Varicose Vein Surgery

Surgery for varicose veins involves a general or spinal anaesthetic, and pulling out the superficial veins. Usually it requires cuts in the groin or back of knee as well as multiple small cuts to remove the veins from the lower leg. The procedure can take between one to two hours depending on the complexity and whether both legs are operated on. Usually it is performed as day case but occasionally patients may need to stay overnight.

Advantages are that all treatment is carried out in one setting and even large veins can be removed. Risks include bleeding/bruising, infection, blood clots, and numbness on the inside of your leg. You will need one to two weeks off work. Long term results are excellent with surgery, but as with all interventions there is a risk of recurrence of varicose veins.

The procedure

The surgery is generally performed using an incision in the groin. A wire is then passed down the vein and caught below the knee. It is then tied and pulled out with the wire. If you have varicosities below the knee, then tiny incisions are made to pull out the veins. You entire leg is wrapped up in cotton wool and bandaged up. You are encouraged to walk that day but to have your leg elevated for most of the first day. On the second day the crepe bandage and cotton wool is removed and wear some white TED stockings. Leave any underlying dressings and white paper strips intact for at least 3 days. We recommend that you wear the white TED stockings for at least the first week and walk around as much as possible. Sometimes the white stockings may get blood on it, in which case it can be washed as re-used.

Complications of Varicose Vein Surgery

Please remember these are possible complications. Hopefully none of these will occur to you.

• Bleeding: Sometimes a little blood will ooze from the wounds during the first 12-24 hours. This usually stops on its own. If necessary, lie down, elevate the leg and press on the wound for ten minutes. If bleeding continues after doing this twice, phone your General Practitioner or the surgeon.
• Lumps/bruising: Occasionally hard, tender lumps appear near the operation scars or in the line of the removed veins. These can be present 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 or surgeon.
• DVT: There is a very small risk of developing a deep vein thrombosis. The best way to prevent DVT is to be active. Walking is the best exercise. You should aim to walk at least 30 minutes daily after surgery.
• Numbness: Rarely numbness can develop in a part of the lower leg or foot. This usually occurs due to pulling on nerves during the operation. If the skin is not completely numb, then the symptoms usually settle after some weeks or months. The scars on your legs will continue to fade for many months.
• Recurrence: 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. 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. There is no foolproof way of preventing varicose veins.

Patient Information following Varicose Vein Surgery

• Following anaesthetic for at least 24hrs you should not:
  • Drink alcohol
  • Operate any dangerous machinery
  • Sign any legal document or make important decisions
  • Look after children on your own
• Pain: In the first week after the operation you may need to take a pain killers such as paracetamol or ibuprofen to relieve the discomfort. You may notice the inside of your thigh may become bruised after the operation this is where the vein has been stripped and will gradually resolve. Bruising may take 3 to 4 weeks to resolve.
• Bandages: The bandages can be removed at 24hrs and you can change into stockings which will be given to you before you leave hospital. You should wear your stocking day and night for 2 weeks. After this period some patients benefit from wearing them for another 2 weeks during the day.
• Mobilising: Walk as much as possible after first 24 hours, with at least 20 minutes of regular daily walking in the first 2 weeks after surgery. You should avoid sitting with legs down. For first week sit with feet elevated so that your heels are higher than your hips to aid drainage of excess fluid from tissues and assist healing. Generally try to keep moving when standing, as this helps to reduce pressure in the veins and minimise the risk of thrombosis occurring.
• Bathing or Showering: Keep the wound dry as possible for the first 72hours. Sometimes bathing or showering immediately after surgery may lead to bleeding from smaller incisions. You should avoid pools and public spas for at least 2 weeks after surgery and your wounds a re fully healed. If Steri-strips (adhesive strips) are used these can be washed off in shower after 72hours.
• Driving: You should avoid driving until you are safe to do an emergency stop without pain or protecting the operated leg as in an emergency your response may be prolonged. In most patients this will be several days after the operation and up to a week if both legs have been operated.
• Work: If this applies to you, return to work when you feel sufficiently well and comfortable. This will vary from person to person but generally you should be able to return to work within 10 days of surgery depending on your job. Your GP will advise further on this.
• Lifting: there are no limitations in this area
• Follow Up: follow up check by Gp practice in 3-4 days to check dressings and clinic appointment in 3 to 6 weeks.

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