Surgery for Varicose Veins
The traditional way of treating varicose veins is by removing them surgically, with an operation in the operating theatre, with the patient asleep, under general anaesthetic. It has, for decades been considered 'The Gold Standard' of treatment for varicose veins.
Varicose Vein Surgery usually involves admission to the ward or the Day Stay Unit of a hospital a few hours before the procedure. The patient needs to have been starved before the procedure for at least 6 hours to make the anaesthetic safe. The patient undergoes the formal admission procedure, and is consulted by the anaesthetist before the procedure to ensure that the patient and anaesthetist are happy with the proposed anaesthetic. The surgeon comes to ensure that the patient understands the proposed procedure, obtains consent for the procedure and may have to draw on the legs where the varicose veins are so that they can be identified and removed during the operation.
When everyone is happy, the consent forms signed and all checks performed, the patient is put onto an operating grow and wheeled on the trolley to the anaesthetic room to be put to sleep by an injection through a needle placed in the arm or hand. Once the patient is asleep they are placed onto the operating table in the theatre and machine ventilated with safety monitors attached. The patient is cleaned and covered in sterile covers to reduce the chances of wound infection.
The surgery is performed, usually, through a main incision (cut) made in the groin. The veins are identified in the tissues and disconnected from the main vein at the top of the leg. There are frequently many branches of the vein which need to be identified and ties with ligatures. Once the 'High Tie' has been performed, the vein is opened and a wire passed down the leg, inside the vein, as far as it will go. The end of the wire is retrieved with a hook or clip through another cut further down the leg and from that end the vein is pulled down the leg, 'Stripped" under the skin and out of the cut at the bottom. The space where the vein has been removed from is often temporarily packed with gauze to reduce bleeding.
Depending on how many veins have been identified for removal, there are multiple small cuts made to allow a hook to pass through the skin to pull out the veins. This is known as 'Multiple Avulsion'.
The small incisions for Avulsion are each stuck together either with skin glue or paper stitches. The larger incisions for the High Tie and the Striped vein are closed, once all the packs are removed, with stitches. These stitches are usually absorbed by the skin over time and do not need removal. The leg is bound with tight bandaging before the patient is wheeled out to the recovery bay to recover from the anaesthetic and to receive strong pain relief and, frequently, nausea relief in a monitored safe environment.
After a period in the recovery ward, the patient is either taken to the Discharge lounge for a further period of supervised rather than monitored recovery before being discharged to a carer. Alternatively theu are admitted to the ward for over-night observation before discharge the following day.
On the following day, the bandages are removed and replaced with compression stockings. This is done either on the ward, or in a dressings clinic at the hospital. The stockings should be worn continuously for at least 48 hours, preferably longer, to prevent excessive bruising and swelling. Activity is encouraged, with plenty of walking on a daily basis to encourage blood flow, and to improve the recovery period. The patient is usually seen again by the surgeon after 2 to 6 weeks. Any further intervention can be assessed for and planned at this stage.
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