Vascular Surgery 

Your care may differ slightly from what is described here because it is adapted to meet your individual needs, so it's important to follow your doctor's advice.

Varicose veins are swollen, twisted and unsightly veins (usually on the legs) that look lumpy and bluish through the skin. They happen when the valves in the veins become weak or break, allowing blood to collect in the veins just under the skin instead of being carried up to the heart.

If left untreated, the poor circulation associated with varicose veins can lead to skin problems, such as eczema and ulcers, and they may bleed heavily if a prominent vein is injured.

Varicose veins do not tend to get better without treatment, and usually get worse with time. The most effective treatment for many varicose veins is to have them surgically removed.

Varicose veins are usually removed under general anaesthesia, which means you will be asleep during the procedure. For more information, please see the separate Bupa health factsheet, Anaesthesia.

The procedure is routinely done as a day case. However, you may need to stay in hospital overnight, particularly if you are having operations on both legs.

Your surgeon will explain the benefits and risks of having your varicose veins removed, and will also discuss the alternatives to surgical treatment.

The most effective treatment for many varicose veins is to have them surgically removed. However, it is possible that the condition will come back again, even after surgery.

The hospital will send you a pre-admission questionnaire. Your answers help hospital staff to plan your care by taking into account your medical history and any previous experience of hospital treatment. You will be asked to fill in this questionnaire and return it to the hospital.

If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your surgeon specifically tells you not to. If you are unsure about taking your medication, please contact the hospital.

The exact method used to remove varicose veins can vary. A commonly performed technique, called ligation and stripping, involves tying off and removing the main vein affected in your leg.

Two small cuts (about 5cm long) are made, one in the groin at the top of the main vein affected and one near your knee or lower down near your ankle. The top end of the vein near your groin is tied to stop blood flowing through it. Then a flexible wire attached to a special tool at one end is passed through the vein. The wire, along with the vein, is carefully pulled out of the leg through the lower cut. Sometimes the vein is tied off but not removed. Your surgeon will usually also make several tiny cuts (about 5mm long) on your leg to remove smaller veins.

The cut in the groin is usually closed with stitches, and any small cuts on your leg are sealed with fabric strips. Your legs will then be tightly bandaged.

After surgery, blood can still flow up your legs because the deeper network of veins is left untouched.

The procedure usually takes one to two hours, depending on the exact type of operation you are having and whether one or both legs are being treated.

You will usually be able to go home once you have made a full recovery from the anaesthesia. However, you will need to arrange for someone to drive you home and then stay with you for the first 24 hours.

You will have bandages on your leg. You should leave the bandages in place until your follow-up appointment. These apply pressure to assist healing.

You may also be given compression stockings to wear on your legs. These should be worn as advised by your surgeon.

Your treated leg is likely to feel sore, so you will need to take it easy. Do not stand still for long periods of time. During the first two weeks, try to take short (half hour) walks at least three times a day. This helps to loosen your joints and muscles, and will help speed up your recovery. When sitting down, make sure your feet are higher than your hips. This stops blood pooling in your leg and reduces the pressure on your healing wounds.

Your recovery time will depend on whether one or both legs have been treated and the exact procedure used. Ask your surgeon for specific advice.

Removing varicose veins is a commonly performed and generally safe surgical procedure. For most people, the benefits, in terms of improved appearance and reduced discomfort, are greater than the disadvantages. However, all surgery carries an element of risk. This can be divided into the risk of side-effects and the risk of complications.

These are the unwanted but mostly temporary effects of a successful procedure. After surgery, your legs will be sore and bruised and the wounds may bleed a little. These side-effects should settle within a week or two. Scarring will usually fade with time, but won't disappear completely.

This is when problems occur during or after the operation. Most people are not affected. The main possible complications of any surgery include an unexpected reaction to the anaesthesia, excessive bleeding during or soon after surgery, or infection. A blood transfusion may be required to replace the lost blood, or antibiotics to treat an infection.

Some of the complications specific to varicose vein surgery are listed here.

After surgery, it's possible to develop a blood clot (DVT) in the deep veins in the leg. In most cases this is treatable, but it can be a life-threatening condition. Compression stockings and blood-thinning injections may be used to help prevent DVT.
Damage to the nerves in the skin, resulting in small numb patches on your legs. The feeling usually returns but may take a few weeks or months.
Rarely, nerve damage near the knee can affect movement in the ankle which may be permanent.
Occasionally hard, tender lumps appear near the scars or along the line of the removed veins. These usually disappear after several weeks. Rarely, small patches of brown skin form where the veins were removed.
There is a chance the varicose veins may re-occur in other veins.

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