Surgical treatment of varicose veins

The results of the Duplex ultrasound investigations pinpoint the exact location of the varicose veins. If large veins inside the leg are found then surgical removal of these varicose veins may be the best treatment. However, if the problem is thread or spider veins, or even varicose veins if they are tiny and near to the surface of the skin, the best form of treatment would be microsclerotherapy (injection treatment).

Typical stripping surgery usually requires a short stay in hospital, generally one night. No food or drink should be taken for six hours before the time of the operation.

A general anaesthetic is usually used for the surgery. There is, however, an alternative called a spinal anaesthetic for those patients who would rather be awake during the surgery. The surgery is carried out by tying off the source of any veins in which valves have failed with small incisions that are 3-4cm in length. Depending on which particular veins are diseased incisions are either made in the groin and/or behind the knee and/or near the ankle. These small cuts heal with a minimum of scarring and only one small stitch is usually required to close them. A technique called “inverted stripping” is used where a large vein inside the leg is affected. This involves a special instrument which is passed along the vein and the diseased vessel is inverted and removed through a tiny incision in the skin. This method causes less bruising and pain.

There is also a technique called a hook phlebectomy which is used to remove smaller veins. This involves very small incisions in the leg (about 2mm long). Special hooks and forceps are used to avoid the need to make large incisions. In fact, the incisions are so small that they do not require stitches but are merely covered with a small plaster.

Bandages are applied after the operation to compress the leg and reduce swelling and bruising. Before you leave the hospital, the bandages will be removed and compression stockings are applied which are worn for about two weeks. It is possible after the operation to be up and about within a few hours and you should be able to walk normally the following day.

Following the operation it is advisable to sit with your feet raised and to avoid standing in one position for long periods. Gentle exercise is also beneficial. You should not drive a car for at least 24 hours after the anaesthetic. Long haul flights are best avoided for 2 weeks after the operation.

Some bruising and discomfort is to be expected after the operation but this can be treated with simple analgesics such as ibuprofen or paracetamol. Bruising may last for 3-6 weeks and there may rarely be some discolouration for a few months afterwards. Any stitches should be removed a week or two following surgery. A return to work should be possible within 1-2 weeks.

Laser Treatments

The ELVeS™ and EVLT™ treatments are quick, minimally invasive procedures that offer an effective alternative to the surgical stripping of veins. They are performed under local anaesthetic and are highly effective with over 97% of first-time treatments being successful. Local anaesthetic is administered. Under ultrasound guidance, a thin fibre-optic probe is inserted through a tiny entry point, usually near the knee. Laser energy is delivered in short pulses to seal the faulty vein so that blood cannot flow through it. This eliminates unsightly bulging that causes discomfort and embarrassment. After treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg. Walking immediately after the procedure is encouraged. Normal daily activity can be resumed.