You have varicose veins, which are expanded and enlarged veins under the skin, in your legs, as your vascular surgeon has revealed to you. These are brought on by weakening of their wall and improper closure of their valves, which would typically guide blood flow in one direction—toward the heart.
You will usually be a candidate for this operation:
- If the skin of the lower leg has changed colour, has become thickened or has developed eczema, especially with sores (leg ulcers)
- If a varicose vein has bled through the skin
- If you have had an episode of thrombophlebitis, i.e. redness, pain and inflammation over a vein
- If you have symptoms, such as burning, itching or a heavy leg
- If the veins are a cosmetic problem to you
Surgery’s goal is to lower the elevated blood pressure in the veins under the skin. In addition to being risk-free, removing the damaged superficial veins enhances blood flow back to the heart through the deep leg veins. Surgery is successful in managing symptoms, preventing varicose vein problems, and stopping the growth of new varicose veins.
Without a doubt, varicose veins is a disorder that can only be treated; it won’t go away on its own or with ointments, medications, etc. Small varices that are not producing symptoms often don’t need to be fixed, but they may certainly be for cosmetic reasons.
Before the operation is performed, certain investigations and tests need to be done. These usually include blood tests, chest X-rays, electrocardiography and examination by a cardiologist. These investigations will be done a few days before or on the day of admission. Also, duplex ultrasonography of the leg veins may be performed to map the damaged veins and their connections.
When you are admitted, you will need to bring with you all the medications you are on. Your medical history will be recorded. Your vascular surgeon will explain certain aspects of the procedure and immediate postoperative care. You will be required to sign a paper attesting to your understanding of the need for the procedure, its risks, and your consent to the surgery.
Before the procedure, your veins will be marked up with a waterproof pen to demonstrate to the surgical team which veins will be removed. Make careful to note every varicose vein you have.
When you are admitted, it will be quite useful to bring with you all medications you are on. Your medical history will be recorded. Later, your vascular surgeon and the anaesthetist who will put you to sleep will visit. They will explain certain aspects of the procedure and of the immediate postoperative care. You will be asked to sign a form confirming that you understand why the procedure needs to be performed, the risks of the procedure and that you agree to the surgery.
Your vascular surgeon will visit you immediately before the procedure to mark up your veins with a waterproof pen, agreeing with you which veins will be removed. You should ensure that all your varicose veins are marked.
Problem veins can be resolved using a variety of therapies, each of which has benefits and drawbacks. Because different types of varicose veins react better to different treatments, it is crucial to choose the approach that is best for you. Therefore, depending on which veins have leaky valves and the severity of the varicosities, the procedure varies a bit from case to case.
Some innovative, less intrusive techniques have been created since the late 1990s. In contrast to open surgery, they use a thin, flexible tube to thermally ablate the saphenous vein in its place instead of removing it (called a catheter). Small electrodes at the catheter’s tip burn the vein’s walls from within and damage the tissue. The vein ultimately stops functioning as a vein, scar tissue progressively replaces it, and the vein is finally absorbed by the body.
Radiofrequency closure (RFC) and LASER, or Endovenous laser treatment, are two techniques for thermal ablation (EVLT). These procedures may be carried out without the use of general anaesthesia, but they need for the administration of local tumescent anaesthesia, which has drawbacks that need to be made clear to patients before it is chosen for their treatment. The varicosities themselves must also be removed, which necessitates vein avulsions (phlebectomies) using minute incisions. The leg is then tightly wrapped from the toes to the groyne.
Another even less invasive method is “chemical ablation” of the saphenous vein, i.e. foam sclerotherapy of the trunk of the saphenous vein under ultrasound guidance, which does not even require local anaesthesia. However, it has limited indications and the results are not uniformly as good as with the aforementioned techniques.
Your vascular surgeon will advise you regarding which procedure is the best for your particular situation.
Following the operation you will probably stay in the theatre recovery area for a few hours, and then you will be transferred back to the ward.
You may have a stinging or burning feeling in your leg once the anesthesia wears off, but no significant pain is expected. It is rare to feel sick following this type of surgery, and you should be able to have something to drink and eat a few hours later.
We will encourage you to get up and walk as much as possible just a few hours after the operation. Over the course of the first 24-48 hours, a few of the smaller wounds can bleed a bit. Bandages or stockings make controlling this condition simple. You may develop some bruising in the thigh and calf, which will disappear completely within the next few weeks.
Blood returns to the heart through the deep veins more effectively than it did before to the procedure thanks to the removal of the superficial veins.
Complications are uncommon following varicose vein surgery.
- Infection over the leg can occur, especially in individuals with abdominal obesity or with an active leg ulcer, but it isn’t severe and settles down with antibiotics.
- Damage to a skin nerve is uncommon with the techniques we use today; however, it may occur. This will cause a reduced feeling to the touch or numbness over a skin area and may be quite annoying initially, but it settles down with time and only rarely remains a problem.
- Deep venous thrombosis (DVT) is very rare with the precautions we take today, especially with early postoperative ambulation.
- The appearance of new varicose veins following a well-performed procedure may occur in 25-35% of the cases in a period of 10 years. Occasionally, a new procedure may be required.
- The appearance of some new spider veins is not uncommon following varicose vein surgery.
You will usually be discharged the day of the operation or the following day, after removal of the bandages and application of a thigh-long antiembolism stocking. Some bruising in the leg is almost unavoidable to occur, but will disappear completely within 3-4 weeks. The stocking helps you feel the leg more comfortable, and the vascular surgeon will advise you how long to wear it for.
Your vascular surgeon will recommend that you walk for at least 1 hour every day, avoid standing and keep the leg elevated when you don’t walk. He/she will also tell you when you may wash the wounds, when the stitches will be removed and when you may return to your work.
Varicose veins, as well as spider veins, are damaged veins, which do not function properly. Their removal is not only harmless, but it improves the venous circulation in the leg. From the moment varicose veins appeared, the nearby healthy veins have taken over their work, i.e. to return of blood to the heart.
After going home, try to resume your normal activities as soon as possible, but avoid standing. The more you exercise your leg the more discomfort you may have, but the quicker it will return to normal.
Strictly apply moisturising cream and compression stockings daily for at least 6 weeks after the procedure to ensure a good post-operative result.
Increase physical exercise and reduce your weight.
