What are varicose veins?
Varicose veins are veins that have become stretched and subsequently appear more prominent. They are a very common problem which usually affects the legs.
Veins are blood vessels in the body that return blood to the heart. Normally, contraction of muscles in the leg pumps the blood upwards. Blood flows from the superficial veins (near the surface of the skin), into the deep veins (deeper within the leg). One way valves are present at the junction of these two veins to prevent blood from going the wrong way. It is when these valves stop working that varicose veins occur.
Problems with varicose veins
Varicose veins are usually harmless and most people have no problems with them at all. Occasionally however they can cause symptoms. Most commonly this is pain, aching, itching or bleeding. Other problems include:
• Ankle swelling
• Brownish colour around the veins
• Eczema in the surrounding skin
• Shrinking of skin in affect areas
• Inflammation of the varicose veins
• Leg ulcers in the affected area
You will be asked a number of questions about your varicose veins to help us identify how they are affecting your life and how best we can help you. We will also use a doppler or duplex device, which is a form of ultrasound scan, to assess your veins. If treatment is being contemplated, we may need to carry out other tests to ensure that an operation would be safe for you.
Most people in fact do not require treatment for their varicose veins, but if they do the only option is an operation. Varicose vein surgery is very common with a great deal of success in removing the veins and alleviating symptoms. There are however some risks associated with it. These include the small risk of bleeding, wound infection (around 1-2%), and persistence or recurrence of the varicosities.
On the day of the operation you will have your basic observations recorded (heart rate, blood pressure etc), your varicose veins marked out with a pen, and a discussion with the surgeon about the operation. The surgeon will discuss the operation with you and seek your consent to proceed. If you are having a general anaesthetic you will also meet your anaesthetist. Shortly after this you will have the procedure.
There are two types of operation available for varicose veins within our unit, endovenous laser therapy (EVLT) or the more traditional type of surgery. If your veins are suitable for EVLT, this will be offered to you. If they are not we will recommend to you that you have the traditional operation. This is normally because the veins are too narrow or bendy to accommodate the laser device.
Endovenous Laser Therapy (EVLT)
This operation is most commonly performed under local anaesthetic, meaning you will be awake throughout the procedure with the area we are operating on being numbed. Occasionally we may need to give you a general anaesthetic and put you to sleep, so you will be asked not to have anything to eat or drink in the run up to your operation.
The operation is performed with the assistance of the duplex (ultrasound) machine. A small cut is made in the skin usually around the level of the knee, and a laser device is fed through the vein up towards the groin. We will then inject some liquid into the skin around the vein to cool down the area. Everybody in the theatre, yourself included, will wear some goggles. This is to protect the eyes from the harmful effects of the laser. Apart from this risk laser treatment is quite harmless. The laser will be turned on and the device slowly withdrawn through the leg, which 'burns' the vein. If there are any particularly prominent veins over the lower part of your leg, we may make some small cuts in the skin to remove these.
This operation is performed under general anaesthetic either as a day case procedure, or in certain situations a one night stay might be required.
A cut is made either in the groin, or the back of the knee depending on the type of varicose veins you have. As described previously, varicose veins occur when the valve between the superficial veins (near the surface) and deep veins (deeper in the leg) no longer work. In this operation the junction of the two veins is physically divided. If the operation is being performed at the groin, in addition to dividing the junction of the veins we may also 'strip' the vein. This means removing it down to the level of the knee. Any veins below this point are removed through tiny cuts in the skin.
After the operation
Your leg will be bandaged after the operation, and this must remain on for 24 hours. You will be given all the information you need about how to care for your legs after the operation and what bandages/support stockings to wear. If you are having a day case procedure, you will be allowed home within a few hours. If you are having an inpatient operation, you will normally go home the following morning. All the stitches we use are disolvable, but if this is not the case you will be informed. We will not normally make any changes to your medications, but will ensure you have some painkillers when you go home. You should not drive until you can safely perform an emergency stop, which is normally about two weeks.
You may experience some tenderness, lumpiness and bruising at the site of the operation. If however you are concerned about your wound, you should seek assistance in the first instance from your general practitioner or from the hospital. We will arrange to see you again in the outpatient clinic six weeks after your operation to see how you are getting on.