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Varicose Veins Guide

What are varicose veins?

Varicose veins that have become dilated, bulging and twisted. Veins contain valves which allow the vessels to carry most of the blood from your extremities back to the heart. These valves allow the blood to only flow in one direction. If the veins become widened and varicose, these valves no longer perform their function correctly, causing the blood to flow backwards down the veins. This causes downward pressure when standing, walking around or sitting. Lying down and raising the legs usually makes the legs feel better.

Treatment Options

The main medical reason for treatment is skin damage andulceration.However, only a small percentage of people will have this problem. If your legs ache and are painful, it might be worthwhile to have the varicose veins treated. Specialists use Doppler ultrasound machines to examine blood flow in the veins in order to determine if treatment is needed.

There are three main methods of treatment:

Support hosiery

These support stockings or tights are issued according to your leg measurements. There are various colours and classes of compression. Consult with your doctor to discuss the different options.

Laser ablation of reticular and spider veins (small, fine veins)

This is an outpatient procedure. A fine laser fibre is inserted into the vein to ablate the inner cavity or lumen. It works best for varicose veins which are not under pressure from leaky valves higher up. This procedure is typically used for varicose veins that are not medically harmful. The doctor will advise you if you qualify for this treatment.

Surgery

You will either be treated as a day-patient or as an in-patient, depending on whether you are medically fit and have somebody at home with you. The operation is done while you are asleep. The surgeon will make a cut over the top of the varicose vein and tie it off where it joins the rest of the venous system in the groin. The cut is closed with stitches under the skin. The main vein is removed by “stripping” it (passing a wire through the vein all the way from the groin to an area around the knee). It helps to guard against varicose veins forming again. The blood will flow up collateral veins after this main vein is removed.

Endovenous Laser

You will be treated as a day patient and will be able to mobilize very quickly after the procedure. There will be no cut in your groin. The laser fibre is inserted through a sheath, via a needle puncture into the faulty vein. As the thermal laser energy is applied to the vein, it retracts and closes.

Before the operation

The following tests would have been performed:

  • Blood tests

  • Electrocardiogram (ECG)

  • Urine test

  • You will be seen by the anesthetist

Medications

You should continue taking your normal medications. Please consult your doctor for advice if you are taking WARFARIN or HORMONE REPLACEMENT.

Belongings and valuables

Please bring your own toiletries and pajamas. Leave any valuables at home.

The day before the surgery

You will not be allowed to eat or drink anything immediately before your operation. Usually, you will not be able to have food up to 6 hours before the operation, but you will be allowed to have small quantities of clear fluids, tea and coffee up to 2 hours before the operation.

After the operation

After 2 to 3 hours in the ward, you should feel well enough to go home. Before you leave, the ward staff will check your leg and give you painkillers and an advice sheet to take with you.

IN-PATIENT

You will be able to get up within a few hours of the operation. Bandages will be changed and/or replaced with stockings as needed. You will be able to go home as soon as you and the doctors agree – usually on the first or second day after the operation.

DIET AND FLUIDS

You will not be able to eat or drink anything until your doctor gives you permission to.

ACTIVITY

Surgery on one leg only

You might feel tired on the first 2 or 3 days after the operation and your leg will be stiff after walking long distances during the first week. By week 2, you should be able to walk longer distances even though the leg might still be bruised and tender. You will need to wear compression stockings for 6 weeks.

Surgery to both legs

You might feel tired for the first week, especially after walking long distances. It could be 2 to 3 weeks after the operation before you are walking really comfortably. Your legs might still be bruised and tender for a month or more. You will need to wear compression stockings for 6 weeks.

Endovenous laser ablation

You will be able to resume your normal activities within 24-48 hours with the exception of vigorous exercising.

Compression stockings will only be required for 1-2 weeks.

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