Surgical Treatment Of Varicose Veins

Pre-operative Workup

Most patients require a duplex (ultrasound) scan of the veins of the leg, to confirm which system (long or short saphenous) is involved.

The majority require little else, as the operation is generally performed in young, relatively fit patients. However, those with a significant past medical history may require a complete workup to determine fitness for anaesthesia.

Day of Procedure

You will be admitted to hospital on the day of the operation. You will need to fast for 6 hours prior to the operation. Your anaesthetist will meet you and discuss the relevant aspects of the anaesthetic with you. Mr Bell willl see you in the holding bay, and mark your veins with a permanent marker.

The operation

The operation is performed with the aim of eradicating the troublesome veins, and hopefully preventing others from emerging.

For patients with varicose veins due to long saphenous incompetence, the sapheno-femoral junction is ligated in the groin via a skin crease incision. In addition it is important in most cases to remove or strip out the long saphenous vein from the groin to the knee, in order to prevent the veins from recurring.

Where the short saphenous system is incompetent, the sapheno-popliteal junction needs to be ligated, best performed with the patient in the prone position.

In addition, the varicose veins are then removed via tiny stab incisions (multiple phlebectomies). These incisions are closed with steri-strips and a firm bandage applied to the leg, which is exchanged for a surgical compression stocking the following morning. (Compression stockings can be purchased from the Moonee Ponds office)

Post-operative course

It is recommended that you do not shower for 2 days following surgery and do not drive for 4 days. Class 1 compression stockings are to be worn for 2 weeks following surgery, day and night (removed for showering). It is advised that you do not over-exert yourself and avoid strenuous exercise for 2 weeks. Reasonable activity is suggested.

A post operative appointment 2 weeks after surgery is required to check on your progress at which time you will be cleared to return to work if appropriate. If the appointment has not been made by the hospital please contact our office on 9372 9999 to arrange a time.

A medical certificate will be provided upon request.

How are varicose veins diagnosed?

The diagnosis of varicose veins can be made with simple examination of the leg. In order to determine, which system is involved, a duplex scan (ultrasound) is often useful in planning appropriate treatment.

What are the treatment options?

Treatment is not always required. If the varicose veins are not troublesome to the patient, and the patient is not concerned by their appearance, to do nothing is an option.

Mild symptoms can often be controlled with compression stockings which may also prevent the veins from enlarging.

For relatively minor varicose veins with trivial venous reflux, injection sclerotherapy may be sufficient to control the veins.

For prominent varicose veins, a more definitive procedure is required. This can be achieved by either:

  • Open Surgery.
  • Endovenous Laser Treatment (EVLT)

Surgical treatment ( a more detailed description is given in procedures performed) of the varicose veins requires interruption of the reversed flow from the deep veins to the superficial through the faulty valves.

For varicose veins arising from the long saphenous system, this requires ligation of the sapheno-femoral junction in the groin. In order to reduce the possibility of recurrent veins, the long saphenous vein is removed (or stripped) from the groin to the knee using a vein stripper. For varicose veins arising from the short saphenous system, the sapheno-popliteal junction is ligated behind the knee. The precise location of this junction is variable, and it needs to be accurately located with ultrasound prior to surgery. The varicose veins are removed by “stab avulsions”, via a series of tiny skin incisions.

The leg is bandaged immediately to reduce bruising and swelling. In most cases the bandages are removed the following morning and replaced with compression stockings, which need to be worn continuously for 14 days.

Another method involves Endovenous laser ablation of the long saphenous vein (EVLT) (see procedures performed). This involves the passage of a laser probe along the saphenous vein, following cannulation of the vein under ultrasound guidance. The laser probe is then used to ablate the saphenous vein by inflicting a thermal injury to the inner lining of the vein, causing it to thrombose or clot. This has the advantage that it can be performed under local anaesthesia, with the expectation of an earlier return to work.

What are the complications of surgery?

Some bruising is inevitable following surgery for varicose veins. This is usually most prominent on the inner aspect of the thigh from where the long saphenous vein has been stripped. Not uncommonly, patients notice residual tender lumps at the site of previous veins, which usually disappear with time.

It is important to emphasise that complete eradication of ALL veins can NEVER be guaranteed.

Moreover, even in the very best hands, a number of patients (10-15%) will develop recurrent veins in due course.