What is it?

A varicose vein is a superficial (close to the surface) vein lying under the skin.. It has swollen because of overspill of blood from veins running deep in the muscles of the legs. This happens because certain valves that allow the blood to flow from the superficial to the deep veins of the leg and not the other way around are not working any more. Varicose veins may cause no symptoms. However, most patients experience problems such as itching, aching and a feeling of heaviness in the legs. Less frequently, varicose veins can cause bruising and swelling and can get clotted. Rarely they can also be the cause of leg ulcers.

The Operation

Usually, the main feeder vein to the varicose veins is tied off through two small cuts - one at the groin and one below the knee - and is then removed. There are many ways of doing the operation and you can ask your surgeon for details of his method. The most frequently used method is the passing of a special wire through the cut in the groin into the vein followed by stripping of the vein. Sometimes another feeder vein behind the knee has to be tied off as well using a similar procedure as for the main feeder vein. Following that, smaller varicose veins are removed through tiny cuts dotted down the leg. Your operation will either be a day case, where you come into hospital on the day of the operation and go home the same day, or a non-day case, where you are in hospital for one or two nights. A general anaesthetic is given so that you will be asleep during the operation. Local anaesthetic may be injected into the groin as well as into the other smaller cuts on your skin to make them pain free when you wake up.

Any Alternatives

If you leave things as they are, there is no harm done in the short term. Over 5 or 10 years or more, you will probably notice the veins getting worse. This is usually associated with worsening of the symptoms and you will experience more pain, bruising and swelling. Injection treatment works on its own, if the veins are only seen below the knee and they are relatively small Injections are also useful to control small veins that are still there after an operation. Elastic stockings are helpful if you are not keen on an operation. They can help determine if your pains are due to varicose veins. Laser treatment, ointments, and drug treatment are not helpful for your type of veins. Camouflage make-up is helpful to cover up small flare veins.

Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital. On the ward, you will be checked for past illnesses and will have special tests to prepare you so that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital

There will be some slight discomfort on moving. Painkilling tablets should easily control this discomfort. If not, you can have painkilling injections. By the end of one week the wound should be just about pain-free. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions during this time. The nurses will help you with everything you need until you can do things for yourself. There will be a dressing on the groin wound which may be changed after 24 hours for a day case or 48 hours for a non-day case. An elastic sleeve bandage is always used. You will need to wear it for about 10 days. Under the elastic sleeve, the wounds may be covered with tiny paper strip dressings. Take off all dressings and bandages 10 days after the operation. If the elastic sleeve becomes slack or too tight let the nurses know. Sometimes there are stitches under the skin which melt away, so that the wound does not need any more attention. You can wash, bathe, or shower as soon as the stitches, clips or paper strips are taken off. Soap and tap water are quite alright to use. Salted water is not needed. Some hospitals arrange a check-up about one month after you leave hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.

After - At Home

At first discomfort in the wound will prevent you from harming yourself. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 10 days. You may restart sexual relations within a week or two, when the wound is comfortable enough. You should be able to return to a light job after about two weeks, and any heavy job within four weeks. The wounds take a month or more to heal and soften up. Sometimes injections are given for minor veins that are still present.

Possible Complications

As with any operation under general anaesthetic there is a very small risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.

Minor complications after an operation for varicose veins occur in about 17% of cases. They include:

• minor bleeding from one of the wounds which almost always stops by applying some extra pressure on the wound or more frequently bruising and swelling. Bruising and swelling may be troublesome, particularly if the veins were large. They may take four to six weeks to settle down completely.
• minor infection of one or more of the wounds or of a bruised area of the skin that settles down with antibiotics in a week or two.
• occasionally there are numb patches in the skin around the wounds which get better after two to three months. This is due to the cut of very small nerves of the skin around the wounds.

The chances of serious complications are very small (less than 1%). This includes the formation of a blood clot in one of the deep veins of the leg that can potentially push a life-threatening embolus (part of a clot) to your lungs or cause damage to one of the big arteries, veins or nerves of the leg. All necessary precautions will be taken to avoid such complications (i.e. helping you to be as mobile as possible after the operation and giving you blood thinners to avoid the formation of clots in your leg) and it is important to know that they very rarely happen in centres with good experience in performing this operation.

Finally, you have to keep in mind that approximately 1 in 10 patients may need more treatment to the veins in the 10 years after the operation.

General Advice

Do leave yourself enough time to get over the operation. Practically all patients are back to their normal duties within one month. If you have both legs operated on, the recovery is a little slower. These notes should help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.