Varicose Veins are very common. Most often, they are of no danger to one’s health, but can occasionally lead to more serious problems.
What are varicose veins?
Varicose veins are dilated, tortuous veins which arise due to dysfunction of the valves in the veins. This causes the veins to enlarge with time. They are most commonly found on the legs.
How are varicose veins diagnosed?
The diagnosis of varicose veins can be made with a simple examination of the leg. They generally cause unsightly bulges on the leg and can cause various symptoms, including discomfort, tingling or even a warm sensation.
A duplex ultrasound scan will show which valves are involved and will help determine how best to deal with the varicose veins.
What are the treatment options?
Treatment is determined by the extent to which the veins bother the patient. If the varicose veins are not troublesome, and there is no concern about their appearance, then there is really no need to intervene.
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 alone may be sufficient to control the veins.
If the veins are more prominent, a more definitive procedure is required. This can be achieved by either open conventional surgery or newer less invasive methods such as Endovenous Laser (EVLT), Radiofrequency (RF), or gluing. Refer to the treatment section for more information.
Varicose Vein Surgery Consultation
Surgical treatment of the varicose veins requires interruption of the reversed flow from the deep veins to the superficial through the faulty valves, in addition to removing the obvious varicose veins.
Before any operation takes place, you will be assessed by Dr Bell in one of his consulting rooms. This will involve a history and physical examination of your legs. It is highly likely a venous duplex ultrasound will be performed to help in planning treatment.
The Varicose Vein Surgery Procedure
You will be given instructions on the timing of admission. In most cases admission will be on the day of surgery, but if there is any change from this, Dr Bell’s team will inform you accordingly.
Be aware that you should continue your regular medications, except for blood thinners which may need to be ceased 48 hours prior to surgery. You will be advised accordingly.
Your anaesthetist will see you prior to the operation and will discuss the anaesthetic aspects with you in detail.
The procedure generally lasts an hour or so, depending on the extent of the varicose veins.
In order to interrupt the reversed flow due to faulty valves, a small incision is made in the groin in most patients. The long saphenous vein is detached from the deep (femoral) vein. In some patients, where the problem may arise behind the knee, the incision is made there. The long saphenous vein is usually removed or “stripped’ to reduce the chances of the veins returning. This can produce bruising on the inner thigh.
The varicose veins, which are marked with a felt pen prior to surgery, are removed by a series of tiny “stab” incisions, which are generally closed with steri-strips (tape). The leg is bandaged to reduce bruising and swelling after the procedure.
In most cases, patients will be expected to stay in the hospital overnight so their condition can be monitored.
The bandages are removed the following morning by the nurse and replaced with compression stockings. These stockings need to be worn continuously for 14 days, with patients only taking them off to shower. You can safely shower over the steri-strips, which will gradually come off themselves.
We encourage you to do as much walking as you can manage. You may also require simple analgesia such as Paracetamol and/or Nurofen to manage post-operative pain.
An appointment will be made for Dr Roger Bell to review your condition 2 weeks after surgery takes place.
Frequently Asked Questions
What are the potential complications?
Acute superficial thrombophlebitis. This is due to a thrombosis (clot) in a varicose vein. The vein becomes hard, tender and inflamed, and may take several weeks to settle. Unlike a deep vein thrombosis, this is usually not dangerous and does not require anti-coagulation (blood thinners).
Bleeding. This is a very uncommon event, but if it occurs the bleeding can be frightening. Treatment involves compression of the bleeding point with a bandage, and elevation of the leg.
Bruising: 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 generally disappear with time.
Wound infection/collection: It is uncommon to develop a wound infection or fluid collection (lymphocoele), though this is far more likely with redo (revision) surgery for recurrent veins.
DVT: The incidence of Deep Vein Thrombosis (DVT) is exceedingly low (less than one in 500).
Swelling of the leg. This can occur due to faulty valves and high pressure in the veins.
Venous pigmentation and eczema. These are skin changes that reflect very pressure in the veins. They are often an indication that treatment of the varicose veins and venous insufficiency is necessary.
Lipodermatosclerosis. This is hardening of the soft tissues of the lower leg, and again a reflection of exceedingly high venous pressures. These patients are at risk of ulceration.
Venous ulceration. This typically occurs in patients with signs of venous hypertension such as lipodermatosclerosis and venous eczema. It most often overlies the inner ankle (medial malleolus).
Residual Veins: It is important to emphasize that complete eradication of ALL veins can NEVER be guaranteed.
Haemosiderin Staining: Occasionally we see staining (a brown pigment) which has the appearance of a bruise and may take several months to disappear.
Recurrent Veins: Even in the very best hands, a number of patients (10-15%) will develop recurrent veins in due course.
To find out more about the potential complications, please contact Dr Roger Bell.
How do varicose veins form?
Will my varicose veins come back after treatment?
When should varicose veins be treated?
Melbourne Varicose Vein Treatment Clinic
For information about the surgical treatment of varicose veins, CLICK HERE!