What are varicose veins?
Varicose veins are enlarged, sometimes twisted veins that most often develop in the leg. They can be hereditary, tending to run in families. They can be worse during or after pregnancy, or if you are overweight. While they can be uncomfortable and unsightly, they don’t usually cause any serious health problems. Veins carry blood to the heart. Along the length of all veins are valves, which only let the blood flow in one direction. The valves in the legs have to work harder to pump the blood that extra distance and problems occur when these valves become weak and don’t close properly. The blood flows backwards and pools in the veins. This causes the valves to weaken under the pressure and become enlarged and bulging in appearance – what we call varicose veins.
How we treat you
There are a number of treatments for varicose veins, but only surgery can fully remove problem veins. Don’t worry; having a vein removed won’t affect the circulation of blood, as it will flow through other veins instead. The valves that often cause the problems are in the two large veins that run along the length of your leg, just under the skin. Varicose vein surgery is normally performed under general anaesthetic, which means you are asleep during the operation. There are other forms of anaesthetic, and you should ask for details when you have your pre-admission assessment, otherwise you can discuss these with the anaesthetist, when you meet on the day of surgery. It usually takes about an hour to operate on one leg. Before your operation, the consultant may mark the varicose veins with a waterproof pen, so it’s clear where the problem veins are. In surgery, the problem vein is taken out through a cut (incision) in the groin or the back of the knee. To fully remove the entire vein, it may be necessary to make several small cuts along the length of the leg, where the consultant marked your legs. Afterwards, the cuts are stitched (sutured) and covered with a dressing. The smaller cuts may be closed with adhesive paper strips or stitches. Your leg is then wrapped in a bandage – this applies pressure to reduce bleeding and bruising. After the operation, it’s usual to go home the same day. However, if your consultant feels it’s necessary, you may be asked to stay overnight. It’s a good idea to come prepared, just in case.
Other available treatments
You can temporarily reduce the appearance of varicose veins if you wear support stockings and elevate your legs when resting. However, the following treatments are more effective, as they close off varicose veins, so that they no longer carry blood. These treatments are suitable for some types of varicose vein problems, but not all. Your consultant will discuss the most suitable treatment for you.
Injection
The injection treatment (or sclerotherapy) involves injecting a chemical into the vein to close it completely, so that it no longer carries blood. This treatment can only be used on smaller veins. Although it can improve the appearance of your legs, they may still ache. After the injection, you’ll have to wear support stockings for three to six weeks.
Laser
A thin tube (a laser thread) is inserted into the vein through a small cut. The laser probe heats the vein from the inside, causing it to close. This is done with a local anaesthetic, which means the area to be treated is numbed so you won’t feel any pain. It takes about forty-five minutes to an hour for this treatment on one leg. After the treatment, you will stay in the outpatient department for one to two hours and you will wear a support bandage for seven to ten days afterwards.
Radiofrequency ablation
A thin tube is inserted into the vein above or below the knee. The tube delivers radiofrequency energy to the vein wall causing it to collapse and seal shut. Once the vein is closed off, other healthy veins take over. There may be some bruising and you will need to wear support stockings for seven to ten days afterwards. You can generally have these treatments as an outpatient.
Before your operation
Before you come into hospital for your operation, you will be asked questions about your health by one of our nurses. Further ‘pre-assessment’ questions may be asked over the phone, or you might be asked to come into the hospital for some simple tests, such as a blood test or a test on the heart called an ECG (Electrocardiogram).
Please let us know if you are taking any regular or herbal medication. We need to know everything about the medication you take. Be sure to bring your medication with you on the day of your operation in the original containers. If you do take prescribed medicine on a regular basis, we will give you specific advice about continuing your medication, and what to do on the morning of your operation. If you’re a diabetic you’ll be given instructions about your medication on the day of surgery and told when to stop eating and drinking. It’s particularly vital you tell us if you are taking any type of blood thinning medication (anticoagulant). Medication of this kind can make your blood clot more slowly. We’ll need to ensure your blood is clotting normally before we operate. If you are having a general anaesthetic, it’s very important not to eat or drink anything for four to six hours before your operation. This helps to prevent any regurgitation of stomach contents during the anaesthetic, as this can cause damage to the lungs. If you are going home the same day as your operation and have had a general anaesthetic, you’ll need someone responsible to stay with you for 24 hours afterwards. Also, because of the effects of the anaesthetic, you will not be able to drive, so you’ll need someone to help you get home. Please let us know if anyone you have been living with, or had close contact with, has had MRSA or if they work in a healthcare organisation. MRSA stands for Meticillin Resistant Staphylococcus Aureus. This bug, which can be found on the skin, doesn’t normally cause problems. But if it gets inside the body, it can cause an infection that can be difficult to treat.
