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. The removal of varicose veins does not affect blood flow because other veins and especially the deep veins take over this job. The operation is particularly suitable for people with:
The aims of surgery are to reduce to normal the pressure in the skin veins. This will prevent existing varicose veins from enlarging further, and will prevent new varicose veins from growing. For those with skin changes around the ankles or previous ulceration, reducing the pressure prevents worsening of the skin change and usually reduces the risk of further ulceration. For this group, the addition of support stockings further protects the skin around the ankles. Before the treatment Coming into hospital The surgeon who will be performing your operation will visit you immediately before the procedure. He will 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. The doctor who will give you the anaesthetic will also visit you, and explain the anaesthetic to you. The treatment The operation Less frequently, when the principal vein on the back of the knee has a leaking valve, it too needs ligation. This is performed through a horizontal incision about 3cm long on the back of the knee. The vein is then removed as before. The short saphenous vein is rarely stripped from the leg because it lies close to a nerve, picking up skin sensation, which may be damaged. Finally, in most cases, the visible varicose veins are removed from the leg through tiny incisions about 2-3mm in length. Incisions are placed about 3-5cm apart along the line of the varicose vein. There may be a large number of tiny incisions if the varicose veins are extensive. The larger incisions are closed with a stitch, which lies beneath the skin and doesn’t need to be removed. The smaller incisions are not stitched because they heal well. The leg is bandaged firmly from toe to groin at the end of the operation. After the treatment Some of the smaller incisions may bleed a little over the first 24-48 hours. For this reason, it is best to keep the leg covered with bandages or stockings for the first 48 hours. After this time, the stockings may provide support to the bruising making the leg more comfortable. They may be worn for up to 10 days, but do not usually help beyond this time. The incisions, although initially very visible, will subside to become virtually invisible within 9-12 months. There is usually extensive bruising in the leg, particularly down the inside of the thigh. This bruising usually lasts for 3-4 weeks. Removal of the skin veins means that blood returns to the heart through the deep veins more efficiently than before the operation. Going home Regular daily exercise such as going for a walk or using an exercise bike to provide a gradual return to normal activity is recommended. To rest up after the operation raises 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 will be able to drive within 48 hours of the operation provided the leg is not too uncomfortable. Bathing: You can bath or shower within 48 hours of operation. Sometimes bathing or showering immediately after surgery may lead to bleeding from the smaller incisions. Work: If this applies to you, you should be able to return to work within 1-3 weeks of surgery depending on your job. Your GP will advise you of this when you see him/her for your sick-note. Lifting: There are no limitations in this area. Medicines: You will usually be sent home with some painkillers. You will be advised on their use before you leave hospital. Complications Chest infections: These can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy. Wound infection: Wounds sometimes become infected and this may need treatment with antibiotics. 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? More information and advice about vascular health. Whilst we make every effort to ensure that the information contained on this site is accurate, it is not a substitute for medical advice or treatment, and the Circulation Foundation recommends consultation with your doctor or health care professional. The Circulation Foundation cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. The information provided is intended to support patients, not provide personal medical advice. |