As your vascular surgeon has explained to you, you suffer from varicose veins of your legs, which are widened and buldging superficial veins caused by weakening of their wall and by failure of their valves to close properly and direct blood flow one-way towards the heart.
You will usually be a candidate for this operation:
The aim of surgery is to reduce the excess blood pressure in the veins lying under the skin. Removing the damaged superficial veins is not only harmless, but improves the return of blood to the heart via the adjacent healthy superficial veins (which have already taken over their work), and mainly via the deep leg veins. Surgery is effective in controlling symptoms, in preventing complications of the varicose veins as well as in preventing the development of new varicose veins.
Certainly, varicose veins is a condition which will not heal itself or with ointments, drugs etc, but only with some intervention. Generally speaking, small varices not causing symptoms do not necessarily need to be treated, however, they can very well be treated for cosmetic reasons.
Before the operation is performed, certain investigations and tests need to be done. These usually include: blood tests, chest x-ray, 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 for mapping of the damaged veins and their connections.
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.
There are several different treatments for sorting out problem veins and each has its advantages and its disadvantages. It is important to select the right method for you, because different types of varicose veins respond better to different treatment. Thus, the operation varies a little from case to case depending upon which veins have leaking valves and the extent of the varicosities.
Most commonly, the long (or greater) saphenous vein (LSV), which is the main superficial vein in the leg, is affected. To perform stripping of the long saphenous vein, the surgeon first makes a small (3-4 cm) incision in the groin area and usually another incision in the calf below the knee. Then, he/she disconnects and ties off the junction of the LSV to the femoral vein and all the major branches associated with the LSV, and removes it from your leg by stripping it with a special wire (stripper). Less commonly, the short (or lesser) saphenous vein is affected and it is tied off and disconnected from its junction to the popliteal vein via a small incision behind the knee.
Also, vein avulsions, or phlebectomies, can be done alone or together with LSV stripping. These are performed through tiny incisions about 2-3mm in length, which 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 stitches, but the tiny ones do not need to be stitched. The leg is bandaged firmly from toes to groin at the end of the operation.
Although these procedures may sound painful, they are generally very well tolerated; in most cases, we can guarantee that you will require no pain relief following the procedure with the technique we use.
After the late 90′s, some new methods have been developed, which are less invasive but may also require surgical incisions on the skin of the leg to remove varicosities. They differ in that the saphenous vein is not stripped, but thermally ablated in its place using a thin flexible tube (called a catheter) inserted into the vein. Tiny electrodes at the tip of the catheter heat the walls of the vein and destroy its tissue. The vein is no longer able to carry blood, is gradually replaced by scar tissue and is eventually absorbed by the body.
Methods of thermal ablation include radiofrequency closure (RFC) and endovenous laser therapy (EVLT). These methods may be performed without general anaesthesia, however, they require the use of local tumescent anaesthesia and this has certain limitations which should be explained to the patients before such a method is selected for their treatment. Vein avulsions (phlebectomies) with tiny incisions are also required in order to remove the varicosities themselves, and the leg is bandaged firmly from toes to groin at the end of the operation.
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.
A new procedure, called Clarivein® , is essentially used to reinforce the effect of the chemical injury of sclerotherapy combining it with mechanical disruption of the intima, or the internal lining of the vein (chemico-mechanical sclerotherapy). A rotating catheter is inserted into the vein, together with the sclerosant drug. The rotating motion irritates the vein intima and helps spread the drug throughout the vein. This is a completely painless method, but not suitable for large veins or for large legs.
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 until you are fully awake, and then you will be transferred back to the ward.
You may have a stinging or burning feeling in your leg when you wake up, 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. Some of the smaller incisions may bleed a little over the first 24-48 hours. This is easily controlled with bandages or stockings. It is common that you develop some bruising in the thigh and calf, which will disappear completely within the next few weeks.
Removal of the superficial veins means that blood returns to the heart through the deep veins more efficiently than before the operation.
Complications are uncommon following varicose vein surgery.
The leg may be a little uncomfortable over the next few days. This discomfort is due to the bruising, i.e. the inflammatory reaction to the blood which occurs following surgery, and gradually resolves. With the techniques we use today, it is unlikely that you will need any pain relief (even in cases of saphenous vein stripping).
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.
Increase physical exercise and reduce your weight.