OPEN SURGICAL

Surgery may be needed for some people. Usually, the results of surgery are preferable to the appearance of large varicose veins. Most scars or stains resulting from surgery are faint, but sometimes they are permanent and unsightly.

Not all surgeons use the same technique. Ask how the surgery is to be done.

About two in 10 patients who have veins treated by surgery will develop new varicose veins in the long term. The surgeon can give no guarantee that varicose veins will not come back.

Many patients ask, “Where does the blood flow after the veins have been removed?”. Most of the blood flow in the leg is through the deep veins (not touched by surgery) and not through the surface veins. Varicose veins do not function effectively when the person is standing. In fact, the veins are actually carrying blood the wrong way. Other normal veins have had to take over the function of these veins. Therefore, treating varicose veins improves the circulation in the leg.

TECHNIQUE

The patient is usually admitted to hospital on the day of the procedure. If the patient has not shaved her or his legs, they will be shaved on the ward. The veins are marked by a pen before surgery.
The surgeon can carry out the operation in various ways. Some surgeons simply tie off the saphenous vein while others remove or “strip” some or all of the vein.

The surgeon will make a small cut high in the groin (for the long saphenous vein) or at the back of the knee (for the short saphenous vein). Other very small incisions are required for other surface varicose veins that are to be removed.

Making several small incisions gives a better cosmetic result than making a few large incisions. Some small veins are too small to be removed surgically and may be treated with injection sclerotherapy at a later time.

CARE AFTER SURGERY

  • Your stocking should be worn for the next four weeks. These can be removed for a shower and should be replaced immediately after showering.
  • The dressings on the leg are waterproof so you can shower with the   dressings on. The dressings can slowly be removed as they gradually fall off themselves over the next week.
  • You should expect mild to moderate discomfort in the first few days. Unless contra- indicated, you may use panadol/panadeine or panadeine forte for the first 48-72 hours. After this period, you may use panadol as required.
  • You should begin normal activities the next day. Going for a 20-30 minute walk each day is a required minimum. Avoid any strenuous exercise and running for at least 4 weeks after the treatment
  • It is normal for some swelling, lumpiness, bruising and tenderness to be associated with the healing process. This can sometimes be mistaken for infection. Contact the rooms for an earlier review if there are any concerns.
  • It is better to avoid any prolonged travel of greater than 4hours duration for the next 6 weeks. If you need to travel during this time, please discuss the appropriate ways of preventing deep venous thrombosis (DVT).
  • A follow up appointment should be made for 6 weeks post-operatively.

While surgery on varicose veins is considered to be safe and effective, there are a few possible side effects. If you have any concerns or want to know more please contact us.

Scars 
Scars usually fade, but sometimes they are permanent and unsightly. Healing and fading of scars can take a few months. Patients should not get the legs sunburnt during this time as this can make the scars worse.

Discolouration
Brown discolouring can occur over some of the treated area. Although the colour usually fades, sometimes it is permanent and unsightly.

Soreness
Sore lumps may be due to bruises (in the space left where the veins came from) or blood clots within remaining short lengths of vein. These lumps usually shrink and lose their soreness over a few weeks.

Numbness
Some nerves run close to surface veins. They may be injured during surgery, particularly when a stripping operation is performed between the knee and ankle. This may cause some numbness,“pins and needles” or, occasionally, pain. Recovery from this can be very slow, up to two years in some people, and in rare cases it is permanent.

Loss of long saphenous veins 
Removal of the long saphenous vein can prevent its future use as a heart artery bypass. Therefore it is usually not removed in patients who have diabetes, high blood pressure, heart disease or artery disease in the legs or arms. However, a badly diseased long saphenous vein is of no use for a heart artery bypass.

Side effects of anaesthesia 
Modern anaesthesia is safe with few risks, however some people do have a serious reaction to anaesthetic drugs. If you have ever had a reaction to an anaesthetic drug, tell your surgeon.

Fortunately, serious problems after surgery are uncommon.
Infection may occur in wounds, especially in patients who have ulcers.
Blood clots can occur in the deep veins.