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Surgical treatment of varicose veins

Varicose Vein Treatment Melbourne

 

How are varicose veins diagnosed?

The diagnosis of varicose veins can be made by simply examining the leg.

A duplex ultrasound scan will show which valves or veins are impacted, and will also help determine the best course of action to deal with the varicose veins.

What are the treatment options for varicose veins?

Treatment is determined by the extent of the impacted veins. If the varicose veins are not troublesome, and there is no concern about their appearance, then there is usually no real need to intervene.

Mild symptoms can often be controlled by wearing compression stockings, which may prevent the veins from enlarging.

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

For prominent varicose veins, a more definitive treatment is required, this can be achieved by:

  1. Open Surgery.
  2. Endovenous Laser Treatment (EVLT)

Surgical treatment for 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.

Another method involves endovenous laser ablation of the long saphenous vein (EVLT). 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.

Pre-operative Workup

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

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 on the day of your operation and will need to fast for 6 hours prior to having the varicose vein treatment.

Your anaesthetist will meet you and discuss the relevant aspects of the anaesthetic.

The varicose veins surgeon will mark the affected veins with a market.

The operation

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

There are three steps to the operation.

1. Deal with the underlying cause, which may involve ligating the saphenous vein in the groin or behind the knee, or any incompetent perforating veins, which is the root of the problem.

2. Removing the unsightly or uncomfortable varicose veins via multiple nicks in the skin.

3. Remove or strip the saphenous vein as this will dramatically reduce the chance of other varicose veins emerging.

Post-operative care

At the time of surgery, the leg will be bandaged up. These are removed the following morning and replaced by stockings, which are to be worn for 2 weeks.

You are encouraged to remain as active as possible, however this does not mean overdoing it.

It is common to experience some bruising, particularly on the inner thigh from where the saphenous vein was stripped. This is generally the greatest source of discomfort suffered.

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; and the reoccurrence of varicose veins can never be guaranteed either.

For more information, contact us here.