Varicose veins on the legs can be both unsightly and painful. Superficial, spiderweb-like varicose veins are usually just cosmetic issues, but more severe varicose veins present as large blue or purplish lumps or bulges. While there are several causative factors, including genetics, varicose veins most commonly occur in people whose lifestyles involve a large amount of standing and walking. If self-help and minor treatments do not cure or reduce the symptoms of varicose veins, then surgical treatment may be required.
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The goals of treating varicose veins are symptom relief, the improved appearance of your legs and the prevention of any complications. Before a surgical procedure is considered, doctors may suggest you try some self-help treatments such as wearing compression stockings or spending less time on your feet. If these do not work, then some minor procedures such as radio-frequency ablation, endovenous laser treatment or ultrasound-guided foam sclerotherapy may be effective. The only effective way of treating severe varicose veins is vein stripping and ligation. You can usually have this done as an outpatient, and your total recovery time should be about four weeks.
At your first consultation, the doctor will look at your bare legs and discuss your symptoms before referring you to a phlebologist, a doctor who specialises in vein conditions. You will be asked when you first noticed your varicose veins, whether they are painful and how severe the pain is. You will also be asked whether you have tried any self-help treatments and what seems to improve or worsen your symptoms.
Depending on the state of your overall health, your surgical procedure for varicose veins will be carried out under general anaesthesia. In certain circumstances, for example, if you have a respiratory condition that makes a general anaesthetic riskier, the surgical intervention can be carried out under a local anaesthetic.
The surgical procedure for varicose veins is called vein stripping and ligation. It involves tying shut the affected veins and then removing them through several small cuts in your skin. You do not need to worry that having a vein or veins removed will affect your blood flow, circulation or general health. As the veins most commonly affected are the two large ones that run just under your skin, blood simply flows through other, deeper veins. Before you go to theatre, the consultant may mark the affected varicose veins with a marker pen. Once in theatre, a series of incisions are made along the length of your leg, including in the groin and at the back of the knee. A hooked tool is then used to pull the vein through these incisions. Once the surgeon is happy the vein has been totally removed and there is no severe internal bleeding, the cuts are closed with adhesive strips or sutured, depending on their length, and covered with a sterile dressing. A pressure bandage is then applied. This reduces bleeding and bruising while also helping to keep the wounds clean and prevent a DVT from forming. Should everything go smoothly, you should be able to leave the hospital within a couple of hours of your procedure.
Although vein ligation and stripping is the most common form of surgical procedure for varicose veins, a phlebectomy may be carried out if your veins are smaller and causing less severe symptoms. With a phlebectomy, smaller and fewer incisions are made, and the smaller veins that branch off from larger veins are removed. This procedure results in less scarring than vein stripping.
Transilluminated powered phlebectomy is a new treatment which is still considered experimental. It is not yet recommended by NICE but can, however, be offered to patients if doctors feel it will be more beneficial than traditional methods. One or two small incisions are made, then an endoscopic transilluminator or special light is inserted under the skin. This illuminates the leg from within, allowing the surgeon to clearly see which veins are affected. These are then removed by suction through the incisions. Like vein ligation and stripping, it is usually carried out under general anaesthesia.