surgical treatment

surgery for varicose veins

Surgery works by removing the abnormal varicose veins completely so that blood cannot flow through them in an abnormal direction. Surgery has 3 objectives:

1.Flush ligation
of the major leaking vein with the deep veins.
This is the key step in the operation as it immediately removes the abnormal pressure on the distant veins.
If the long saphenous vein is affected this requires a cut in the groin and if the short saphenous vein is the culprit then there will be a cut in the crease behind your knee.
All tributaries of the vein are carefully divided and the main vessel is tied off flush with the femoral vein.

2.Inversion stripping.
The main segment of the abnormal vein is pulled out of the tissue to avoid the chance of it re-canalising and forming new connections with other small veins.
This is called stripping of the vein.
I use a method called inversion stripping where a small wire is passed along the vein and secured at one end.
Pulling on the wire inverts the vein on itself – a bit like pulling a sock inside out.
This method causes far less damage to the tissues than older techniques.
There is consequently less bruising and pain.

3.Distal stab avulsions. Smaller veins are pulled out of the tissue through a series of 2-3mm ‘stab incisions” in the skin.
I use a device called a phlebectomy hook to do this part of the surgery as it reduces the size of the incisions resulting in less scarring.

Varicose vein surgery involving only one leg is usually performed as a day-stay procedure.
If both legs are affected you will usually need to have one night in hospital. You will require a general anaesthetic and surgery takes 1-2 hours on average.
Details relating to anaesthesia are contained in the anaesthetic information sheet.
Please make sure that you have read this.

Surgery is intended to deal with the major site of reflux and the larger varicosities.
Small residual veins and spider veins are best treated with sclerotherapy at a later date.
If this is necessary it will involve extra costs.

If you are going home on the day of surgery you will not be able to drive yourself and will need to have a responsible adult to transport you and to stay with you overnight.

recovery

You will not be able to drive safely for about 5 – 7 days depending on the extent of surgery.

Most people are up and about by the next day and fit to return to work within a few days.

If work involves a lot of standing or physical activity you are best to have 10-14 days off.

Expect to return to all sporting and vigorous activities within about 6 weeks.

If you live outside Auckland consider spending the first night in the vicinity either staying with friends or at a local motel. This avoids the need for a long journey immediately after your anaesthetic and ensures that help is at hand if you are unfortunate enough to have a problem such as bleeding.

You may find it uncomfortable to move around for the first few days after surgery.

You may have some tenderness and discomfort that lasts for several weeks.

It's normal for the cuts in your leg to feel bruised and sore, and they will leave small scars.

Possible complications of surgery:

Numb patches on the skin
Small sensory nerves to the skin may be stretched or cut during surgery. The numbness may improve over a few weeks but can be permanent. It does not affect the function of the leg.

Wound infection
some of the incisions may become red, hot and swollen a few days after surgery because of infection. You will need a course of antibiotics. This occurs in about 5% of cases.

Bleeding
You may have bleeding from one of the incisions. In most cases this is minor and will be controlled by extra bandaging and applying pressure to the area. Occasionally more severe bleeding may require a return to theatre. There is about a 2% chance of this happening.

You may notice hard, tender lumpy areas under the skin near the incisions. This scar tissue gradually softens are usually disappears after a few months.

Scars can sometimes become thickened, red and tender. This is called hypertrophic scarring.

There can sometimes be changes in the skin after surgery. Brown patches or clusters of tiny spider veins can develop.

Varicose veins can recur for a number of reasons. Thorough preoperative assessment with ultrasound and careful surgery optimise the chances of a successful result.

more serious problems

Deep vein thrombosis
Deep vein thrombosis is a risk with all surgical procedures. It is more likely in people who are overweight, smokers, women taking the oral contraceptive pill and those with a previous history of DVT. For most people early mobilisation after the operation is sufficient precaution but in higher risk situations other measures may be considered to keep things as safe as possible.

Flying
Long airplane flights increase the risk of DVT. We suggest that you avoid such trips for 4 to 6 weeks after surgery. Also plan your operation to allow a similar time to elapse after an overseas flight.

Nerve damage
There is a major nerve in the crease of your knee that can very occasionally be damaged. This causes weakness in your foot, which may be permanent. It is called foot drop and one study showed a risk of 1:600 for this complication.

Most people make a quick and comfortable recovery and are often surprised how little pain they have experienced!

Treating all types of venous leg conditions from large varicose veins to small spider veins
  • Endovenous Laser Treatment
  • Ultrasound Guided Sclerotherapy
  • Micro-Sclerotherapy
  • Duplex Ultrasound Venous Mapping

Appointments can be made
directly or by referral from your regular doctor.

THE VARICOSE VEIN CLINIC

Level 1, Ascot Central
Ellerslie Racecourse Drive, Remuera, Auckland 1051
(Off Greenlane Road East)

Phone: 09 520 9465
Fax: 09 625 6410