Varicose Vein SurgeryBy
What is varicose vein surgery?
Varicose vein surgery is a general term for different methods of surgically treating varicose veins. Varicose veins most often occur in the thighs and calves. They can look blue, twisted and bulging, and feel uncomfortable. Some people seek varicose vein surgery for cosmetic reasons to treat large and unsightly varicose veins. Others need relief from symptoms, such as burning, soreness and cramping.
Varicose vein surgery is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Nonsurgical treatments for varicose veins include endovenous laser treatment, endovenous radio frequency ablation, sclerotherapy, and surface laser treatment. Consider getting a second opinion about all your treatment choices before having varicose vein surgery.
Types of varicose vein surgery
Your surgeon may perform one or more types of varicose vein surgery, depending on the location and type of varicose veins that need treatment. He or she may also combine varicose vein surgery with other procedures, such as sclerotherapy, surface laser treatment, endovenous laser treatment, or endovenous radio frequency ablation.
The types of varicose vein surgery include:
Ambulatory phlebectomy (also called micro-incision phlebectomy, hook phlebectomy, stab avulsion phlebectomy, and microphlebectomy) removes portions of varicose veins through small incisions using a hook. It usually takes place in a doctor’s office or outpatient surgery center using a local anesthetic.
Ligation and stripping usually removes the saphenous vein, a large vein in the leg. Your surgeon makes two cuts near the top and bottom of your leg. He or she will cut the saphenous vein in the upper incision, run a wire down through the vein, and pull it out of your leg through the lower incision. This surgery takes place in a hospital or surgical center using general anesthesia.
PIN stripping removes a vein through one incision. Your surgeon makes a cut near the top of your leg. He or she runs a device called a PIN (perforate invaginate) stripper through the cut down the vein, attaches the device to the end of the vein, and pulls the vein up through the cut. This type of surgery takes place in a hospital or surgical center using general or regional anesthesia.
Transilluminated powered phlebectomy (TIPP) removes portions of varicose veins using tools that your doctor inserts near the veins. They include a lighted tool that provides a better view of the vein’s location, and a cutting and suction tool that breaks up the vein and suctions it out of the leg. TIPP takes place in a hospital or surgical center using general or regional anesthesia.
Why is varicose vein surgery performed?
Your doctor may recommend varicose vein surgery for varicose veins that are large, protruding or unsightly. Varicose vein surgery may also be appropriate if your varicose veins are causing symptoms, such as burning, aching, soreness and cramping.
Veins are blood vessels that carry blood from your body back to your heart. There are valves inside veins that help direct blood back to your heart. When the valves are damaged or weakened, blood can pool in your veins causing them to swell and weaken. This results in varicose veins.
Your doctor may only consider varicose vein surgery for you if other treatment options with less risk of complications are ineffective. Less invasive options for treating varicose veins include endovenous laser treatment, endovenous radio frequency ablation, sclerotherapy, and surface laser treatment. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on varicose vein surgery.
Who performs varicose vein surgery?
The following specialists perform varicose vein surgery:
Vascular surgeons specialize in the surgical treatment of diseases and conditions of the lymphatic system and blood vessels outside the heart and brain.
Phlebologists specialize in diagnosing and treating vein conditions including varicose veins, spider veins, chronic venous insufficiency, and vein birth defects.
Dermatologists specialize in the medical and surgical care of the skin, hair and nails.
How is varicose vein surgery performed?
Your varicose vein surgery will be performed in a doctor’s office, surgical center, or hospital, depending on the type and extent of your surgery. Your doctor will perform your varicose vein surgery using one or more types of anesthesia, depending on the type of surgery:
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your varicose vein surgery
Varicose vein surgeries that use only a local anesthetic, such as ambulatory phlebectomy, generally include these steps:
You will remove your clothing and possibly dress in a patient gown.
While you stand up, your doctor will mark the veins needing treatment with a pen.
You will lie on the examination table to allow access to the vein site or sites.
Your doctor will clean and prep your skin.
Your doctor will inject the area with local anesthetic and close off or remove your varicose veins. You will be awake and alert during the procedure.
For varicose vein surgery that involves general anesthesia, such as transilluminated powered phlebectomy, PIN stripping, and ligation and stripping, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will respect your privacy and give you blankets for modesty and warmth in the surgical suite.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
For general anesthesia, your anesthesiologist or nurse anesthetist will place a tube in your lungs to protect and control your breathing. You will not feel or remember this or the surgical procedure.
Your doctor will use one or more small incisions, surgical techniques, and specialized instruments to close off or remove your varicose veins.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of varicose vein surgery?
Any surgical procedure involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during the procedure or throughout your recovery. You can best reduce the risk and seriousness of potential complications by following the treatment plan your doctor designs specifically for you.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clots, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of varicose vein surgery
Complications of varicose vein surgery include:
- Change of skin color near the vein removal site
- Damage to deeper veins
- Inflammation of the remaining vein or at the incision site
- Numbness near affected veins
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes avoiding heavy lifting and strenuous activity as recommended by your doctor.
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications and wearing your compression stockings exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my varicose vein surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can best prepare for varicose vein surgery by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For varicose vein surgery, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need varicose vein surgery? Are there any other options for treating my condition?
What type of varicose vein surgery will I need?
Where will my varicose vein surgery take place?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What assistance will I need at home?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my varicose vein surgery?
Knowing what to expect can help make your road to recovery after varicose vein surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will likely walk normally and go home the same day if you are recovering well. In other cases, a hospital stay of one day may be required. Your doctor will ask you to wear compression stockings after your surgery to stabilize your veins and help them heal.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes a few days to a few weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after varicose vein surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness such as passing out, dizziness, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage or pus coming out of an incision in your leg
How might varicose vein surgery affect my everyday life?
Varicose vein surgery may cure your condition or significantly reduce your symptoms. It will most likely relieve much of the bulging, discomfort and discoloration from your varicose veins. It will not prevent varicose veins from coming back, and you may need more varicose vein surgery in the future.
You can make changes in everyday life that may help prevent or delay recurrence of varicose veins including:
- Losing weight
- Wearing compression stockings
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- Ambulatory phlebectomy information. American Society for Dermatologic Surgery. http://www.asds.net/AmbulatoryPhlebectomyInformation.aspx
- Frequently Asked Questions. The American College of Phlebology. http://www.phlebology.org/patientinfo/faq.html
- Phlebectomy of Varicose Veins. RadiologyInfo.org http://www.radiologyinfo.org/en/info.cfm?pg=phlebectomy
- Treatment Options. The American College of Phlebology. http://www.phlebology.org/patientinfo/treatment.html
- Varicose veins and spider veins fact sheet. Womenshealth.gov. http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm
- What Are Varicose Veins? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/vv/