Surgical
Treatment
The
results of the investigations pinpoint exactly
where the varicose veins are
coming from. If this affects large veins inside
the leg then an effective treatment is surgical
removal of varicose veins. A less invasive though
slower way to treat these veins would be ultrasound
guided foam sclerotherapy. If the problem is
simply spider veins or small varicose veins close
to the surface of the skin, then the best treatment
is injections (or "sclerotherapy").
Surgery often requires a short hospital stay,
usually no more than one night. The time of admission
is usually a few hours before the operation and
this allows some simple preparations to be made.
No food or drink should be taken for six hours
before the scheduled time of the operation, whether
having a general or spinal anaesthetic. The surgeon
will visit before surgery to confirm the proposed
treatment and obtain a signature on the consent
form. The anaesthetist will also perform an examination
to confirm fitness for the intended type of anaesthetic.
Surgery is usually performed under general anaesthesia,
but a spinal anaesthetic is an alternative for
patients who would prefer to be awake during
surgery. The varicose vein operation involves
tying off the source of any veins in which the
valves have failed through incisions 3-4cm in
length. These are made either in the groin or
behind the knee depending on which veins are
diseased. One stitch is required to close these
small cuts which heal with minimal scarring.
Where a large vein inside the leg is affected,
that vessel is removed by a technique known as "inverted
stripping". To do this a special Swiss instrument
is passed along the vein and then the entire
length of the diseased vessel is inverted and
removed from within itself and taken out through
a tiny incision in the skin at one end of the
vessel. This method causes less bruising and
pain.
Smaller varicosities are usually removed by a
technique called "hook phlebectomy".
Tiny incisions are made in the leg (not more
than 2 mm in length) over the varices. Again
special Swiss hooks and forceps are used in order
to avoid the need to make large incisions in
the leg. These incisions are so small that no
stitches are required, and they need only be
covered by small plasters.
At the end of the operation bandages are applied
to the leg. These gently compress the leg, reducing
swelling and discouraging bruising. After the
operation it is possible to be up and about within
a few hours and within one day of the operation
your legs will be sufficiently comfortable for
you to be able to walk normally. You should be
able to go home the day after surgery. Before
you go home, the bandages will be removed and
firm compression stockings applied which should
be worn for two weeks.
Following surgical treatment for varicose veins,
it is best to sit with the feet elevated and
to avoid standing still for extended periods.
It will not be necessary to walk for six miles
a day! However, gentle exercise is very beneficial
such as walking twenty minutes three times a
day. You must not drive a car or make any important
decision for 24hrs after an anaesthetic, however
when it is comfortable to perform an emergency
stop driving can be resumed. Short haul flights
can be taken within 3-4 days but long haul flights
are best avoided for 2 weeks after surgery.
The immediate effects of the operation includes
some discomfort and bruising of the legs. The
discomfort is usually not severe and can be treated
with simple analgesics. The bruising may last
3-6 weeks. Occasionally some discoloration remains
for several months. The stitches (in the groin
or behind the knee) should be removed one to
two weeks after the operation. Most people able
to return to work within one - two weeks. Sometimes
tender lumps can be felt in the legs where veins
have been removed. These are small bruises and
gradually disappear over period of weeks. Occasionally
nerves in the skin are stretched during the operation
leading to small areas of numbness or pins and
needles near the incisions. These often recover,
but sometimes permanent numb areas remain. The
appearance of the surface dermal flares and reticular
veins is not improved by the surgery and a few
extra thread veins may occasionally appear.
The long term outcome of carefully performed
varicose veins surgery is excellent. The scars
fade to tiny white marks over a period of several
months and become very difficult to see. The
veins which have been removed at the operation
will never return, but sometimes the normal veins
which have deliberately left behind become varicose
veins. These can be treated by injection or further
surgery if necessary.
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