What Is Varicose Vein Surgery?

Introduction 

Our veins are some of the main tubes that form our circulatory system, with the role of carrying oxygen-depleted blood back to our heart. When the veins are weakened or damaged, the blood cannot flow properly to the heart, causing a blockage in the vein resulting in conditions like varicose veins or oedema. 

Varicose veins appear engorged, swollen, twisted or lumpy in appearance. Varicose veins commonly affect the legs or feet. You may not experience any discomfort if you have varicose veins and it is usually not a serious condition.¹

However, if you are experiencing discomfort caused by varicose veins, speak to your GP, as they can diagnose you based on your symptoms and direct you to the appropriate treatment, if necessary. Some people will also choose surgery if their varicose veins have affected their self-esteem.

In this article, we will discuss what varicose vein surgery is and what you should expect. 

Understanding varicose vein surgery 

Your GP will diagnose you based on the presentation of your symptoms and the extent of your condition. You may be asked to describe your pain and any situations in your life that exacerbate your condition.

Purpose and goals of surgery 

Your doctor may first recommend adopting self-care practices at home before treatment. This may include compression stockings, exercising regularly and avoiding standing up for long periods. 

If your condition has not improved, and is causing further complications, you will be directed to a vascular specialist who will advise you on the appropriate treatment.

Preparing for varicose vein surgery 

Before your surgery, your vascular specialist will guide you through what to expect with your surgery and the aftercare. You may not be able to eat several hours before your surgery. If you are taking any medications, they will discuss whether or not to stop taking these. 

Types of varicose vein surgery

Endothermal ablation

This type of surgery is considered the “gold standard” treatment and is usually the first choice of treatment to treat varicose veins in the lower extremities. It is safe and efficient and improves patients' quality of life.²

This type of ablation uses energy from high-frequency radio waves or lasers to seal the faulty vein, allowing healthy veins to restore normal blood flow.

Before your procedure, you will receive anaesthesia to help reduce the pain when the surgery is performed. An ultrasound is used to find the vein and a small incision is made to insert the catheter (thin tube). Heat is generated by high-frequency radio waves from the catheter, to seal the vein. A bandage is wrapped around the area once the surgery is complete.

Endothermal ablation has fewer complications and a shorter recovery time than surgery. It is usually performed in an office setting and takes one hour. You will be able to go home the same day. 

To prevent complications with your incision, your doctor will tell you how to practise aftercare. It will involve wearing compression stockings, keeping your leg dry, clean, and elevated.

Sclerotherapy

You may be considered for sclerotherapy if endothermal ablation is not suitable for you. A vascular specialist will inject a special foam or chemical solution into your vein. An ultrasound may be used to inject the solution into the correct vein.³

Before the treatment begins, your vascular specialist may try a test solution to see if you react to it. 

You may feel a mild discomfort as the solution is injected into your vein. The number of sessions you will receive depends on your condition and the size and location of your veins.

Vein stripping and ligation 

Vein stripping and ligation involves tying your veins and then removing them. This allows your healthy veins to restore normal blood flow. 

You may receive general anaesthesia, which makes you unconscious, or a sedative. The procedure will usually take one to three hours. You will need to follow the care instructions for your incisions, provided by your vascular specialist or a nurse. You will be able to go home once the sedative has worn off. 

Postoperative care and recovery 

There is no risk of the varicose veins returning. After surgery, it will typically take two to four weeks to recover. You should be able to resume your normal activities. It is recommended to walk and move around frequently to prevent blood clots and improve circulation.

Your doctor may schedule follow-up appointments to assess your condition and prevent any complications.

Potential risks and complications

Most surgeries will have some risks and complications involved. Treatments for varicose veins are generally safe with low risk and complications. 

You may experience some side effects after surgery, which is normal and will usually fade over time. If you are experiencing side effects that are painful and causing extreme discomfort, it is best to speak to your vascular specialist who performed the surgery. 

Some side effects you may experience could be:

• bruising
• itching
• skin discolouration 
• swelling 
• blood clots (rare) 

Long-term complications can be rare and may include recurrence of varicose veins, nerve damage, skin changes, blood clots and infection.

Always follow the care instructions given by your doctor to minimise the risk of long-term complications. 

Criteria for considering surgery

Varicose veins are usually not a sign of concern. Many people choose surgery for health or cosmetic reasons. Surgery might be recommended if you are experiencing significant discomfort, swelling, or pain. Additionally, some people opt for surgery when conservative treatments such as compression stockings and lifestyle changes have not worked.

The decision to undergo surgery should involve a discussion between you and your healthcare provider. Your preferences, concerns and expectations should be taken into account. Your doctor will also consider your general health to balance out the risks associated with surgery.

Treatment is not required if you are not experiencing discomfort or pain in the affected area.

Lifestyle changes and prevention 

Varicose veins occur when there is a build-up of blood pressure in the veins. This can happen if you are overweight, pregnant, have an inactive lifestyle, or stand for long periods. You may be at risk of varicose veins if you have a family history of them.⁴

To relieve the symptoms, or prevent varicose veins from exacerbating, it is recommended to adopt some lifestyle changes such as:

• maintaining healthy weight 
• regular exercise
• taking breaks: if you are required to sit down or stand for long periods, you should take a break and move frequently
• wearing compression stockings: these are tight-fitting socks that apply pressure to your legs, helping to improve blood flow
• having a healthy diet

FAQ's

What are varicose veins?

Varicose veins are swollen or enlarged veins that usually occur on the legs or feet. They have various risk factors including being older, being overweight, being female, being pregnant, familial history of varicose veins, and having a job that requires long periods of standing. 

How do I know if I need to have varicose vein surgery?

Varicose veins usually appear blue or purple, usually found in the legs and feet and may appear bulging, lumpy, and twisted under the skin. If you are experiencing any discomfort from the varicose veins, you need to speak to a GP and they will advise you on how to alleviate the symptoms. They may suggest lifestyle changes such as regular exercise, wearing compression socks or elevating your feet; if these are not sufficient to alleviate discomfort you may be recommended for surgery.

What does the surgery involve?

There are 3 different procedures that may be used for varicose vein surgery:

1. Endothermal ablation - heat is used to seal the affected veins
2. Sclerotherapy - special foam or a chemical solution is injected into the affected veins to seal them
3. Ligation or stripping - affected veins are tied off then removed

Is the surgery associated with any risks?

Like all surgeries, there are some risks associated with varicose vein surgery such as bleeding, nerve injury, infection, deep vein thrombosis and the recurrence of varicose veins. 

Will the surgery completely eliminate varicose veins?

The problematic veins will be eliminated, however, surgery doesn’t prevent new varicose veins from forming, Furthermore, varicose veins may recur over time. The surgery is offered to reduce discomfort and for cosmetic reasons.

Can I prevent varicose veins from forming or worsening?

There’s little evidence to support the idea that you can completely prevent varicose veins from forming or stop them from getting worse.

Summary

Several types of varicose vein surgeries are offered to patients who are experiencing pain in their lower extremities or are experiencing low self-esteem associated with their condition. The surgeries that are typically offered for varicose veins are endothermal ablation, sclerotherapy and vein stripping and ligation. 

You may not know which type of therapy is right for you so having a healthy discussion with your doctor is important. They will consider your general health, and discuss your preferences and your concerns. 

The surgeries are safe with minimal risks but you may experience mild side effects which will fade over time. After your surgery, you must follow the care instructions provided by your nurse or specialist to ensure a smooth recovery and minimise long-term complications.