What are varicose veins?
Varicose veins are tortuous dilated superficial veins, they can be extremely prominent and range from a minor dilatation of a vein to a large bunch of grape-like structures behind the knee. They are sometimes associated with discolouration of the skin and ulceration around the ankle.
Are varicose veins considered purely cosmetic?
They can be unsightly but most patients complain of not only the appearance, but of symptoms relating to them. These symptoms include aching, tingling, tired legs, irritable legs, pain on standing and cramps.
Who should receive treatment?
Anybody with varicose veins, irrespective of whether their complaint is simply cosmetic or symptoms of an underlying problem, should receive treatment. Varicose veins are a slowly progressive condition and will get worse with time. Although the veins may be causing very little trouble at this stage they will, with time, progress and may eventually lead to quite marked skin changes and, in a few patients, ulceration.
When should I complain about my veins?
You should consult your General Practitioner as early as possible and they will then refer you to a surgeon with a particular interest in veins. The earlier you present, the better the long term and cosmetic results.
What does treatment for varicose veins involve?
Before you undergo treatment you will require a formal assessment, this involves a clinical examination and a non-invasive vascular assessment (no needles). The non-invasive vascular assessment involves looking at the flow of blood through the legs, checking to see that the valves in the veins are functioning normally and to see where problems with the veins have arisen. This is a new procedure and allows the doctor treating you to accurately identify the problems and treat you. This will very significantly reduce the chances of you ever having further trouble once you have undergone treatment. It has also resulted in much better functional and cosmetic results.
What treatments are available?
Once you have been formally assessed the treatment options will be discussed with you. These include not receiving treatment therefore putting up with the veins, wearing elastic compression stockings which have been measured and fitted, surgical treatment, VNUS closure, laser treatment (EVLT) or injection treatments.
How do stockings help?
Properly fitted elastic graduated compression stockings worn up to the knee or, in severe cases, up to the thigh, squeeze the superficial veins and divert the blood back through the deeper veins. This reduces venous pooling and is very effective in alleviating symptoms such as heaviness, restlessness and cramps.
What does treatment involve?
If it is necessary for you to undergo surgery you will be admitted to hospital. On arrival to hospital you will be seen by Mr Scurr and his anaesthetist who will arrange to mark the position of the veins on your legs. Sometimes it is necessary for you to have further marks placed on the leg using duplex ultrasound imaging.
The anaesthetist will ensure that you are fit for surgery and you will then be given a very light but full anaesthetic. The effects of the anaesthetic are instantaneous and wear off immediately the operation is completed.
The operation will involve making small incisions (2cm in the groins between the top of your leg and your body). These incisions heal without leaving scars. Sometimes it is necessary to make small incisions behind the knees, but again these incisions are in the skin creases and heal without leaving scars. The remaining surface veins are removed through small incisions 1.5mm in length. These incisions close on their own without the need for stitches and disappear again without leaving any scarring.
After the operation you will have a bandage on your leg which you wear for 12 hours, after which the bandage is replaced with a heavy elastic compression stocking which you wear for 10 days. This can be removed every day so that you can shower (avoid having a bath as it makes the wounds soggy). The elastic stocking can be washed and dried, after the first few days it is not necessary to wear the elastic stocking when you are in bed.
After the operation you will be encouraged to get up and to walk as much as possible. If you are not walking then you should sit on the settee with your feet up. The operation is not painful, although you may require Panadol or Aspirin for discomfort. Occasionally after a few days you will experience increasing discomfort, particularly in the thigh. This does not happen in all patients and is due to the blood reacting with the tissues, if you experience this pain please let us know and we will give you a different pain relieving tablet (Voltarol, a non-steroidal anti-inflammatory).
You can return to driving a car as well as other activities such as returning to work, as soon as you feel comfortable. Some people will return to work within 48 hours, other preferring to take a full week to recover.
Following the surgical procedure you will be seen once in the outpatient department at about ten days to ensure the wounds are healing nicely. You will then be reviewed six weeks after this to assess the result. Most, if not all, of the large veins will have disappeared.
Any residual veins, dermal flares and blushes can be treated by an injection technique. The treatment will continue until you are entirely satisfied with both the appearance and the feel of the leg.
Are there any problems following surgery?
The operation requires a full anaesthetic. Before carrying out a full anaesthetic a consultant anaesthetist will make sure that you are fit. The anaesthetic is extremely light and therefore very safe. Many of these procedures are carried out for principally cosmetic reasons and therefore if there is any doubt about your fitness for anaesthesia the operation will be postponed.
Some patients suffer more bruising than others and some patients take longer for the bruising to clear. Extensive bruising is not really a problem but it will delay your recovery by an extra few days.
You will have many tiny incisions on your leg which heal without leaving scars. Occasionally a small area of altered sensation occurs around these. These areas usually resolve completely. You may be aware of a strange sensation immediately after the surgery over small areas on your leg. This usually settles very quickly without any further treatment.
Can these wounds get infected?
It is extremely rare for these wounds to become infected. Even the wounds in the groin heal without any difficulty. If any of the wounds do become red and angry then you should let us know immediately and we will treat you with an antibiotic.
Will I get a good result?
Yes, all patients notice a marked improvement in their symptoms. The aching improves and the appearance of the legs improves dramatically. The final appearance will depend on how extensive your veins were in the first place and how keen you are to have all the surface veins treated. It is possible to produce an excellent cosmetic and functional result.
Will they come back?
Following our new non-invasive scans and improved operating techniques, the chances of the veins recurring is extremely small. Occasionally a small surface vein may appear but this responds to a simple injection. If you do notice any veins you are encouraged to return to see if any further treatment is indicated. This, however, is extremely rare.
Can I swim?
Following the operation you can remove your stockings every day to have a shower. You should not bath or swim for ten days. By ten days the wounds are fully healed and you can swim.
When can I drive a car?
As soon as your legs feel comfortable, but usually within hours of having surgery.