You have varicose veins, which are expanded and enlarged veins under the skin, in your legs, as the vascular surgeon has described to you. These are caused by the weakening of their wall and by the failure of their valves to close properly, which normally would be directing blood flow one-way towards the heart.
You will usually be a candidate for this operation:
- If the skin of the lower leg has changed color, 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 for you
If you have veins that bother you cosmetically, surgery may be necessary to lower the elevated blood pressure in your subcutaneous veins. Not only is it safe to remove the damaged superficial veins, but doing so also enhances the blood’s ability to return to the heart, mostly through the deep leg veins. Surgery is useful for managing symptoms and avoiding varicose vein problems.
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.
Before the surgery, your vascular surgeon will come to see you to mark your veins with a waterproof marker and decide with you 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.
Varicose veins can be treated with a variety of methods, 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.
The primary superficial vein in the leg, the long (or longer) saphenous vein (LSV), is most frequently impacted. Open surgery (Trendelenberg’s procedure) involves tying up the branches of the LSV near the junction with deep veins and removing the LSV till the knee. Less frequently, the short (or lesser) saphenous vein is damaged, and at the point where it connects to the popliteal vein behind the knee, it is tied off and separated.
Vein avulsions, also known as phlebectomies, can be carried either separately or concurrently with LSV stripping. At the conclusion of the procedure, the leg is tightly wrapped from the toes to the groyne. Although they may seem unpleasant, these treatments are typically fairly well tolerated.
Some innovative, less intrusive techniques have been created since the late 1990s. They are different in that the saphenous vein is not removed; instead, the vein is thermally abated by heating the vein’s walls from within and removing the tissue. This is done using small electrodes at the catheter’s tip. The vein ultimately stops functioning as a vein, scar tissue progressively replaces it, and the vein is finally absorbed by the body.
Endovenous Laser Treatment (ELT) and Radiofrequency Closure (RFC) are examples of thermal ablation techniques (EVLT).
“Chemical ablation” of the saphenous vein, or foam sclerotherapy of the saphenous vein’s trunk under ultrasound guidance, is an additional, even less invasive technique. The outcomes are not consistently as excellent as with the aforementioned procedures, and it has few indicators.
GLUE therapy is the latest FDA approved technology for treatment of varicose veins. There is only a single needle placement within the LSV, following which a glue catheter is placed till 5 cm from the junction with the deep veins (SFJ). The Glue injected into the long saphenous vein makes the veins walls stick together and close permanently. This prevents further leaking of blood into the veins and allows minimally invasive closure of the whole veins without additional injectiona or cuts.
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. This is easily controlled with bandages or stockings. 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, and 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.
