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Varicose Veins Surgery

Varicose veins are swollen, twisted veins that can be seen just under the surface of the skin.

These veins usually occur in the legs, but they also can form in other parts of the body. Varicose veins are a common condition. They usually don’t cause medical problems. If they do, you may need to make lifestyle changes.

Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 1-1.5 hrs
Cost Estimate: Cost Estimate: 1913 USD - 3733 USD These are indicative prices in Indian Hospitals

Weak or damaged valves in the veins can cause varicose veins. After arteries and capillaries deliver oxygen-rich blood to the body, veins return the blood to heart. The veins in legs must work against gravity to do this.

One-way valves inside the veins open to let blood flow through, and then they shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in veins. This causes the veins to swell.

Weak vein walls may cause weak valves. Normally, the walls of the veins are elastic (stretchy). If these walls become weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider, and it causes the flaps of the valves to separate.

When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often twist as they try to squeeze into their normal space. These are varicose veins.

Sometimes varicose veins cause pain, blood clots, skin ulcers, or other problems. If this happens, your doctor may recommend one or more medical procedures. Some people choose to have these procedures to improve the way their veins look or to relieve pain. Many treatments for varicose veins are quick and easy and don’t require a long recovery.

Varicose veins don’t always need treatment. If varicose veins are not causing discomfort, you may not need to have treatment.

Treatment of varicose veins is usually necessary to:

  • Ease symptoms – if varicose veins are causing you pain or discomfort
  • Treat complications – such as leg ulcers, swelling or skin discolouration
  • For cosmetic reasons

If treatment is necessary, doctor may first recommend up to six months of self-care at home, including:

  • using compression stockings
  • taking regular exercise
  • avoiding standing up for long periods
  • elevating the affected area when resting

The patient may need other minimally invasive procedures if conservative treatment is not improving symptoms or rather worsening them. One of the first treatments offered will usually be endothermal ablation. This involves using energy either from high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins.

Radiofrequency ablation

Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut made just above or below the knee.
A narrow tube called a catheter is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy.
This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins.
The procedure is performed under local anesthesia and takes about 30 minutes. Short-term results are excellent using radiofrequency ablation. The procedure may cause some short-term side effects, such as pins and needles (paraesthesia).
You may need to wear compression stockings for up to a week after having radiofrequency ablation.

Endovascular laser therapy

  • Endovenous laser therapy is a technique that uses a laser to destroy the vein. The procedure is usually performed in a doctor’s office and takes about 30-45 minutes. Catheter is introduced into the vein using a ultrasound scan to guide it into correct position. A small laser is passed into the vein through the catheter and positioned at top of the varicose vein. The laser is then fired up and the entire vein is fibrosed. The laser is fired at multiple locations and the entire procedure is performed with some local anesthesia.
  • Recovery is rapid and involves minimal pain. The procedure is relatively new and except for some mild bruising and a numbing sensation, no other effects have been seen in the short term.

Varicose Veins surgery

Several surgical procedures are available to relieve varicose veins, but not everyone with varicose veins is a candidate for surgery.

  • If the patient is pregnant or recently pregnant, it is advisable to wait at least 6 weeks after delivery before considering this option, because many of the varicose veins that occurred during pregnancy will fade.
  • If the veins bother the patient for cosmetic reasons only, and the patient is not bothered by pain or inflammation, then surgery may not be the best option.
  • Surgery is usually reserved for people who either do not get relief from the home care techniques or lifestyle changes, or who for cosmetic reasons want to try methods other than sclerotherapy or laser treatment to make the veins less prominent.

Most of the surgical procedures are performed on an outpatient basis, unless surgery has been done to both the legs.

  • The surgery involves either vein ligation (tying) or stripping or avulsion (pulling away) of the smaller branches.
  • With any surgery, risks and benefits exist. These should be discussed with the health care professional and with the specialist involved.
  • Recurrence of varicose veins does occur and may be due to incompetent perforator veins or failure to ligate the vein more proximally in the groin.

Ligation and stripping

Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.

  • Two small incisions are made, approximately 5cm (2 in) in diameter. The first cut is made near your groin at the top of the varicose vein. The second cut is made further down your leg, usually around your knee or ankle. The top of the vein (near your groin) is tied up and sealed.
  • A tunnelling device is placed under the skin between the two points, and the saphenous vein is dragged or pulled out of the tunnel.
  • This technique will leave not only scars from the incisions, but also a significant amount of bruising and possibly bleeding. The bleeding is easily controlled by pressure dressings and stops immediately. The bruising is usually noticeable for a few weeks.
  • For vein stripping, a recovery period of 5-10 days is needed before returning to a regular routine. For just vein ligation, a few days off is more than adequate.
  • More serious complications are rare, but could include nerve damage or deep vein thrombosis, which is where a blood clot forms in one of the deep veins of the body. The numbness is only mild in nature and does not cause any future problems.

The blood flow in your legs will not be affected by the surgery. This is because the veins situated deep within your legs will take over the role of the damaged veins.

Veins can bulge with pools of blood when they fail to circulate the blood properly. These visible and bulging veins, called varicose veins, are more common in the legs and thighs, but can develop anywhere in the body.
Large varicose veins can be visible, bulging, palpable (can be felt by touching), long, and dilated (greater than 4 millimeters in diameter).

Varicose and spider veins can occur in men or women of any age, but most frequently affect women in the childbearing years and older people. Varicose veins are very common. Some estimates suggest that about 10% to 15% of men and most older women who have varicose or spider veins.

A family history of varicose veins and older age increase one’s tendency to develop varicose veins.

