Surgery for Varicose Veins
1. What are Varicose Veins?
Veins are the blood vessels that carry blood back to the heart. Varicose veins are abnormally swollen (dilated) veins that are visible just below the surface of the skin. Smaller veins in the skin itself are sometimes called "thread veins" or "spider veins". Although these may be unsightly they are not the same as varicose veins.
2. Before your Operation.
Your surgeon may suggest that if you are taking the oral contraceptive pill, it should be stopped one month before the operation. This is to reduce the risk of thrombosis. However, it is very important that you think about other contraceptive methods. Alternatively, he may give you an injection to thin the blood before the operation. You may be called for a pre-admission visit about one week before your actual date to make sure you are fit for the operation. The operation is usually performed as a day-case. However, if you are having both legs operated upon, or if you have any medical problems, it is usual to remain in hospital overnight.
3. Coming into Hospital.
You will be asked to come in either the day before, or on the morning of, your operation. Please bring with you any medicines you are taking and show them to the doctor. You will be received in the ward by a nurse who will note your personal details. You will also be visited by the surgeon who is to perform your operation, who will mark the position of the veins, and the doctor who will give your anaesthetic. Many people are concerned about anaesthetics, so please ask the anaesthetist if you have any specific worries so that he may reassure you. All of these people are ready to answer any questions you may have, so please ask.
4. The Operation.
This is performed under a general or local anaesthetic. The commonest operation is where a cut is made in the groin over the top of the main varicose vein. This is then tied off where it meets the deeper veins ligation). If possible, the main varicose vein on the inner aspect of the leg is then stripped out. Blood can still flow up the leg along deeper, unaffected veins. The cut in the groin is closed with a stitch, usually hidden under the skin. The other veins marked before the operation are then pulled out of tiny cuts. This is called (micro) Phlebectomy (some surgeons may use subsequent injections for this part of the operation). These are then closed with adhesive strips or stitches. Some other veins may be affected, especially one behind the knee. Special scans may be needed before the operation, and this will be explained to you.
A dressing will be placed on the cut in the groin, and your leg will be bandaged up to the top of the thigh. The bandages put on at the operation will stay on your leg until you are advised to remove them by your specialist but this is usually about 7 days.
5. Going home.
For the first week sit with the feet elevated so that your heels are higher than your hips to aid the drainage of excess fluid from the tissues and assist healing. Three times a day take a short walk (a few hundred yards will do, but more if you wish) to avoid stiffness of the muscles and joints. Slight discomfort is normal. Occasionally, severe local twinges of pain may occur in some patients and may persist for some months. In the first week after the operation you may need to take a mild painkiller such as paracetamol to relieve discomfort. Care will be needed when washing.
You should wear the bandage day and night for the first week, after which you may remove it. Thereafter, you may feel more comfortable wearing a compression stocking during the day for a while, but do not need to. You should avoid getting the bandages wet, but can shower or bath in the usual way, after removing the bandage. The transparent dressings in the groins are waterproof and will not come off. These should be removed two to three days after surgery.
6. What next?
You will be asked to remove your own dressings about one week after surgery. Usually, dissolvable stitches are used which do not require removal.
You should avoid driving for about one week from the operation because, in an emergency, your response time may be prolonged. It is essential that you are able to perform an emergency stop without pain. If in doubt, delay driving until you are happy. Swimming and cycling are allowed after the dressings have been removed.
7. Complications to look out for.
Sometimes a little blood will ooze from the wounds during the first 12-24 hours This usually stops on its own. If necessary, press on the wound for ten minutes. If bleeding continues after doing this twice, phone your General Practitioner or the ward.
Occasionally hard, tender lumps appear near the operation scars or in the line of the removed veins. These can appear even some weeks after the operation and need not be a cause for concern. However, if they are accompanied by excess swelling, redness and much pain, they may represent a wound infection and you should see your General Practitioner.
Rarely there is numbness around the wound or ankle. This is unavoidable and is due to pulling on nerves during the operation. It usually settles after some weeks or months. The scars on your legs will continue to fade for many months.
8. Return to normal activity?
You can return to work when you feel sufficiently well and comfortable, generally about a week to 10 days. If you have had both legs operated upon at the same time and you have a number of scars on each leg, it will probably be three to four weeks before you are able to undertake most normal activities. If you have a job that involves much standing and your varicose veins were particularly severe, you may need up to six weeks off work. Your General Practitioner will advise you about returning to work in the light of your progress after the operation.
9. The Future.
You will have been warned that not every visible vein will disappear as a result of your operation and there is a chance that in the future, further varicose veins may develop, as you are clearly disposed to them. The taking of regular exercise, the avoidance of becoming overweight, and the wearing of light support tights or stockings will all help prevent you being troubled by varicose veins in the future.