Patient Information
This information leaflet refers to the techniques that are available on the NHS. The new technique of VNUS Closure (using electric current to destroy the vein from the inside) is only available privately.
[Home] [Detailed description of varicose veins]
Veins are the blood vessels that take blood back to the heart. The leg has 2 systems of veins: deep and superficial. The deep veins start in the calf muscles and join to form a single vein behind the knee (the popliteal vein) which then runs up the thigh deep to the muscles (femoral vein). There are 2 superficial veins (long and short saphenous veins). The long saphenous vein runs from the ankle, along the inside of the leg and joins the deep vein in the groin (sapheno-femoral junction). The short saphenous vein runs from the ankle, along the calf and joins the popliteal vein behind the knee (sapheno-popliteal junction). All these veins have one-way valves that allow blood to flow up the leg only.
There are 2 possible theories to explain why varicose veins develop:
 | The valves may stop working properly and allow blood to flow downwards. This puts pressure on the vein wall, which over time becomes ballooned and tortuous. |
| The vein wall becomes lax. The valves then fail secondarily to this. The down flow of blood and constant pressure on the vein walls causes them to become ballooned and tortuous. |
These ballooned tortuous veins are the varicose veins you can see just under the skin. These veins do not work properly and can be removed – the deep veins are sufficient to take the blood back to the heart.
Do all varicose veins need treatment?
Varicose veins are a common condition. Not all of them cause problems. If your veins are not causing any symptoms or other problems, then they can be left alone or treated simply with compression stockings. If they are causing symptoms (ache, pain, itching etc.), swelling of the lower leg, discoloration of the skin at the ankle, bleeding, phlebitis or an ulcer then they need to be treated. Treatment may involve compression stockings, injection of a substance to scar the veins (injection sclerotherapy) or surgery to remove the superficial veins. Not all patients can tolerate the stockings as they have to be worn long-term and are quite tight. Injection sclerotherapy cannot be used if the valves at the 2 junctions mentioned above are leaking or the veins are predominantly in the thigh. Most patients opt for surgery.
How long will I be in hospital?
When you are seen in clinic, your consultant (or the doctor who examines you) will be able to decide if you are suitable for a day-case procedure (admitted, operated on and discharged the same day) or whether you will require an in-patient procedure (discharged 1 or 2 days after the operation). This depends on your medical condition and your home circumstances.
A week or more before your operation you may be asked to attend the hospital for a pre-operative assessment. In this clinic you will be seen and examined by a junior doctor or day case nurse. Blood tests, a heart tracing (ECG) and chest x-ray may be taken. Sometimes these tests may be done at your initial consultation in the 'varicose veins clinic'.
Preparing for admission to the day case unit
| Do not eat or drink anything for 6 hours before your operation. |
| Do not wear make-up, jewellery or nail-polish. |
| Bring a dressing gown, night-dress, slippers and toiletries. |
| Have a bath or shower before you come to hospital. |
| Make sure you arrange for someone (a relative or friend) to escort you home after the operation and stay with you overnight. |
| Do not bring too much money or valuables into hospital. |
You will be welcomed by a member of the nursing staff before being asked to change into a theatre gown. Your details will be checked by the nurse. The anaesthetist and surgeon will visit you and answer any questions that you may have. You will be asked to sign a consent form if you have not already done so. The surgeon will confirm the exact procedure you are having and will mark the veins to be removed. You should have had all the tests required already but occasionally the anaesthetist may request some further tests – such as a chest X-ray or a heart tracing (ECG). The ward nurse and a porter will take you to the anaesthetic room.
The operating department assistant will check your details again. Some routine monitoring equipment will be used to check your pulse, blood pressure and the amount of oxygen in your blood. The anaesthetist will insert a needle into the back of your hand and use this to give you drugs to send you to sleep. This is a ‘general anaesthetic’. Most varicose veins operations are done this way. Your consultant will have discussed other methods (local or epidural/spinal) with you. If the operation is to be carried out under epidural/spinal anaesthetic, the anaesthetist will insert a needle into your back. Using this technique the lower half of your body will be made numb but you will remain awake during the operation (unless you request a sedative). If the operation is to be done under local anaesthetic, the surgeon will inject the anaesthetic into the area he will be operating on. This stings for a few seconds before going numb. With this technique you are awake, can feel touch and pressure but will not feel pain (if you do, you must tell the surgeon who can inject more anaesthetic).
