Varicose vein treatment

Treatment for varicose veins involves closing off and destroying or removing varicose veins – swollen, lumpy veins that develop due to weak valves in your blood vessels. As the valves in the veins which normally stop blood flowing backwards in the legs get weaker, the blood starts to accumulate and the veins become lumpy. Varicose veins can be small or large, but normally superficial. Although treatment is not always necessary, they can be painful and lead to complications such as leg ulcers.

Your doctor may suggest varicose vein removal if your legs:

• Ache or are painful
• Develop leg ulcers
• Have varicose eczema – dry, flaky, itchy and discoloured skin over your veins
• Bleed easily when knocked
• Are swollen

You may also want to have them treated because you don’t like how they look.

Treatment will close off your affected vein using surgery or alternative techniques. This will:

• Relieve pain
• Reduce the risk of complications
• Improve circulation

Compression stockings can also help relieve the pain, discomfort and swelling in your legs caused by varicose veins. However, they are not proven to help stop your varicose veins worsening or prevent new varicose veins appearing.

Your consultant will examine your veins and ask about your symptoms. They may also send you for an ultrasound scan to help locate damaged valves.

Before treatment, your doctor may recommend:

• Wearing compression stockings to improve circulation
• Avoiding standing for long periods
• Exercises – such as swimming or walking
• Maintaining a healthy weight
• Putting your feet up when resting

The varicose vein is closed off and destroyed or removed, and your blood flow will naturally re-route through your other healthy veins. Treatment methods include:

Endovenous laser ablation (EVLA)

A laser will be inserted into your varicose vein and heat the vein walls, sealing it off so blood can’t flow through it. This destroys the vein and your body will absorb the dead tissue. You may be able to have this procedure in a treatment room rather than an operating theatre and it can be done under a local or general anaesthetic.

Your consultant will:

• Carry out an ultrasound scan to use as a guide to target the correct veins
• Pass a catheter (thin, plastic tube) up your vein, with the help of a needle and wire
• Pass a laser fibre up the catheter to the highest point of the vein to be heated
• Pull the laser along the length of your vein, completely closing it
• Remove the laser and catheter and put a dressing on the needle puncture

This procedure is minimally invasive and less painful than traditional surgery, you can expect to return to normal activities after one to two days. You may find that you have a tightness in your legs, bruising and pain after your procedure. In most cases, these will disappear after a couple of days, but some patients can find they continue for up to two weeks.

Venefit™ (VNUS Closure)

This procedure uses radiofrequency energy to heat the vein walls, sealing them and destroying the vein. Venefit™ is very similar to EVLA but uses radiofrequency energy instead of a laser. You may be able to have this procedure in a treatment room rather than an operating theatre and it can be done under a local or general anaesthetic

Benefits of this treatment compared to alternatives include a faster procedure and less pain and bruising as it’s minimally invasive. After your Venefit™ treatment, a dressing will be applied over the insertion site, you may have pins and needles in your legs and you might have to wear compression stockings for up to a week.

Varicose vein surgery: Ligation and stripping

This is open surgery and a more invasive procedure. While EVLA and VNUS closure treats varicose veins by closing them, surgery involves tying off the vein and then stripping it out. You will be under general anaesthetic for this.

Your surgeon will:

• Make two incisions (cuts), one at the top of your groin, the other further down your leg
• Tie up and seal the top of the vein near your groin
• Pass a thin, flexible plastic wire into the top of your vein through the groin incision
• Pull the wire out through the incision lower down your leg, stripping out the damaged vein at the same time
• Stitch your wound

The advantage of varicose vein surgery is that your surgeon can fully remove the painful veins, but you will be left with some small scarring.

You can usually go home on the same day as your varicose vein surgery, but you may need to stay overnight, particularly if you had surgery on both of your legs. Your leg will be bandaged after your procedure, you may need to wear compression stockings for a week and you may need to recover for up to three weeks before returning to work.

Your surgeon will explain the pros and cons of each method and which is best for you. This will depend on:

• Vein size and shape
• The extent and severity of your veins

Other alternative treatments for varicose veins include foam sclerotherapy, the injection of foam into veins to scar and seal them closed, and phlebectomy, a technique to cut out the affected veins.

Who will be involved?

As well as your chosen surgeon, you may also be seen by an anaesthetist – to administer anaesthetic during the operation.

How to prepare for varicose vein treatment

Your doctor will advise if you need to stop any medication in preparation for your treatment. You may find it helpful to wear loose and comfortable clothing and you should organise for someone to take you home.

If your treatment is being performed under local anaesthetic, you can eat as normal. If your procedure is being performed under general anaesthetic, you’ll need to stop eating six hours before your treatment, but you can drink clear fluids until two hours before.

How long does varicose vein treatment take?

It’s usually under an hour for keyhole procedures and between 60–90 minutes for open surgery.

Anaesthetic choices

Your consultant will advise on what’s best, based on your health and the surgical method used. It will either be:

• A local anaesthetic, when you’re awake but you can’t feel anything in your leg (keyhole techniques)
• A general anaesthetic, when you’re asleep

Pain after varicose vein treatment

There tends to be less pain with keyhole techniques than with open surgery but you’re still likely to feel some discomfort afterwards. Everyone experiences pain differently but you’ll be given painkillers to help you manage this.

Your stay

After your procedure, you’ll be transferred to the recovery area where a nurse will check your wound, pulse and blood pressure. If you are feeling any pain you may be given some painkillers. You’ll usually go home on the same day or the following day. Before you go home, you must be able to have something to eat and drink, walk independently and pass urine.

We aim to get you back to everyday life as quickly as possible, although everyone’s different and your treatment and recovery will be personal to you. You can expect to be home the same day or day after your procedure. Once home, you may need to wear compression socks for up to a week, if you had keyhole treatment you may be able to return to normal activities after a week. It can take between two to four weeks for any aching in your legs to stop, if you had varicose vein open surgery you can expect to make a full recovery four weeks after your procedure.

Your lifestyle after treatment

You’ll need to arrange for someone to take you home after your treatment and to stay with you for the first 24 hours. After your treatment, it’s normal to experience:

• Tightness in your legs
• Pain or discomfort
• Bruising

You’ll need to wear compression stockings during the day for around a week, regardless of which type of procedure you have. These will be given to you before you go home, along with details of a six-week follow-up appointment.

You should try and keep your legs higher than your hips when sitting down, this stops blood pooling in your leg and reduces the pressure on your wounds.

You should be back to most normal activities, including work or driving, within a week if you had keyhole techniques.

For open surgery, recovery will take longer and you may want to arrange help with tasks such as shopping and cleaning.

Gentle walking is good for your legs and you should gradually increase physical activities each day, but check with your consultant before doing vigorous exercise, driving or taking a long-haul flight. You may be able to drive a week after your procedure, though it’s advisable to check with your motor insurance company first.

You’ll be able to shower once your wound has been redressed, but you’ll need to make sure your dressing is kept dry. You’ll be able to have a bath once your wound has healed.

Most people have varicose vein treatment without complications, but all surgery carries some risks. Your consultant will explain them to you before you go ahead.

Varicose vein treatment complications can include:

• Burns to your skin (laser)
• Sensitivity in your thigh (laser)
• Short-term pins and needles (radiofrequency)
• Blood clots in your veins, which can lead to deep vein thrombosis (DVT) and thrombophlebitis (all methods)
• Bleeding (surgery)
• Nerve damage (laser and surgery)
• An allergic reaction to general anaesthetic
• Infection around the wound (all)
• Skin discolouration or reddening (laser)

At Spire Healthcare, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and an ongoing system of review and training for our medical teams.