Varicose Veins Operation Patient Information Leaflet April 2017 1
WHAT IS VARICOSE VEIN SURGERY (HIGH LIGATION AND MULTIPLE AVULSIONS) The operation varies from case to case, depending on where the leaky valves are. Normally you will have a slanting cut about 4-6cm long running in the skin crease of the groin. Through this incision, the top end of the faulty skin vein (long saphenous vein) is tied off to stop blood flowing through it, this is known as ligation. The ligation and removal of the long saphenous vein deals with the cause of the varicose veins and should prevent recurrence. Less frequently, when the faulty skin vein at the back of the knee (short saphenous vein) has a leaking valve, it too needs ligating. This is performed through a horizontal incision of about 3cm at the back of the knee. The vein is then ligated (tied off) like before. Finally, in most cases, the visable varicose veins are removed from the leg through tiny incisions about 2-3mm in length. Incisions are placed about 3-5cm apart along the line of the varicose vein. There may be a large number of incisions if the varicose veins are extensive. The larger incisions are closed with a stitch, which lies beneath the skin and doesn t need to be removed. The smaller incisions are not stitched because they heal on their own. The operation can take approximately 60-90 minutes. The leg is bandaged firmly from toe to groin at the end of the operation. WHAT ARE THE BENEFITS? You should no longer have varicose veins and some or all of the symptoms should show improvement. Although surgery can help prevent the symptoms and complications (ulceration, bleeding, phlebitis) of varicose veins, there is no complete cure for varicose veins. Over time varicose veins can re-occur. Varicose vein surgery does not get rid of thread veins and should be discussed with the surgeon prior to treatment. For those with skin changes around the ankles or previous ulceration, reducing the pressure by operating prevents worsening of the skin change and usually reduces the risk of further ulceration. ARE THERE ANY RISKS INVOLVED? You will need a general anaesthetic for your operation. You will be seen by an anaesthetist prior to surgery to discuss the risks involved and pain relief. Complications after varicose vein surgery are uncommon. 2
Chest Infections: These can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy. Wound infections: Wounds sometimes become infected and this may need treatment with antibiotics. Bad infections are rare. Fluid leak from wound: Occasionally the groin incision may leak blood stained or clear fluid. Usually this lasts a few days when it is bloodstained. Sometimes, clear fluid collects under the groin incision. It may be contained beneath the skin or it may leak through the incision. It is called a lymphocele. This occurs infrequently mainly following re-operation on the groin. If there is leakage from the groin, it may take up to 6 weeks to settle. Nerve injuries: These are uncommon, occurring in about 1 in 20 cases. Two skin nerves are particularly at risk. The first picks up sensation from the top of the foot, and the second from the outer border of the foot. Other unnamed nerves may sometimes be damaged leading to reduced sensation anywhere in the leg. The reduced sensation may be very noticeable at first, but normally diminishes with time, and is not usually a problem in the long term. Deep Vein Thrombosis (D.V.T): Blood clot in the deep veins. This can be a complication of any surgery from time to time. A DVT can occur occasionally following varicose vein surgery but the complication is rare. Recurrent Varicose Veins: Recurrence of varicose veins occurs in about 1 in 15 patients over a ten-year period. Sometimes further treatment may be required. WHAT ARE THE ALTERNATIVES? Foam Sclerotherapy: In this procedure varicose veins are treated by injecting a chemical that is forcibly mixed with air into the vein. This turns the liquid into a foam consistency, like shaving foam. It causes mild inflammation within the vein and subsequently the lumen of the vein is blocked by the scar tissue. It does not require an anaesthetic, cut, or a stay in hospital. Laser treatment & radio frequency ablation: Other centres are using lasers, heat probes and metal clips to close the varicose veins, but we do not offer such treatments at present. Stockings: Support stockings, either to just below the knee or full length will usually control the symptoms of aching from varicose veins. This will relieve aching in the legs but will not remove the varicose veins. They are only available on prescription. Caution must be exercised in people with poor arterial circulation. The consequences of not treating varicose veins are that they may become worse. They may have no significant change. 3
HOW LONG WILL I BE IN HOSPITAL FOR? Varicose vein surgery is usually performed as a day case. If you are generally fit and well, have a family member to take you home, and be with you overnight you will be allowed home the same day. Day case surgery is normally allocated between 8am and 5pm and you will be allowed home when recovered. Those having complex surgery or if you live alone may require a stay in hospital overnight. Tests to assess whether you qualify for the surgery will already be done in out-patients clinic. These include examination with a hand held Doppler and sometimes an ultrasound scan. Immediate pre-operative tests include blood tests and ECG s and will be completed in a pre-operative assessment clinic sometime prior to the day of your surgery. WHAT HAPPENS TO ME WHEN I ARRIVE AT THE WARD / DEPARTMENT? You will be admitted to your bed by one of the nurses who will show you where things are on the ward, complete your