Varicose vein surgery

Animation - how varicose vein ligation and stripping surgery is carried out

About varicose vein surgery

Varicose veins don't get better without treatment and are often treated with surgery. Ligation and stripping and phlebectomy are common techniques but alternative techniques such as sclerotherapy, endovenous laser and radiofrequency ablation are now commonly used too.


Types of varicose vein surgery

There are a number of different techniques for varicose vein surgery, which are described below. Your surgeon will explain your options to you and help you decide which treatment is best for you.

Ligation and stripping

This is a technique that is often used to remove the long or short saphenous veins in your legs. Your surgeon will make two cuts about 4cm long – one in your groin and the second in your lower leg either close to your knee or ankle. Your surgeon will tie off the faulty vein (this is called ligation) through the cut in your groin to stop blood flowing through it. He or she will then use a thin flexible wire to carefully pull (strip) out the varicose vein through the cut in your knee or ankle.

Ligation and stripping is done under general anaesthesia. This means you will be asleep during the procedure.

Endovenous laser and radiofrequency ablation

Your surgeon will make a small cut just near your varicose vein and will insert a fine plastic tube called a catheter into your vein. He or she will use an ultrasound scan to guide the catheter to the correct position. Your surgeon will then pass a fine laser or a probe through the catheter and inside your vein. He or she will use this to heat the wall of the vein, which will destroy it. Your body will absorb the dead tissue. See our frequently asked questions for more information.

These procedures are performed under local anaesthesia. This completely blocks pain from the area and you will stay awake during the procedure.

Sclerotherapy (liquid or foam)

Sclerotherapy involves injecting a chemical into your varicose veins. This will damage the veins and close them. Liquid sclerotherapy is often used to treat smaller veins below the knee. For larger veins, foam sclerotherapy is used. After you have the procedure, your doctor may put a compression bandage over the area or you may be asked to wear compression stockings for up to two weeks.

Studies have shown that this treatment is effective at treating varicose veins in the short-term. However, the long-term benefits of this treatment aren't yet known. The procedure also has potentially serious complications (problems that occur during or after the procedure), which although uncommon, include stroke or damage to nerves. It’s important to tell your surgeon if you have had deep vein thrombosis (DVT) in the past and to discuss the safety of ultrasound guided foam sclerotherapy.

The procedure is performed under local anaesthesia.

Phlebectomy

Phlebectomy is used to remove the smaller surface veins that lie under your skin. Your surgeon will make small cuts (which can be as little as 1mm long) on your leg and use hooks to pull out the affected veins. This procedure may be done with ligation and stripping or with the endovenous laser and radiofrequency or sclerotherapy techniques. It can be used on its own if you're only having surface veins treated.

Transilluminated powered phlebectomy

Transilluminated powered phlebectomy is another option to remove the smaller surface veins but isn’t commonly used. In this procedure, your surgeon will make small cuts in your leg and place a tiny light under your skin to highlight the affected veins. Your surgeon will use a special suction device with blades and cut and remove the varicose vein by suction. As with phlebectomy, this procedure may be done with another procedure or on its own to treat surface veins alone.

Currently, there is limited evidence for the long-term benefits of this treatment. As with any operation, it is important to discuss the safety of this procedure with your surgeon.
 

Preparing for varicose vein surgery

Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours before your operation. However, it's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during varicose vein surgery?

The operation may take between 30 minutes and two hours, depending on the type of veins that will be removed, the technique your surgeon uses and whether one or both of your legs are being treated.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. If you have had a local anaesthetic, it may take several hours before the feeling comes back into your leg(s). Take special care not to bump or knock the area. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You may need to wear compression stockings on your legs to help maintain circulation for up to two weeks after your operation.

Your nurse will give you some advice about caring for your healing wounds before you go home. You will be given a date for a follow-up appointment.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about four weeks. Usually, if you have the endovenous laser and radiofrequency techniques, you won’t have any stitches. If you have non-dissolvable stitches you will need to attend an outpatient appointment to have these taken out.

Recovering from varicose vein surgery

It usually takes up to two weeks to make a full recovery from varicose vein surgery but this will depend on the type of surgery you have and whether you have one or both of your legs treated. The time it takes to recover also varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with the medicine and if you have any questions, ask your pharmacist for advice.

You should be able to drive around two days after your operation. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon's advice.

There are some important things to remember while recovering from having varicose vein surgery.

  • Don't do any strenuous exercise or heavy lifting for several weeks. However, it’s important to keep active and go for a 30-minute walk every day.
  • Don't stand still for long periods of time for the first few weeks.
  • When you sit down, keep your feet higher than your hips. This will help to prevent swelling in your legs and reduce the pressure on your wounds.

What are the risks?

As with every procedure, there are some risks associated with varicose vein surgery. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of varicose vein surgery include:

  • pain, swelling and bruising that usually gets better within a week or two
  • small visible scars from the tiny cuts in your leg – these tend to fade over time

Complications

Complications are when problems occur during or after the procedure. Complications of having varicose vein surgery can include the following.

