Planning for surgery usually requires an ultrasound. This determines which parts of the system are incompetent (refluxing) and causing the varicose veins. This allows a complete treatment to be planned. Some aspects of the system require skin marking under ultrasound guidance before the operation.
The surgery is usually done under a general anaesthetic but occasionally can be done under a spinal anaesthetic after consultation with your anaesthetist. Antibiotics and blood thinners are utilised at the start of the operation.
An operation for varicose veins involves disconnecting the causative incompetent veins from the main venous system through a small incision, usually in the groin or behind the knee. This incision is approximately 3-5cm in length. The incompetent vein is then stripped from under the skin to the level of the knee, utilising a plastic stripping device and a small incision at the level of the knee. Ancillary communications below the level of the knee may also require ligation through small incisions approximately 2cm in length. After the cause of the varicose veins has been thus addressed, then the varicosities themselves are removed through tiny incisions ½ cm in length over the varices. The longer skin incisions are closed with dissolving sutures and the small incisions are closed with adhesive sterile tape.
After the surgery and dressings, the leg will be bandaged firmly overnight. This is usually changed to a compression stocking the following day. The compression stocking is used for 2 weeks. The surgery usually requires 2 weeks rest from work.
Complications are uncommon but can include anaesthetic complications, bleeding, infection, recurrence (~10% over 10 years), nerve damage (usually minor), arterial damage (very rare), Deep Venous Thrombosis and Pulmonary Emboli, and others. Deep venous thrombosis often requires 3-6 months of blood thinner administration.
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