nursing record and take your observations (blood pressure, pulse, temperature). You should bring with you all the medications that you are currently taking. If not already completed in the pre-op assessment clinic, a Doctor from the team will clerk you in by completing your medical details and history in the medical notes. An anaesthetist may also visit you prior to surgery. The surgeon who will perform your operation will visit you immediately before the procedure. He will mark up your veins with a waterproof pen, agreeing with you which veins will be removed. You should ensure that all your varicose veins are marked. He will also sign a consent form if you haven t already completed in clinic. ON THE DAY OF THE PROCEDURE / DURING THE PROCEDURE You may be asked to be nil by mouth overnight or after an early light breakfast, depending on the time of your surgery. Once in the anaesthetic room a small needle will be placed into the back of your hand. The anaesthetic is injected through the needle and you will be asleep within a few seconds. While you are asleep, local anaesthetic will be used around the groin incision and incision on the back of the knee (when used). When you wake up the incisions should be numb. Sometimes a drip is placed into a vein in your arm (wrist usually) to give you some fluids during and following surgery. WHAT HAPPENS AFTER THE PROCEDURE? You will usually be taken to the theatre recovery area after the operation, where you will wake up. When you are fully awake (usually 20-30 minutes) you will return to the ward. 4
The nursing staff will check your blood pressure and other observations on arrival back to the ward. Most people describe the leg as stinging or burning when they wake up. It is unusual for the leg to be painful. Following this sort of surgery you are very unlikely to feel sick, and you should be able to eat and drink again within a few hours. Some of the smaller incisions may bleed a little over the first 24-48 hours. For this reason, it is best to keep the leg covered with bandages or stockings for a minimum of 48 hours. After this time, the stockings may provide support to the bruising making the leg more comfortable. Your doctor will advise you on how long to wear the stocking. The incisions, although initially very visible, will subside to become virtually invisible within 9-12 months. There is usually extensive bruising in the leg, particular down the inside of the thigh. This bruising usually lasts for 3-4 weeks. You will be encouraged to mobilise as soon as possible after surgery to encourage the deep circulation. DISCHARGE ARRANGEMENTS When you are well enough to go home you will need someone to collect you and take you home. You should not require a district nurse visit as the stitches used will be dissolvable. The ward staff will advise you if this is any different. The surgeon will have also decided on a follow up out-patients appointment and this will be written in your notes. The ward staff will advise you of this appointment. You should only require simple pain relief (i.e. paracetamol) after varicose vein surgery. If necessary speak to your GP if this is not sufficient. DAY TO DAY LIVING Most people describe the leg as sore and uncomfortable when they get home. The symptoms may increase steadily from the second post-operative day and are usually at their worst on the 8th-10th post-operative day. The discomfort usually resolves 12-14 days after the operation. Occasionally, when there is phlebitis, the leg will be painful. The pain may last for up to 3 weeks in this situation. When you get home, try to return to normal as soon as possible. The more exercise you take, the more sore your leg will be, but the quicker the leg will return to normal. Regular daily exercise such as going for a walk or using an exercise bike to provide a gradual return to normal activity is recommended. 5
To rest continuously after the operation increases the risk of developing blood clots in the deep veins (deep vein thrombosis or DVT). Regular exercise reduces this risk, but makes the leg more uncomfortable. Driving: You will be able to drive within 48 hours of the operation provided the leg is not too uncomfortable. Bathing: You can bath or shower within 48 hours of operation. Sometimes bathing or showering immediately after surgery may lead to bleeding from the smaller incisions. Work: You should be able to work within 1-3 weeks of surgery depending on your job. Your GP will advise you of this when you see him/her for your sick note. Lifting: There are no limitations in this area. Medicines: You will usually be sent home with some pain relief. You will be advised on their use before you leave the hospital. IF THERE IS A PROBLEM If you have any further questions, please do not hesitate to ask either your consultant or one of his team, or the nurses looking after you on the ward. If any problem arises after surgery contact your GP or attend the Accident & Emergency Department. For advice you can also contact the Vascular Studies Unit on 0161 922 6413 OTHER USEFUL CONTACTS OR INFORMATION Patient Information Centre Further information can be obtained from the Vascular consultants secretaries on 0161 922 6529 SOURCE OF GOOD PRACTICE The Vascular Society website has been consulted to compile this information leaflet. If you have any questions you want to ask, you can use this space below to remind you. If you have any questions you want to ask, you can use this space below to remind you If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Patient Information Centre on 0161 922 5332 6
Document control information Author: The Vascular Studies Unit Division/Department: The Vascular Studies Unit Date Created: November 2010 Review Date April 2017 7