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Date issued: November 2023

Review date: November 2025

Ref: A-105/S/V/CC/Varicose veins operation explained v3

PDF: Varicose vein operation explained.pdf [pdf] 190KB

Why do I need the treatment for varicose veins?

The aim of surgery is to reduce the pressure in the skin veins to normal. This will prevent existing varicose veins from enlarging further and will prevent new varicose veins from forming. Removal of skin veins means that, post-operatively, blood returns to the heart through the deep veins more efficiently than before the operation.

For those with skin changes around the ankles or previous ulceration, surgery prevents worsening of the skin and usually reduces the risk of further ulceration. For this group, the addition of support stockings further protects the skin around the ankle.

As well as ulceration, bleeding and phlebitis (inflammation in the veins and overlying skin) are indications for surgical treatment.

Smaller varicose veins, in the absence of symptoms, don’t need to be treated. Thread veins and ‘spider veins’ are not removed. Surgery is not undertaken for cosmetic reasons.

Before Surgery

Immediate pre-operative tests may include: blood tests, a heart tracing (ECG) and an ultrasound scan. These are usually completed along with a health questionnaire at a pre-admission visit to the hospital a short time before surgery.

Coming into hospital

Varicose vein surgery is usually a day case procedure so long as you are fit and have someone to take you home and be with you overnight. Those having more complex surgery or living alone will stay in hospital overnight.

If you are taking an oestrogen-based contraceptive pill, it is recommended that this is stopped four to six weeks before your operation. This reduces the risk of thrombosis or blood clots.

Please bring with you all the medications that you are currently taking.

Before the procedure, the Surgeon who will be performing your operation will mark your veins with a pen, at the same time agreeing with you which veins will be removed.

The doctor who will give you the anaesthetic will also visit you and explain the anaesthetic to you.

The Operation

Varicose vein surgery is usually (but not always) performed under general anaesthetic. Normally, you will have a small cut in the skin crease of the groin, or behind the knee. The vein is then stripped from the leg through another small incision at the knee. The visible varicose veins are removed from the leg through tiny incisions. The leg is bandaged firmly from toe to groin at the end of the operation to aid venous return through effective compression and to reduce bruising. The bandage is usually removed after 5 days.

After the Treatment

It is unusual for the leg to be painful. Some of the smaller incisions may bleed a little over the first 24-48 hours. Therefore, it is best to keep the leg covered with bandages or stockings for five days.

The incisions, although initially very visible, will fade to become virtually invisible within 9-12 months.

There is usually extensive bruising in the leg, usually lasting for 3-4 weeks.

Going home

Pain: Some people describe the leg as sore and uncomfortable post-surgery. This usually resolves 12-14 days after the operation. Take regular painkillers if you need to (i.e., paracetamol)

Regular exercise: Going for a short walk, every hour, to provide a gradual return to normal activity is recommended. Do not rest for long periods as this increases the risk of deep vein thrombosis (DVT). When sitting, ensure that your heels are higher than your hips to aid your circulation.

Driving: You will be able to drive when you feel confident to perform an emergency stop (usually when the bandage comes off).

Bathing : This is only possible if you can avoid getting the stockings or bandages wet for the first 5-7 days. It is fine after this.

Work: You should be able to return to work within 1-3 weeks of surgery depending on your job. We will provide you with a sick note but if you need longer off work, please see your GP.

Lifting: There are no limitations in this regard.

Wounds : The bandages or stockings put on after your operation should stay on your leg for 5-7 days and then can be removed along with the dressing in the groin. You can do this yourself or make arrangements to see the practice nurse at your GP’s surgery.

Complications:

• Bleeding: sometimes blood will ooze from the wounds during the first 12-24 hours. If necessary, press on the wound for 10 minutes and elevate your leg. Repeat if necessary and, if you are still bleeding, contact your GP.

• Wound infection: Wounds sometimes become infected and this may need treatment with antibiotics. This is more common with re-do varicose vein operations in the groin.

• Fluid leak from wound: Occasionally, the groin incision may leak blood-stained or clear fluid. Sometimes, fluid collects as a lump in the groin, taking several weeks to settle.

• Nerve injuries: These are uncommon (occurring in about 1 in 20 cases). Nerves can be damaged when removing varicose veins close to them. The reduced sensation may be very noticeable at first but resolves with time and is not usually a problem in the longer term.

• Deep Vein Thrombosis: DVT can occur occasionally following this surgery. Patients are advised to be as mobile as possible afterwards to reduce this risk.

• Recurrent Varicose Veins: Recurrence of varicose veins occurs in about 20% of patients over 10 years. Sometimes, further treatment may be required. There is a small risk that surgery for recurrent veins can lead to the possibility of chronic leg swelling.

• Thread veins/blemishes/scars                

What can I do to help myself?

When you get home, try to return to normal as soon as possible. The more exercise you take, the quicker the leg will return to normal and this will reduce the risk of complications.

If you have any concerns following discharge, please contact your GP practice for further advice in the first instance.

Contact details

Vascular Surgical Unit

Surgical Directorate

Plymouth Hospitals NHS Trust

Derriford Hospital

PL6 8DH

Tel 01752 202082

Consultant Vascular Surgeon and Lead Clinician

Mr Devender Mittapalli

Secretary: 01752 431822

Consultant Vascular and Transplant Surgeon

Mr Jamie Barwell

Secretary: 01752 431822

Consultant Vascular Surgeon

Surgeon Commander Cris Parry RN

Secretary: 01752 431822

Consultant Vascular Surgeon

Miss Catherine Western

Secretary: 01752 431805

Consultant Vascular Surgeon

Lt Col Robert Faulconer

Secretary: 01752 431805

Consultant Vascular Surgeon

Mr Hashem Barakat

Secretary: 01752 431822

Vascular Scientists

• Mrs J George
• Mr A Ellison
• Mr R Craven

01752 439228

Vascular Nurse Specialist

Mr Alan Elstone

01752 431805

Matron

Judy Frame

01752 431847