What are varicose veins?
Varicose veins are tortuous dilated veins on the legs. Many people do not like the look of them. They can cause aching of the leg, itching, swelling of the ankle, pain, changes in the colour of the skin, eczema, hardening of the fat under the skin and ulcers.
What causes Varicose Veins?
We do not really know what causes varicose veins but many people have a family member with the condition so it is probably an inherited condition. Varicose veins occur because the non-return valves no longer work properly. Standing, crossing legs, getting pregnant and being fat do not cause varicose veins but, in those people who are susceptible they can be made worse by those factors.
What happens to the blood if a vein is removed. Aren’t they important?
Veins are the pipes that drain blood from the feet back to the heart. They are a bit like a road network. There are plenty of veins in the leg but the main ones, the deep veins, do not become varicose veins. The deep veins are the main ‘motorways’ so it is okay to remove one or two of the ‘A’ roads as the blood will find its way via other veins (‘B’ roads and country lanes). In fact the varicose veins put more ‘strain’ on the other veins in the network and that is why they can cause the symptoms they do. The veins that are affected by varicose veins are sometimes used for bypass grafts in people who have heart disease or a condition called peripheral vascular disease. So the veins are important but only when they are working properly. When they become varicose they cause harm and are, often, not suitable for bypass grafts. It is therefore okay to remove them.
Should I have my operation under a local or a general anaesthetic?
Foam Sclerotherapy is nearly always done when you are awake. It barely hurts because it is done under a local anaesthetic and involves a small tube in the vein ( watch the video). Some people are squeamish or do not like needles so they may find it better to have their operation when they are asleep. Conversely, some patients do not want to go to sleep so they tolerate the mild discomfort of local anaesthetic surgery very well.
If I have the vein removed will I still be able to have heart bypass surgery?
Probably. Most Heart surgeons can use various blood vessels for a bypass. Whilst the great saphenous vein in the leg can be used, there is also an artery inside the chest ( internal mammary) or one in the forearm ( Radial artery) that can be used. When someone has varicose veins, the Great Saphenous vein may not be suitable for bypass surgery anyway. If you are a smoker, have diabetes, high cholesterol or uncontrolled blood pressure then you are at risk of heart disease and should discuss your health with your GP. If you are concerned that you might need your vein for bypass surgery then you need to balance that with the symptoms in your leg before you make a decision to have varicose vein treatment.
How long will I be off work after endovenous ablation or avulsions?
Most people can return to normal activities within a few days of treatment. A day or two after surgery, you can have a shower and then, after putting on a compression stocking, you can return to normal activities. Most people are back to normal within a week but some take longer.
Can I drive after treatment?
Yes, providing you are able to perform an emergency stop. If you have had a general anaesthetic then you should not drive for at least one day and not if you are taking strong painkillers that might impair your ability to drive. Most people do not need to take any painkillers.
How long will the operation take?
Most operations take about an hour. If you need a lot of avulsions or have both legs treated then it can take longer but rarely more than two hours.
How long after the operation can I walk?
We encourage you to walk after the operation. If it is done with you awake, under local anaesthetic, then you will be asked to walk back to the waiting room. If you have had a general anaesthetic then you should get up and walk when you have fully recovered and always with the assistance of one of the ward nurses.
What painkillers are needed? Do I obtain these prior to the operation or from the hospital?
Most people do not need any painkillers after the operation. Your leg will feel like you have fallen into a thorn bush. If you do have pain then taking paracetamol and / or ibuprofen ( with food) is probably all you need. It is worth having some tablets at home, so you can take them after the operation.
Should I wear any special clothes for the operation under local anaesthetic?
If the operation is done with you awake then it is worth wearing high leg pants for modesty as your veincare surgeon will need to be able to treat the vein in the groin. When you go home your leg will have a bandage from the foot to the top of the thigh so you may be best to wear track suit bottoms, or similar loose trousers, and loose shoes. Normal jeans/trousers and boots or fashionable shoes may be too tight. There is also a small chance that you might bleed from some of the tiny cuts so do not wear your best clothes.
Why is my leg hot and lumpy after I have had foam sclerotherapy?
Foam sclerotherapy works by making the blood in the varicose veins solidify. If the veins were large then you can develop inflammation in the vein called thrombophlebitis. This is normal and causes a red line where the vein was. The lumps are often tender. The pain often starts about 5 to 10 days after treatment and settles after about 2 weeks. Taking an anti-inflammatory medicine like ibuprofen can help. There is no need to take antibiotics. The leg will remain lumpy for several weeks but can improve if you massage the area gently. If you are concerned, please call your surgeon or a member of the treatment team.
I think I may have a DVT ( Deep vein Thrombosis)?
DVT can happen after any vein treatment but it is not common. If you have had a DVT before or have a family history of DVT then you may be more likely than others to get a DVT. The signs of a DVT are a hot swollen, tender calf. If you have this then you need an ultrasound of the vein. First you should try and contact the team who treated you. If you cannot get hold of them then you should call the out of hours GP service or go to your local walk-in centre. They will do a blood test (D-Dimer) but it will be abnormal even if you do not have a DVT. It is important that you tell them that you have had vein treatment recently so that they can interpret the results. You may be started on an anticoagulant ( blood thinner) but that may not be necessary if you do not have a DVT. It is therefore important that you have an ultrasound as that is the best way to diagnose a DVT.
Will my leg bleed when I remove the bandages?If you have had Varicofoam ( foam sclerotherapy) then there will only be one or perhaps 2 small holes in the skin. When you remove the stocking and bandages ( usually after 5 days) then there should be no bleeding as the small wound will have healed.