Vascular Surgery Surgery

Surgical treatment of varicose veins may be required to alleviate aching and to stop recurrent bouts of phlebitis.  Surgery is especially necessary when the valves at the groin (the sapheno-femoral junction) and/or the back of the knee (the sapheno-popliteal junction) are leaking (incompetent).

 

There are two main types of surgical procedures used to treat varicose veins:-

 

Phlebectomy is used for moderate sized varicose veins.  In this procedure a surgeon makes a series of tiny (2-3mm) puncture holes along the veins and then takes out small segments of the vein with a tiny hook.

The tiny incisions require no stitches and rarely leave any scarring.  Most people experience very little pain after the operation and are able to walk immediately.

 

Phlebectomy can be performed in one or more sessions under local anaesthesia although general anaesthesia is preferred by most patients.

 

Vein ligation and stripping removes the long and/or short saphenous veins (the main surface veins in the legs).

 

The surgeon makes two or three small incisions - one in the groin and/or behind the knee and the other near the side of the knee.  The saphenous vein and its tributaries can then be tied off and divided from the deep system based on the femoral vein in the groin and the popliteal vein behind the knee. 

 

A flexible wire is then passed through the vein from the groin incision along its entire length and using this wire the vein is stripped out.  Veins are not stripped below the knee.

 

This is usually combined with tiny phlebectomy incisions, as above.  A person undergoing this procedure may receive either general anaesthesia (to be asleep for the procedure) or an epidural (a local anaesthetic injection into the back that numbs the lower half of the body) or very local anaesthesia injections into each site where incisions are made.  Patients usually prefer general anaesthesia.

 

Some doctors believe that the long saphenous vein should never be removed because it is the primary source of a vein used for heart bypass operations.  However, other surgeons feel that if it is damaged, as it is when it is varicose, it will not be suitable for use in bypass surgery anyway.

 

Recovery

 

Most patients are able to leave hospital on the same day as the surgery – or, at the most, the day following surgery.

 

The bandages and any stitches used (usually self-absorbing) will be removed after seven to ten days, during a follow-up visit.

 

It usually takes two to six weeks to recover completely from the operation. During that time it is advisable to keep the leg or legs bandaged, take several short walks every day, starting with five minutes each time and slowly increasing the time and distance covered and keeping your leg elevated above your hips level when lying down or sitting.

 

Most people are able to return to work within one to two weeks of the operation.