Other risk factors include:

  • a sedentary lifestyle,
  • weight gain,
  • prolonged standing, and
  • Pregnancy.

The causes of varicose and spider veins are not entirely understood. In some instances, the absence or weakness of valves in the veins may cause poor venous circulation (blood flow in the veins) and lead to varicose veins. Valves inside veins normally act to ensure that blood in the veins does not flow in a backward direction (retrograde) away from the large (deep) veins and the heart. They are mainly located in perforating veins and some deep veins.
In other cases, weaknesses in the vein walls may cause pooling of the blood. The walls of the blood vessels can become weaker and less competent than normal, causing the volume of blood in the veins to increase, thus leading to varicose veins.
Venous disease (disease of the veins) is generally progressive and may not be prevented entirely. However, in some cases, wearing support hosiery, maintaining a normal weight, and regular exercise may be beneficial.

Many people with varicose veins do not have any physical symptoms. They may, however, have concerns over the cosmetic appearance of the varicose veins.

Symptoms of varicose veins may include:

  • Aching
  • Cramps
  • Itching
  • Swelling
  • Fatigue

Some people may complain of a dull ache and pressure sensation from varicose veins.

There are many different treatments available for varicose veins. These treatments vary based upon the size and location of the varicose veins, the presence of symptoms, and in cases of accompanying skin changes (for example, swelling, dermatitis or ulceration, for example). Briefly, potential treatments may include:

  • Leg elevation while sitting or sleeping,
  • Compression dressings with single or multi-layered systems,
  • Compression stockings,
  • Sclerotherapy (injection of a liquid or foam into the vein to form a clot and permanently destroy the vessel),
  • Ablation (destruction) of abnormal veins with techniques using laser, radiofrequency or other modalities
  • Surgery (removal of the varicose veins, including “phlebectomy” or vein stripping).

In general, sclerotherapy and laser therapy are helpful in treating spider veins (telangiectasias), while ablation and surgery may be a better option for larger varicose veins.

Sclerotherapy involves using a fine needle to inject a substance directly into the vein. This solution irritates the lining of the vein, causing the vein to swell and the blood to clot. The vein then turns into scar tissue that may eventually fade from view. Sclerotherapy is typically used for spider veins and varicose veins. Veins up to 15 millimeters in diameter have been treated successfully. This is generally offered to patients who have tried compression stockings and leg elevation without much success.
With sclerotherapy, after the solution is injected, the vein’s surrounding tissue is generally wrapped in compression bandages for several days, causing the vein walls to stick together. Patients whose legs have been treated are put on walking regimens, which forces the blood to flow into other veins and prevents the development of blood clots. This method and variations of it have been used since the 1920’s. In most cases, more than one treatment session will be required.

Varicose veins are frequently treated by surgically eliminating the “bad” veins. This forces the blood to flow through the remaining healthy veins. In vein stripping surgery, the problematic veins are “stripped” out by passing a flexible device through the vein and removing it through an incision near the groin. Smaller tributaries of these veins also are stripped with this device or removed through a series of small incisions. Those veins that connect to the deeper veins are then tied off. This is now usually performed using outpatient surgical procedures and rarely requires general anesthesia.

Spider veins and small varicose veins can be treated with laser treatment applied from the surface of the skin. The laser applies an intense energy that essentially destroys the small blood vessels in the surface of the skin. Results are variable, and multiple treatments may be necessary to have some benefit. This procedure is generally less invasive than sclerotherapy and vein stripping. A possible problem that may arise after laser treatment is a temporary discoloration of the skin.
Larger varicose veins may be treated with inside the vein catheter ablation or laser surgery. This basically involves inserting a catheter into a large vein in the lower leg and closing the vein by applying heat generated through laser. This technique has proven to be less painful, and it also has a faster recovery time compared to vein stripping surgery.

Doctors who provide surgical treatments (vein stripping and laser ablation) include general and vascular surgeons. Sclerotherapy and laser treatment are often performed by dermatologists, though some general, vascular, and plastic surgeons also perform sclerotherapy treatment.

Patients should consult their doctor about the safety and potential side effects of each type of treatment.
For surgical removal of veins, potential side effects include those for any surgery performed under anesthesia, including nausea, vomiting, as well as the risk of post-operative wound infection. Surgery may also result in scarring where small incisions are made, and the formation of blood clots is a potential complication as well.
For sclerotherapy, the side effects can depend on the substance used for the injection. People with allergies may want to be cautious. Skin burns or permanently mark or stains on the skin may form and fade over time. Occasionally, sclerotherapy can lead to the formation of blood clots.
Laser treatments can cause scarring and changes in the color of the skin.

The most worrisome complication of all these treatments is formation of blood clots, which may require further treatments, including blood thinners or other treatment, and have a very low risk of causing death.

Many factors will affect the rate at which treated varicose veins recur. These include the underlying diagnosis, the method used and its suitability for treating the particular condition, and the skill of the physician. Sometimes the body forms a new vein in place of the one removed by a surgeon. An injected vein that was not completely destroyed by sclerotherapy may reopen, or a new vein may appear in the same location as the previous one.
Many studies have found that varicose veins are more likely to recur following sclerotherapy than following surgery. However, no treatment method has been scientifically established as being free from recurrences. For all types of procedures, recurrence rates increase with time. Also, because venous disease is typically progressive, no treatment can prevent the appearance of new varicose or spider veins in the future.

Prevention of varicose veins may be accomplished by periodic leg elevation, avoidance of prolonged standing, and wearing elastic support hose. Regular exercise and control of weight can also be beneficial. These measures can prevent or slow down the progression of varicose veins.

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