, but normally diminishes with time and is not usually a problem in the longer term.
Deep Vein Thrombosis: DVT complicates any operation from time to time. It also occurs occasionally following varicose vein surgery. Patients with extensive varicose veins associated with skin changes are probably at greatest risk, but the complication is rare.
Recurrent Varicose Veins: Recurrence of varicose veins occurs in about 1 in 15 patients over a ten-year period. Sometimes further treatment may be required.
What can I do to help myself?
When you get home, try to return to normal as soon as possible. The more exercise you take, the more sore your leg will be, but the quicker the leg will return to normal. If you have further questions, please do not hesitate to ask either your consultant or one of their team, or the nurses who are looking after you on the ward.