Ask the expert: what to expect from varicose vein surgery

The understanding of vascular diseases and their effect on our lives is often poor. Vascular Disease Awareness Month strives to highlight and promote awareness to the general public. Consultant Vascular Surgeon, Mr Roderick Chalmers has explained how varicose veins develop and what is involved in treating them.

Varicose veins are swollen and enlarged veins that usually occur on the legs and feet. They may be blue or dark purple and are often lumpy, bulging or twisted in appearance.

Other symptoms include:

• aching, heavy and uncomfortable legs
• swollen feet and ankles
• burning or throbbing in your legs
• muscle cramp in your legs, particularly at night
• dry, itchy and thin skin over the affected vein

Causes of varicose veins

Varicose veins develop when the small valves inside the veins stop working properly. If the valves are weakened or damaged, the blood can flow backwards and collect in the vein, eventually causing it to be swollen and enlarged (varicose). The most common treatment options include:

• endothermal ablation (radiofrequency ablation) – where heat is used to seal affected veins
• sclerotherapy – this uses special foam to close the veins
• ligation and stripping – the affected veins are surgically removed

The damaged valves in the veins cannot be cured so the best way is to remove the affected veins. The aim of surgery is to take pressure off the skin veins, by tying and dividing (and often removing) the principal skin veins in the leg. The removal of varicose veins does not affect blood flow as other veins, especially the deep veins, take over this job.

This will prevent existing varicose veins from enlarging further and will prevent new varicose veins from growing.

Before the treatment

Before varicose vein intervention, patients are routinely assessed using colour flow ultrasound. This test shows the underlying source of the varicose veins and confirms no problems with the deep veins. Also, if patients have had surgery previously, the scan gives useful information regarding prior treatment.

Coming into hospital

Varicose vein surgery is usually performed as a day case. Those who are having more complex surgery and those who live alone will stay in hospital overnight.
The surgeon who will be performing your operation will visit you before the procedure. He will agree with you which veins will be treated and mark up your veins with a waterproof pen.

The operation

Over 90% of patients will be suitable for the minimally invasive procedure of radiofrequency ablation. The vein trunk or trunks causing the varicose veins is closed from inside with heat energy. At the same time, the varicose veins are removed via tiny skin incisions using a special vein hook.

There are no sutures involved. The small skin wounds are closed using paper tapes (steri-strips). The treated leg is bandaged with elasticated bandages which stay in place for 48 hours. When the bandages are removed a full-length stocking is worn for a further five days.

After the treatment

It is unusual for the leg to be painful. Most people describe the leg as stinging or burning when they wake up. Following this sort of surgery you are very unlikely to feel sick and you should be able to eat and drink again within a few hours.

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. The incisions, although initially very visible, will decrease and become virtually invisible within 9-12 months.

Going home

After radiofrequency ablation return to normal activities occurs in roughly one week although patients are fully mobile immediately. Any discomfort usually resolves 12-14 days after the operation. Regular daily exercise such as going for a walk or using an exercise bike to provide a gradual return to normal activity is recommended.

Recurrent varicose veins

Recurrence of varicose veins occurs in about 1 in 15 patients over a 10 year period. Sometimes further treatment may be required.

What can I do to help myself?

When you get home, try to return to normal as soon as possible. The more you exercise the more uncomfortable your leg will be, but the quicker the leg will return to normal. If you have further questions, please do not hesitate to ask either your consultant or one of the nurses.

If you have any concerns or would like to find out more about varicose vein surgery, contact us on 0131 316 2507 or info@spireedinburgh.com.