OPEN SURGERY FOR VARICOSE VEINS

Open surgery for the treatment of varicose veins can be performed as a day case or as part of an overnight hospital stay.

It can be used to treat all types of varicose veins, but is usually reserved for circumstances where minimally-invasive treatment using radiofrequency ablation (see radiofrequency ablation) is not suitable. It is not suitable for spider veins (telangiectases), which are treated using micro-sclerotherapy (see microsclerotherapy).

The treatment is contraindicated during pregnancy.

You will be sent a prescription for a full-length class I compression stocking to wear after your bandages are removed following the procedure. Please collect this stocking prior to your treatment.

Loose-fitting pants should be brought with you to the hospital to wear over leg bandages. Tracksuit pants are ideal.

The procedure is performed under general anaesthetic. You will need someone to drive you home following treatment.

The exact procedure will vary depending the venous anatomy. The most common open procedure is for treatment of the main superficial vein in the thigh (long saphenous vein).

A small incision is made in the groin crease. The top of the main incompetent vein is dissected and ligated (tied off). A fine plastic wire is passed through the vein and retrieved through a small nick in the skin (usually on the inside of the leg at the knee level). A tourniquet is applied to the leg to minimize ooze. The main incompetent vein is then removed from the thigh through the small nick in the skin. Any remaining varicose veins below the knee or in the thigh are removed via tiny nicks in the skin. The groin wound is closed using dissolvable sutures. Steristrips are placed over the remaining small wounds.

The leg is wrapped in several layers of compression bandaging following the procedure. This should be worn full-time for 72 hours.

It is important to walk regularly in the days following the procedure. Avoid standing still for prolonged periods. When not mobilising, you can rest with your legs up.

At 72 hours, the practice nurse will remove the bandaging and review your leg. Be sure to bring the full length class I compression stocking with you to your appointment. The stocking should be worn during the day and removed at night when in bed until day 7.

You will be scheduled for a review appointment with Mr Milne at 2 weeks post-procedure.

Travelling:

You may travel short distances, under 4 hours, 2 weeks following the procedure. It is ideal to avoid flights/train/car travel over 4 hours duration for 4 weeks following the procedure. It is important to stay hydrated and walk around the cabin regularly whenever flying.

Discomfort/bruising/swelling:

• It is normal to expect some discomfort and bruising after treatment.

• Mild swelling is common.

• Panadol or panadeine can be used

• Excessive pain or numbness of the foot or leg should be reported to the practice immediately. This is sometimes due to tight bandaging around the ankle and can be relieved by removing the outer layer of bandaging.

• It is important to stay active following the procedure

Bleeding:

• Some ooze through the bandaging can occur in the first 24 hours following treatment

• This is not dangerous. It usually stops on its own, and can be helped by resting with the legs up

• If persistent, you should contact the office and our practice nurse will arrange for a second layer of bandaging to be applied

Infection:

• This occurs in ~1% of cases and usually involves the groin wound

• Most infections just involve the skin and settle quickly with oral antibiotics

Lymph leak:

• Rare (<1%)

• This is usually only seen following redo surgery in the groin

Deep vein thrombosis (DVT):

• Rare (<1% of cases)

• If this occurs, a course of oral anticoagulation is prescribed with a follow up ultrasound

Nerve injury

• The saphenous nerve lies very close to the long saphenous vein in the lower leg, and can be injured during surgery (~5% of cases).

• This is not dangerous. It can cause tingling and numbness. Less commonly a shooting discomfort is felt along the inside of the lower leg

• It usually improves over weeks to months

• Damage to major nerves which control movement of the leg is extremely rare

Recurrent veins (in the years following the procedure)

• Recurrent varicose veins occur in ~20% of patients in the 5 years following treatment for varicose veins

• If this occurs, a repeat ultrasound scan can be performed to determine the nature of recurrence and best treatment option