The whole leg is cleaned with iodine (brown stain) or chlorhexidine (pink stain) and sterile drapes positioned to create a clean operating field.
If you are having surgery to the long saphenous vein, a 2 inch cut is made in the groin and the junction between the long saphenous and femoral veins isolated. It is tied and divided. A ‘stripper’ (metal wire covered with plastic) is passed down the long saphenous vein to just below the knee. This allows the long saphenous vein to be removed from the thigh. Any veins that the surgeon marked before the operation are then pulled out (avulsed) through tiny cuts.
If you are having surgery to the short saphenous vein, a 1-2 inch cut is made at the back of the knee and the junction between short saphenous and popliteal veins isolated. This is tied and divided. A stripper is passed down the short saphenous vein to the ankle. This allows the vein to be removed from the calf.
The main cut in the groin or back of the knee is closed with a dissolving stitch buried under the skin. The other wounds may have sticky tape dressings (‘steristrips’) or no dressings at all. The leg is wrapped in brown sticky bandages. These bandages are designed to be left on for a week.
What are the possible complications of this surgery?
The possible complications of the procedure include:
| Bleeding - this usually presents as bruising in the thigh. Rarely a collection of blood (haematoma) under the groin wound will need to be surgically drained. |
| Wound infection - usually in the groin cut but can involve any cut and presents a few days after the operation. The majority settle with antibiotics. Rarely an abscess may form - this requires a second operation to drain. |
| Patches of numbness sue to skin nerve damage at the avulsion sites. |
| Damage to the saphenous nerve - this may occur during long saphenous surgery. It can cause numbness, pins and needles or pain along the inside of the calf and ankle. The majority will settle in time but some cases are permanent. |
| Damage to the sural nerve - this may occur during short saphenous surgery. It can cause numbness, pins and needles or pain along the back of the ankle into the sole of the foot. The majority will settle in time but some cases are permanent. |
| Blistering - this may be due to an allergic response to the glue in the dressings, steristrips or the bandage or friction from the bandages. The blisters are usually superficial and heal without scarring. |
| Deep vein thrombosis - is a risk with any surgery. |
| Damage to major nerves - this rare complication is mainly a risk with operations at the back of the knee. It is rare but causes severe problems (such as 'foot-drop'). |
| Damage to major veins or arteries in the leg - this is rare. |
After your operation you will be taken into the recovery area. The needle in the back of your hand will be connected to a bag of fluid. Routine observations will be carried out. You will have an oxygen mask on your face. Once you are fully recovered (after about 30 minutes) you will be taken back to the ward.
The nurses will continue to monitor your recovery. If you are in pain tell the nurses who will give you appropriate painkillers. When you are feeling more awake and recovered from the effects of the anaesthetic, you will be offered something to eat and drink. The nurses will allow you to stand when they are happy with your observations. Please do not try this on your own without a nurse present as you may faint and hurt yourself. Before discharge you will be given a supply of pain-killers and possibly laxatives (constipation can occur for the first few days).
On the first night simply rest at home. Thereafter, you must try to resume normal activity as soon as possible. Do not treat yourself as an invalid, but equally do not try to do too much too soon. Try to take a regular walk - this gets the calf muscles to pump the blood back to the heart. Use common sense - 'if it hurts don't do it'. Take the pain-killers regularly for the first few days. Some discomfort is normal. If the bandages are too tight contact your general practitioner's nurse. The bandages can be removed and the white stockings (TED stockings) put on instead (day and night for the first week).
If the wound bleeds and this does not stop after 10 minutes of pressure and lying down, call your general practitioner or attend the casualty department.
If the wound becomes more painful and red, see your general practitioner for antibiotics.
Keep the wound dry for the first 2-3 days. Keep the bandages dry for the week.
Once the bandages are removed you may bathe the leg - the steristrips will simply lift off during this. Wear the TED stockings during the day for the next 4-5 weeks whilst the bruising settles.
You can drive after a week - as long as you can do an emergency stop without pain. You can return to work when you are comfortable to do so.