Varicose veins surgery: What you need to know

Varicose veins are enlarged, swollen, and twisted veins that typically appear dark blue or purple, causing not only cosmetic concerns but also discomfort and health complications. For some people, surgery becomes a necessary option to manage varicose veins effectively.

Mr Paul Bachoo, consultant vascular surgeon, offers an expert understanding of varicose veins surgery.

How do I know if I need surgery for my varicose veins?

Surgery for varicose veins is typically recommended when:

• Symptoms are severe: When varicose veins cause significant pain, swelling, or skin changes such as ulcers, surgery might be necessary.
• Complications arise: If complications like bleeding, thrombophlebitis (inflammation of veins), or chronic venous insufficiency develop, surgery might be required.
• Non-surgical treatments fail: When conservative treatments such as compression stockings, lifestyle changes, or medication fail to alleviate symptoms.
• Cosmetic concerns: Some patients might opt for surgery to improve the appearance of their legs when varicose veins are prominently visible.

What types of procedures are available for varicose veins?

Varicose veins surgery refers to a range of medical procedures aimed at treating varicose veins. Several procedures are available, each with its own method and indications.

Vein ligation and stripping

During vein ligation and stripping, an incision is made in the skin over the vein. The vein is tied off (ligation) to prevent blood flow. A wire is then inserted into the vein and pulled out, stripping the affected vein from the leg. General anaesthesia is used.

The recovery period is typically two to four weeks. Patients may experience bruising and swelling, but normal activities can usually resume within a few weeks.

Ambulatory phlebectomy

During an ambulatory phlebectomy, tiny incisions or needle punctures are made along the vein. The vein is then extracted piece by piece using a specialised hook. Local anaesthesia is applied.

The recovery period is short. Patients can walk immediately and resume daily activities within a few days.

Endovenous laser therapy (EVLT)

During EVLT, a catheter is inserted into the vein. A laser fibre is then threaded through the catheter into the vein, emitting laser energy. The laser energy causes the vein to collapse and seal shut. Local anaesthesia is applied after.

Recovery is quick, often within a week. Patients can generally return to their normal activities immediately.

Endogenous mechanochemical ablation (ClariVein)

With this technique, a small probe is placed into and up the inside of the vein. A special motorised handle is then attached. As the probe is withdrawn down the vein it is mechanically disrupted and sprayed with a chemical to seal it closed.

Sclerotherapy

During sclerotherapy, the affected vein is identified. A sclerosant solution is then injected directly into the vein, causing it to scar and close. The varicose vein eventually fades from view.

There is minimal downtime after sclerotherapy. Patients can immediately resume normal activities, but multiple sessions may be required for optimal results.

Uniquely, these separate procedures can be safely combined to offer a tailored surgical procedure.

Are there any risks or complications associated with varicose veins surgery?

Like any medical procedure, varicose veins surgery carries potential risks and complications. General risks include bleeding, infection, and adverse reactions to anaesthesia.

Specific risks for each procedure include:

• Vein ligation and stripping: Bruising, nerve injury, and deep vein thrombosis (DVT).
• Ambulatory phlebectomy: Bruising, skin discolouration, and minor scarring.
• EVLT: Burns, nerve injury, blood clots, and skin pigmentation changes.
• Sclerotherapy: Allergic reactions to the sclerosant solution, blood clots, and skin ulceration.

Will I need to wear compression stockings after surgery?

Yes, wearing compression stockings is typically recommended after varicose veins surgery in order to help reduce swelling, prevent blood clots, and improve circulation, thus promoting faster healing. Generally, wearing compression stockings will be required for one or two weeks continuously post-surgery, exactly as prescribed by the surgeon.

If you would like to schedule an appointment with Mr Paul Bachoo, head on over to his Top Doctors profile today.