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Conventional varicose vein surgery

Produced by:
Mr Paul Hayes MD FRCS
Mr Kevin Varty MD FRCS
Department of Vascular Surgery
 
Name of procedure: Surgery on the long saphenous varicose veins (in the leg)

Varicose veins are very common, affecting at least 10 to 15% of the adult population in the UK. This condition can be embarrassing and painful and, if untreated, can lead to leg swelling, pigmentation of the skin of the lower leg, and ulcers.

Here, we outline some of the benefits, risks and alternatives to the operation.  We want you to have an informed choice to enable you to be involved in the decision-making process.  Please ask your surgeon or the specialist nurse about anything you do not fully understand or wish to be explained in more detail. 

You will be asked to read this form carefully and you and your doctor (or other appropriate health professional) will sign it to document your consent.  

Surgery on the long saphenous varicose veins

The long saphenous vein starts at the groin, runs underneath the skin of the thigh and calf, and ends in the foot. In the groin, the long saphenous vein connects with the femoral vein (in the deep system of veins). At this point, a valve prevents high-pressure blood from the femoral vein entering the long saphenous vein. In varicose veins, this valve has become leaky.

Admission

Surgery

The first part of the operation is to make an incision (cut) in the skin crease of the groin and find the junction of the long saphenous and femoral veins and then disconnect them.

The long saphenous vein is then stripped (removed) to just below the knee. Research studies have shown that this reduces the chance of the varicose veins growing back (called recurrent varicose veins). Surgeons no longer strip the vein to the ankle because in the lower calf the vein runs very close to a nerve that can be damaged by the procedure and can cause a numb foot. Instead, it is safer to remove any varicose veins in the lower leg by using multiple small incisions (2 to 5mm long) known as avulsions.

The groin wounds are then closed using self-dissolving sutures (stitches), which are inserted underneath the skin so they cannot be seen. The much smaller avulsion wounds usually heal well without any sutures; occasionally, paper ‘Steristrips’ are used to close these wounds. Very occasionally, a suture is required.

At the end of this operation, compression bandages are applied to the leg to prevent bleeding and bruising. The operation usually takes about 30 to 60 minutes for each leg but you might be away from the ward longer because all patients spend a minimum of half an hour in the recovery room while they wake up from the anaesthetic.
 
After the operation

When you return to the ward you might feel drowsy, but you should not feel any pain or sickness. If you do have any pain or feel sick, please tell the nurse who is looking after you and they will give you a painkiller or something for sickness.

As explained above, your leg will be bandaged firmly. You should remain in bed for the first 4 to 6 hours, and if you require anything, use the nurse-call button.

Later, when the nursing staff are happy with your progress, you may sit up and, later still, get out of bed under supervision. Once you have woken sufficiently, you can start drinking fluids again and have something light to eat.
 
Discharge from Hospital


The operation can be performed either as a day case or with an overnight stay.

Self-adherent compression bandages, or non-adherent crepe bandages, are removed after 24 to 48 hours.

Once the bandages are removed, you will be given a pair of compression stockings to wear for the next 2 to 4 weeks, or until the legs feel comfortable. The purpose of the stockings is to support the leg, to help blood flow through the deep veins of the leg and to reduce the amount of bruising and tenderness.

At night, the stockings can be removed if this is more comfortable. Bleeding through the bandages or stockings can occur; this is not unusual and is nothing to worry about. If this happens, please elevate the legs, apply continuous pressure to the point of bleeding for 10 to 20 minutes and it should stop. If you are still concerned, please call the daytime number for the hospital given to you on the information sheet, or you can call your GP.

The small avulsion wounds on your leg(s) will usually be closed with tape rather than sutures. The main wound at the top of the leg will be closed by dissolvable sutures underneath the skin. Try to keep these wounds dry for three days. After that, you may take a shower but try to avoid soaking the wounds in a bath until after 5 days. In water, the tape will come off the leg wounds but do not worry about this. Rarely, there might be some sutures to remove, and the ward nursing staff will arrange for this to be performed.

Returning to work and normal activities

Intended benefits of the procedure

To remove the uncomfortable / unsightly veins from your leg, and prevent their growth or recurrence.

Some veins may remain at the end of the operation. Small thread veins can be injected to improve the cosmetic appearance of the leg.

Serious or frequently occurring risks

Removing varicose veins always produces some bruising and soreness. The severity of this depends on how many veins are removed. Sometimes, it can take several weeks for all the bruising to settle completely.

Because the main wound is in the groin, this area can become infected. If the wound becomes painful and red this can indicate infection, which can usually be treated by a course of antibiotics. The same applies to other wounds on the leg (avulsions).

Small nerves lying next to the veins can be disturbed, which can lead to patches of numbness in the lower leg and foot in 10 to 20% of patients. This usually resolves over the first year after surgery but occasionally, it is permanent.

Rarely, a deep vein thrombosis (blood clot; DVT) can occur in the deeper veins of the leg and, occasionally, this can lead to a pulmonary embolus (blood clot to the lung). Blood clots on the lung can be fatal. Thrombosis occurs in less than 1% of patients.

Varicose veins can grow back (recur), usually by regrowth of the veins. After 5 years, 10% of patients can have this recurrence.
 
Your anaesthesia

Generally this operation is performed under general anaesthesia.  A general anaesthetic allows you to be in a state of controlled sleep whilst your surgery proceeds.  You will be unaware of your surgery and will feel no pain.

1. Your preoperative visit

2. Your anaesthetic

3. Post Operative Care

4. What are the risks of anaesthesia?

 

Clinics
Treatments
Surgeons
Cambridge Vascular Group
Cambridge Vein Clinic:
Cambridge Heart Clinic, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ
Spire Cambridge Lea, 30 New Road, Impington, Cambridge CB24 9EL
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