  • Hard, tender lumps can sometimes form along the line where the removed vein used to be. These usually disappear after a few weeks.
  • Damage to the deeper veins in your legs, which may cause a DVT. This is very rare (only two in a 100 people get this complication), but you may need to have further surgery to repair any damaged veins.
  • Damage to the nerves in your skin but this isn’t common – about one in 20 people get this complication after having surgery to remove varicose veins. You may get small numb patches or painful, very sensitive patches on your legs. This should get better in a few weeks or months.
  • An infection in your wound. You may need to take antibiotics to treat this.

Although many people won't need any further treatment after surgery, it's possible varicose veins may re-occur.

What is the difference between endovenous laser ablation and radiofrequency ablation?

Answer

Endovenous laser ablation uses heat from a laser to close your vein, whereas radiofrequency ablation uses heat from an electrical current to close your vein.

Explanation

Endovenous laser treatment uses a fine laser, which your surgeon will pass inside your varicose vein. The laser will heat the inside of your vein and destroy it.

Radiofrequency ablation uses a high-frequency electrical current to heat the wall of your varicose vein. Your surgeon will pass a fine catheter inside your varicose vein, which will release an electric current to heat the wall of your vein and destroy it.

In both procedures your surgeon doesn’t physically remove the varicose vein. Instead he or she will damage the walls of the vein, which will cause it to collapse and cut off the blood flow through the vein. The dead tissue will be slowly absorbed by your body.

The benefits of having endovenous laser treatment or radiofrequency ablation therapy include:

  • fewer side-effects – less bruising and less scarring, if any
  • a shorter recovery period
  • a very low re-occurrence rate up to 10 years after treatment

Your surgeon will discuss all suitable alternatives to varicose vein surgery with you.

Why might I need another operation for my varicose veins?

Answer

Varicose vein surgery doesn't cure varicose veins and it isn't always possible to prevent more from developing. Therefore, you may need a repeat operation to treat varicose veins in later years.

Explanation

Varicose vein surgery doesn’t cure varicose veins. Varicose veins come back in about one in 15 patients over a 10-year period.

Even if you have had your varicose veins completely removed, new varicose veins can still develop. If you do develop more varicose veins, your surgeon may advise you to have another operation or an alternative treatment.

There are a number of things that you can do to help reduce your risk of developing more varicose veins, even after surgery.

  • Do regular exercise to improve your circulation and general health. Your GP can advise you on the best types of exercise for you.
  • Maintain a healthy weight. If you’re overweight, it can increase your risk of getting varicose veins. Try to lose excess weight by eating healthily and doing regular exercise. Ask your GP for advice on how to lose weight.
  • Don't sit or stand still for long periods of time, particularly if you're pregnant. If your job involves a lot of standing, try to change position frequently and move around every 30 minutes. When sitting, gently move your feet to stretch your calf muscles and increase your circulation.
  • When you rest, try to keep your legs raised – ideally above the level of your heart. Lie down and rest your legs on a foot stool, for example.

I have varicose veins but I don't want surgery. Are there any medicines that my doctor could prescribe to treat my varicose veins?

Answer

No, there is no evidence that creams or medicines are effective at treating varicose veins.

Explanation

Over the years many different medicines and creams have been tried for the treatment of varicose veins. However, there is no evidence to suggest that any of these work.

A small clinical trial in women with varicose veins showed that a medicine called rutoside can reduce symptoms such as night cramps and feelings of tiredness, but more research is needed in more people to determine if it’s effective.

There is no evidence to suggest that herbal creams, lotions and other medicines for poor circulation are effective for the treatment of varicose veins.

Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine.

I'm pregnant and I have developed varicose veins. Can I have surgery?

Answer

If you’re pregnant, you have a greater chance of developing varicose veins. They usually improve around three or four months after you give birth so surgery isn't recommended. Your GP will usually suggest that you wear compression stockings to improve the circulation in your legs. 

Explanation

Pregnancy can increase your chances of getting varicose veins – most commonly in your legs but you can also get them in your vulva (the opening to your vagina). If you develop varicose veins while you’re pregnant, any treatment you receive will focus on the relief of symptoms such as pain, night cramps, tingling and leg aches. Varicose veins often improve around three or four months after you give birth, so your GP won't recommend any surgery unless there is no improvement after this period. Occasionally, if you have a blood clot (thrombosis) in your veins, or bleeding from your veins, you may need to have surgery. You can have this under local anaesthesia to prevent problems with your pregnancy.

There are a number of things you can do to improve the circulation in your legs when you’re pregnant, which may help to reduce your risk of developing varicose veins.

  • Do regular exercise to improve your circulation and general health. Your GP can advise you on the best types of exercise for you.
  • Don't sit or stand still for long periods of time. If your job involves a lot of standing, try to change position frequently and move around every 30 minutes. When you sit, gently move your feet to stretch your calf muscles and improve the circulation in your legs. Try to keep your legs raised when you rest; for example rest them on a footstool when you sit down.
  • When you rest for longer periods, try to lie down on your left side as this will reduce pressure on the veins in your legs and feet.

Your GP may suggest that you wear compression stockings to help maintain your circulation. They may also relieve any swelling and aching in your legs.