Surgery for varicose vein

Typically varicose veins are caused by incompetence of the valves within the superficial veins. As these valves become more incompetent, blood backs up (away from the heart) and causes dilatation of superficial veins. While these veins are not harmful, they may lead to swelling, discoloration, and discomfort in the lower extremities. Varicose veins typically do not respond to injection sclerotherapy or lasers. As they are not terribly dangerous, treatment is reserved for patients that are having symptoms. The most effective therapy for varicose veins is removal.

Varicose Vein Surgery

This minimally invasive procedure is done at NYU in the outpatient surgery unit on the 10th floor of Tisch Hospital. The patient is admitted early in the day and undergoes surgical excision which takes approximately 1.5 hours. The patient is then placed in the recovery room for approximately one hour and then is discharged home. Typically, the patient stays in bed on the day of surgery and is walking normally the day after surgery. A tight dressing is applied on the day of surgery and this is also removed the day after surgery.

The surgery is extremely cosmetic. This performed with a half inch incision at the level of the ankle and a one inch incision at the level of the groin. There are a series of other microincisions along some of the branches of the veins on the leg. These incisions are approximately 1/8 of an inch in length and heal virtually without scarring.

Spider veins are not treated with surgery. Typically these are treated with injection sclerotherapy or laser therapy. Radio frequency ablation surgery is another technique used for treating large varicose veins. Vascular surgeons at New York University currently do not use radio frequency ablation, as the avulsion phlebectomy procedure has been a more effective procedure in the removal of varicose veins.

Veins carry deoxygenated blood. Varicose veins are knobbly, twisted and darkish-blue in appearance, and are most commonly found on the legs. Blood is collected in the superficial veins of the leg, just below the skin surface, and delivered to deeper veins that run within the calf muscles. The muscular action of the calves helps to pump the blood against the force of gravity towards the heart. One-way valves inside the veins prevent blood from travelling backwards. If these valves fail to close properly, blood pools in the superficial veins. Over time, the affected veins distend with blood (become ‘varicose’). The cause is unknown. Varicose vein surgery is the removal of these distended veins. Treatment can be undergone for therapeutic or cosmetic reasons.

Problems associated with varicose veins

Problems can occur if the faulty valves are located within the veins that perforate the calf muscles (deep veins). Associated problems may include:

• Aching in the legs.
• Skin rashes such as eczema.
• Brownish ‘stains’ on the skin surface, caused by the eruption of capillaries.
• Skin ulcers.
• Blood clots forming within veins (thrombophlebitis).

Medical issues to consider

• The type of surgery required is determined from a number of tests, including a physical examination and an ultrasound scan. You need to discuss a range of issues with your doctor or surgeon including:
• Medical history, since some pre-existing conditions may influence decisions about surgery and anaesthetic.
• Any medications you take on a regular basis, including over-the-counter preparations.
• Any bad reactions or side effects from any drugs you have experienced.
• Whether or not you are pregnant. Varicose vein surgery is generally not advised for women during pregnancy.

Surgical techniques include:

• Ligation and stripping - the vein is cut and tied off (ligation). Stripping the vein involves inserting a slender instrument into the vein through a small incision. The vein is then pulled out through a second incision.
• Phlebectomy - small incisions are made, and the veins removed with a special hook.
• Immediately after the operation
• After the operation, you can expect:
• Firm bandaging on the legs, to reduce bruising
• Pain-killing medication
• You will be encouraged to walk around
• A hospital stay of one or two days.

Common side effects of surgery

Some of the common side effects of varicose vein surgery include:

• Swelling, which may take a few weeks to subside. The feet and ankles are particularly prone.
• Scarring, although scars tend to be less noticeable than varicose veins and fade with time.
• Brown staining of the skin may occur, but tends to fade with time.
• The skin and calf muscle may be painful, swollen and bruised.
• Unintentional injuries to nerves may cause patches of numbness or ‘pins and needles’.
• These patches may recover in time (up to two years in some cases) or they may be permanent.

Possible complications following surgery

Varicose vein surgery is considered to be safe, but all surgery carries some degree of risk. Possible complications may include:

• Infection, particularly if skin ulcers were present
• Blood clots forming within deep veins
• Bleeding or bruising.

Taking care of yourself at home

Be guided by your doctor, but general self-care suggestions include:

• Allow for one (or perhaps two) weeks off work following surgery. You will need to avoid any hard physical exertions during this time.
• Don’t remove your bandages yourself. Leave bandages for your doctor to remove.
• To keep the bandages dry while showering, wrap your bandaged leg in plastic.
• Take at least a half hour walk every day.
• Sunburn can make scars look worse. Avoid sun exposure if possible for six months.
• Wear a compression stocking for as long as your doctor advises.
• Avoid prolonged periods of standing, or sitting with your legs crossed.
• Support stockings may be needed if your legs continue to ache.
• Long term outlook
• You will need to have a check-up a few weeks after surgery and, again, several months later. About 20 per cent of people who undergo varicose vein surgery will develop new crops of varicose veins given time.

Things to remember

• Varicose veins are knobbly, twisted and darkish-blue in appearance, and are most commonly found on the legs.
• Varicose veins are caused by faulty valves within veins that allow blood to pool.
• Treatment options include sclerotherapy and surgery to remove the veins.

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