What are varicose veins and why do they occur?

Veins rely on one-way valves within them to help channel blood from the peripheries back to the heart. Blood collects in the superficial veins of the leg just below the skin, and is channelled into deeper veins at various sites, but principally behind the knee and in the groin. Varicose veins occur when these superficial veins become distended and knobbly due to the pooling of blood within them.

The cause of varicose veins is uncertain, though the make-up of the vein wall may be different in those with varicose veins. Heredity, gravity, hormones, and in women pregnancy, all play a part. The end result is failure of the valves causing blood to pool in the vein, which becomes distended as a result. The increased pressure in the vein puts stress on the valve below, which itself fails and thus the varicose veins spread.

What are the symptoms of varicose veins?

The following are symptoms frequently attributed to varicose veins:

·  Aching in the legs, especially when standing

·  Burning, throbbing or itching of the legs

·  Limb swelling

·  Inflammation within the veins (thrombophlebitis)

Severe varicose veins can cause skin conditions including:

·  Skin rashes

·  eczema

·  Pigmented stains, particularly around the ankles

·  Ulceration

Is surgery necessary?

Treatment may be desirable for reasons of cosmesis, and particularly where there are symptoms from varicose veins or skin changes. Surgery is the traditional form of treatment, but other forms of treatment including endovenous (key hole) surgery using radiofrequency ablation (VNUS) and foam injection treatment will be discussed with you and the most appropriate technique selected.

What is the aim of surgery?

The aim of surgery is two-fold. Firstly the vein with the non-functioning valves is dealt with through a small incision in the groin, behind the knee, or sometimes both. The superficial vein is either ligated (tied off) or, as is usual through a groin incision, stripped out to just above or below the knee. This requires a small second incision. The varicose veins themselves are then dealt with through tiny incisions over the veins, which are removed with a hook.

Immediately after the operation

Following surgery:

·  Your leg(s) will be tightly bandaged to limit bruising and to help close residual veins.

·  On discharge the bandages will be removed and replaced with stockings. These should be worn for two weeks

·  In the majority of cases the sutures will be a combination of dissolvable stitches and paper stitches, so there are no stitches that require removal.

·  You will be discharged with painkillers

·  Most patients can go home the same day.

Looking after yourself at home:

·  You should re-gain your normal level of activity as soon as possible to aid the circulation in the legs. If sitting, do so with your feet raised.

·  Try to walk a little everyday; for example walk the dog, or collect the newspaper.

·  The wounds should be kept dry for 72 hours after surgery and you will have a waterproof dressing to facilitate this. After this time all the dressings can be removed. This is often best done in the shower, but avoid getting soaps or cosmetics on the wounds until they are healed.

·  You will need up to two weeks away from work; if your job is particularly strenuous you may need more.

·  Sunburn can make scars look worse. Avoid excessive sun exposure for six months if possible.

Side effects and complications of surgery:

Varicose vein surgery is very safe and serious complications are rare. There are however some complications and side effects:

·  Bruising can be marked, especially where the vein has been stripped. This is unsightly and can take several weeks to resolve but is of no long term significance.

·  Infection is uncommon and is usually treatable with simple antibiotics.

·  Hard lumps at the site of vein removal. These usually resolve within a few weeks.

·  A tender ridge on the inside of the thigh if the vein has been stripped. This is quite common and again may take a few weeks to resolve.

· 

·  Limb swelling is uncommon after varicose vein surgery. It usually resolves shortly after surgery but can very rarely be permanent. Again this is more likely after surgery for recurrent veins.

·  Nerve damage is rare after surgery but there may be patches of numbness. These usually resolve but can take several months to do so.

·  Scarring. This is usually minimal after varicose vein surgery.

·  There is a very small risk of deep vein thrombosis after varicose vein surgery, hence the importance of maintaining a high level of activity.

The long term outlook

The outcome following varicose vein surgery is usually very good and satisfaction rates are high. The following should be considered however:

·  It is not possible to guarantee removal of every single varicose vein and you may have the odd residual vein. This is more likely if your veins are very bad.

·  Surgery usually alleviates the symptoms you may have been experiencing in your legs. However occasionally symptoms such as swelling and cramp have causes other than varicose veins and hence surgery will remove the veins but not treat the symptoms.

·  It is only possible to treat the veins present at the time of surgery. Surgery is not a life-long cure and overall 20% of patients will require further surgery at some point.

What if I have problems after my operation?

You will be offered a routine follow-up appointment six weeks or so after your operation. Should you have any concerns prior to this please telephone my private secretary at 24 West Street, Chichester on 01243 789630

Mr D K Beattie

January 2013