If we think it is necessary we can test you before your operation to see if you have this bug on your body. To further reduce the risk of any infection, we would ask you to have a shower or bath before you come to the hospital. Please ask any friends and family with infections (especially sickness and diarrhoea) not to visit you in hospital. Also, it’s best to leave plenty of time to get to the hospital on the day of your operation, so you’re not rushed and arrive as relaxed as possible. On the day at the hospital, we’ll show you to your room where one of our Healthcare Team will meet you to explain each stage of your treatment and recovery. They’ll take notes on your general health, medical and surgical history and ask if you have any allergies. Your blood pressure, pulse and temperature will be taken and an identification band with your name and hospital number on it will be placed on your wrist. You will be shown where the alcohol hand rub is and how you and your visitors should use it. You will also see staff members using this before they treat you; please feel free to ask us if we have washed our hands. Your consultant will come to see you. And if you haven’t signed a consent form already, you’ll be asked to sign one by your consultant. This is to confirm that you understand the details of your operation, the benefits and the risks associated with it, both during and after your operation. When it’s time to go to the operating theatre, our ward staff will take you. There, our theatre staff will take you to the anaesthetic room. They are very reassuring – they will understand how you feel and will try to help you in every way possible.
After the operation
Once your operation is over, you’ll be taken to the recovery room where you will wake from the anaesthetic. Your wound, blood pressure and pulse will be checked carefully. When you are stable and comfortable, a nurse will take you back to your room.
Back in your room
Once back in your room, our nursing team will continue to check on you to make sure you are recovering well. Try not to touch or disturb your dressings as this can introduce infection. If you notice any bleeding or have any pain, don’t hesitate to speak to one of the nurses. After you’ve recovered from the effects of the anaesthetic, you can have something to eat and drink. Don’t forget to wash your hands with soap after going to the toilet at any time. If you are going home the same day as your surgery, you’ll need to have passed urine before you can be discharged. This is because after an anaesthetic, passing urine can sometimes be difficult, and we want to make sure you have no problems when you get home.
Getting up for the first time
We understand that you may be anxious or worried about getting up, but we will do all we can to help and reassure you. Don’t worry; a member of our Healthcare Team will be there to help you, whenever you are ready. The reason for getting you moving is to improve your circulation and avoid stiffness. You may be feeling tender and sore, but you can get pain relief medication to deal with any discomfort – just ask one of the nurses if you have any pain.
Going home
Before you go home, we’ll supply you with two pairs of support stockings, which help improve blood circulation. For best recovery, you should wear these as instructed – this may be for four to six weeks. Your consultant will let you know how long you will need to wear them. Once you have been discharged and someone has arrived to help you home, you may leave the hospital. It’s usual to return to see your consultant as an outpatient after your operation. You may also need to have stitches removed. You’ll be given information about these appointments before you go home.
At home
When you get home, you may be tired for the first few days, and should rest. However, it’s also important to aim to gradually increase your physical activity each day, and by the end of two weeks, you should build up to walking thirty minutes a day. To help you manage these activities, it’s recommended that you take any pain relief medication we have prescribed. Continue taking this until you are pain free. When you are resting, you should keep your feet up and elevated to improve blood flow. Also, at all times, it’s best to avoid long periods of standing. It’s best to shower for the first few weeks after your operation to avoid problems with your wounds – soaking in the bath will not help them to heal.
Getting back to normal
By four weeks, you should be back to most activities, as long as your wounds have healed. Depending on what type of job you do, you should be able to return to work within two weeks. After around one week, you should be able to drive – but only if you can comfortably operate the pedals and control your car in all situations. This includes an emergency stop. If you are in any doubt about your insurance cover, it’s best to contact your insurance company. You may resume sexual activity whenever it’s comfortable.
Risks specific to varicose vein surgery are:
Developing a lump under the wound in the groin. This may be filled with fluid or blood (haematoma) and may need to be drained, if it doesn’t go away
Discoloration of the skin. Although uncommon, brown stains may appear on the skin where the veins have been removed
Numbness or tingling around some of the wounds in the legs. This usually goes away but can take a few weeks or months
Injury to the main arteries in the legs, but this is rare
Some complications to be aware of:
DVT (deep vein thrombosis) is a risk after any operation. Being immobile during surgery causes the blood flow to slow and increases the chance of a clot occurring, usually in the leg. This clot can occasionally break off and move through the blood stream to the lungs and cause difficulty in breathing (pulmonary embolism).
Signs and symptoms of a DVT to look out for:
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Swelling in the leg
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Pain or tenderness in the leg
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Increased warmth in the swollen leg
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Red or discoloured skin on the leg
Infection of the wound is a risk of any surgery.
Your wound will be monitored while you are in hospital and if an infection is diagnosed antibiotics may be prescribed.
Signs of a wound infection to look out for when at home:
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The wound may be warm to the touch
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Pain or tenderness
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Redness or swelling around the wound site
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Oozing of pus or fluid
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Offensive smell
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Your temperature may be raised
Bleeding is a risk with any type of surgery and can result in bruising that may cause discomfort. Severe bleeding and the need for a blood transfusion are very unusual but may be required. Scarring occurs where the surgery took place and usually heals leaving a thin white line. Sometimes, however, there can be an overgrowth of the scar tissue making it unsightly. Pain from the surgery around the area of the wound and general aching around the area.
If you have any concerns or questions about your veins, get in touch. It’s easy to make an appointment, just give us a call on 0800 688 699.
