Discharge advice laser treatment of varicose veins Day Surgery Unit Patient Information Leaflet
Introduction Laser treatment is one of the latest forms of treatment that can be offered to certain patients with varicose veins. It is not suitable for all varicose veins and can only be used on a certain group of patients who have a long and fairly straight segment of vein in the leg. We are pleased to be able to offer this new treatment for you. It is a very safe procedure with minimal complication rate. The advantage is that it reduces the pain and bruising of the standard surgical stripping procedure which is the traditional treatment for varicose veins. It is now widely used throughout the United Kingdom and the western world and the procedure has been approved by the National Institute of Clinical Excellence (NICE) which has issued guidelines and patient information. This can be obtained by telephoning 0870 1555 455, quoting reference N0500. Outline of the procedure The operation is carried out under ultrasound guidance and local anaesthetic which is injected into the thigh with a fine needle. Occasionally a general anaesthetic may be required if additional procedures are planned for you by the surgeon. A fine tube (catheter) is inserted into the vein through which a laser fibre is passed up to the groin. The laser energy will be delivered through this fibre into the vein to cause it to heat and shrivel up. This will usually be painless at the time. 2
Safety and efficiency There is good evidence that the procedure is a very safe and efficient way of causing complete closure of the main varicose vein trunk in nearly all patients. Studies have shown that two years after this treatment, in 93 per cent of patients the vein remained closed. In another study there were no recurrences (of the varicose veins) seen. These results are better than the results from surgery. Complications The most common complication is pain and bruising along the vein that has been treated. However it is well documented that these symptoms are relatively mild compared to surgical stripping. Occasionally there is some damage to the skin. Bruising may result due to a puncture of the vein. Nerve damage is an unpleasant side effect of laser treatment, particularly if the main vein behind your knee has been treated (short saphenous vein). However all these complications are milder and less frequent than the standard surgical treatment. Advantages After the procedure you will be given a tight compression stocking to wear for one to two weeks and you may need to take a simple painkiller like paracetamol on a regular basis for up to a week. You should be able to resume normal activity within reason in two to three days and this is a huge advantage compared to surgery. However if the surgeon has decided to perform additional procedures such as phlebectomies at the same time as the laser treatment, it is possible that your recuperation may be slightly affected by the additional procedures. 3
Recurrence Varicose veins have a habit of appearing elsewhere once the main vein has been treated which is true even after laser treatment of your veins and should be no different to surgery. However the chances of the same vein coming back are much less. Specific instructions It is important to remain active after your operation and you should start walking the morning after your operation. Try to walk at least three 20 minute walks a day, spacing the walks throughout the day. As the days progress walking will become easier and you can increase the amount you walk. You will probably experience some degree of pain or tenderness following your operation. It is fairly common after varicose vein procedures to have sharp pain or numb areas due to damage to very tiny skin nerves which run along the veins. This can last approximately one week. The compression stockings should remain on your leg(s) night and day until the stitches (if any) are removed in seven to 14 days. Until the stitches are removed you will not be able to have a bath (specific instructions for this will be given prior to your discharge). The stocking(s) should be worn for a further five weeks during the day time only. The stocking(s) may be washed using lukewarm water with no detergent and dried flat. Do not tumble dry. 4
It is not unusual for the wound to bleed on the day of operation. If it does, do not panic, sit and elevate your leg on bed/settee. You should apply continuous pressure over the stocking where the bleeding is for five to 15 minutes this should stop the bleeding. If after this time the bleeding has not stopped, continue applying pressure and contact the helpline at the Day Surgery Unit, Russells Hall Hospital, Monday to Friday, 8am to 5pm on 01384 456111 Ext: 1886. Outside these times phone the Surgical Assessment Unit on 01384 244124. Do not drive for two weeks following your surgery. Please ask your admitting nurse if you require a sick note. It is not unusual for your leg(s) to be bruised in appearance or hard and tender to touch following your operation. Over the course of several weeks the bruising, tenderness and/or discolouration should become less noticeable. Occasionally bruising may take a few months to clear up completely. If you experience discomfort with your stockings e.g. tightness, do not cut your stocking or roll it down the leg as this can act as a tight band affecting the blood flow in the leg. If you experience any problems please contact the helpline on the above telephone numbers. Remember: everyone recovers differently following surgery so do not worry if you feel tired and weak for several days as this is quite normal. However should this persist for a prolonged period please see your GP. 5
If you have any problems or worries following your operation e.g. excessive pain or bleeding over and above what you would expect from small cuts, do not hesitate to contact the helpline on the above telephone numbers. You may use this helpline for 14 days after your treatment/operation. If you have any problems or queries after the 14 days please contact your GP. Scarring Usually the small stab incisions fade away in twelve to eighteen months but the skin damage/pigmentation that you had prior to surgery may be permanent. Nerve damage Damage to small skin nerves is common and causes temporary symptoms. Very rarely a more important nerve can get damaged short or long term particularly if you have had an operation on the back of your knee. Air travel The fact that you have had a procedure for varicose veins does not reduce your risk of having a Deep Vein Thrombosis. The current advice is to wear support stockings/tights and try to be mobile during long haul flights. It is not advisable to fly within six weeks of your surgery. 6
If you have any questions or if there is anything you do not understand about this leaflet please contact: For urgent queries: Day Surgery Unit 01384 456111 Ext 1886 (7.30am to 9pm, Monday to Friday) or at all other times contact: Surgical Assessment Unit 01384 456111 Ext 2699 For non-urgent queries please leave a message on Tel: 01384 456111 Ext 1842 and a member of staff will get back to you.. 7
Originator: T Trevis, A Larkin Date originated: June 2012 Date for review: June 2015 Version: 2 DGH ref: DGOH/PIL/00644 8