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Before your Operation.
I will suggest that if you are taking the oral contraceptive pill or HRT your protection against thrombosis will be by giving you an injection to thin the blood before and after the operation.
The operation is usually performed as a day-case or with an overnight stay. If you are having both legs operated upon, having an operation for recurrent veins or if you have any medical problems, it is usual to remain in hospital overnight. A special scan may have been recommended before surgery and this will take place as an out-patient before your operation.
Coming into Hospital.
You will be asked to come in on the morning of your operation. You should not eat or drink anything when you wake on the morning of your operation. Please bring with you any medicines you are taking and show them to the doctor. You will be received in the ward by a nurse who will note your personal details. You will also be visited by me, the surgeon who is to perform your operation, and I will mark the position of the veins and answer any questions you have. The doctor who will give you your anaesthetic will also see you. Many people are concerned about anaesthetics, so please ask the anaesthetist if you have any specific worries so that he may reassure you. All of these people are ready to answer any questions you may have, so please ask.
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The Operation.
This is performed under a general or epidural anaesthetic. The commonest operation is where a cut is made in the groin over the top of the main varicose vein. This is then tied off where it meets the deeper veins. If possible, the main varicose vein on the inner aspect of the leg is then stripped out. Blood can still flow up the leg along deeper, unaffected veins. The cut in the groin is closed with stitches. The other veins marked before the operation are then pulled out of tiny cuts. These little cuts do not need stitches but are covered by small airstrip dressings. Another system of veins may be at fault behind the knee and this requires a cut in the skin crease behind the knee to tie the vein off.
A dressing will be placed on the cut in the groin, and your leg will then be fitted with the compression stocking that has previously been measured for you. The stocking should be worn continuously for at least 72 hours after your operation. It may then be removed at night but you should still use it during the day for 4 weeks. This method helps to give you the best possible result from your vein surgery and reduces the amount of bruising that may occur.
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Going home.
Walking is encouraged from the day after your operation. Throughout the day take short walks (a few hundred yards will do, but more if you wish) to avoid stiffness of the muscles and joints. Slight discomfort is normal. Occasionally, severe local twinges of pain may occur in some patients and may persist for some months. In the first week after the operation you may need to take a mild painkiller such as paracetamol to relieve discomfort. After 72 hours you may remove the stocking at night and can wash the leg. Leave the small plastic airstrip dressings. These will fall off in about 5 days. A clean paper type dressing will be given to you for the groin wound.
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What next?
You will be given an appointment to attend for removal of the dressings if they remain and the stitch in the groin and by the knee if used.
You may wish to avoid driving for about one week from the operation because, in an emergency, your response time may be prolonged. It is essential that you are able to perform an emergency stop without pain. If in doubt, delay driving until you are happy. Swimming and cycling are allowed after the dressings have been removed.
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Complications to be aware of.
Sometimes a little blood will ooze from the wounds during the first 12-24 hours This usually stops on its own. If necessary, press on the wound for ten minutes. If bleeding continues after doing this twice, phone your General Practitioner or the ward.
Occasionally hard, tender lumps appear near the operation scars or in the line of the removed veins. These can appear even some weeks after the operation and need not be a cause for concern. However, if they are accompanied by excess swelling, redness and much pain, they may represent a wound infection and you should see your General Practitioner or contact me.
Bruising along the leg is common and will fade after a few weeks.
The scars on your legs will continue to fade over many months.
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Effects of varicose vein surgery on nerves.
Numbness around the wounds is not unusual and will go away after a few weeks.
Stripping the vein along the thigh may bruise a skin nerve that runs with it. Occasionally you may notice some numbness on the inside of the thigh around the knee or on the inside of the foot. This will not restrict your activities in any way. It will usually recover but may take several months. Stripping of the vein is an important part of the operation. If the vein is not stripped for those patients having groin operations, there can be a 30% recurrence rate for your veins in the future.
For those who have a vein operation with a cut behind the knee, a skin nerve that goes to the outside of the foot may be bruised. You may notice some numbness on the outside of the foot in the area of the little toe. It will not limit your activity in any way and will usually recover after some months.
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Return to normal activity?
You can return to work when you feel sufficiently well and comfortable, generally about a week to 10 days. If you have had both legs operated upon at the same time and you have a number of scars on each leg, it will probably be two weeks before you are able to undertake most normal activities. If you have a job that involves much standing and your varicose veins were particularly severe, involving both legs, you may need up to three weeks off work. Your General Practitioner will advise you about returning to work in the light of your progress after the operation. You will be given a follow up appointment to see me about 2 weeks after surgery.
You will have been warned that not every visible vein will disappear as a result of your operation and there is a chance that in the future, further varicose veins may develop, as you are clearly disposed to them. You may wish to have some follow up injection treatment or a local anaesthetic minor phlebectomy. The taking of regular exercise, the avoidance of becoming overweight, and the wearing of light support tights or stockings will all help prevent you being troubled by varicose veins in the future.
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