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Patient Information – Varicose Vein Surgery

This leaflet tells you about the condition known as varicose veins. It explains what is involved, and the common complications associated with this condition. It is not meant to replace discussion between you and your doctor, but as a guide to be used in connection to what is discussed with your doctor.

Why do I need the operation?

Veins are the blood vessels that carry blood back to the heart. Varicose veins are abnormally swollen (dilated) veins that are visible just below the surface of the skin. Smaller veins in the skin itself are sometimes called "thread veins" or "spider veins". Although these may be unsightly they are not the same as varicose veins.

Before your operation

If you are taking the contraceptive pill you will normally be given an injection to thin the blood, just prior to surgery. Alternatively the pill may be stopped four weeks before surgery and other forms of contraception may be used. Please discuss with your surgeon the alternatives.

You may be called for a pre-admission visit before your actual date to make sure you are fit for the operation. The operation is usually performed as a day-case. However, if you are having both legs operated upon, or if you have any medical problems, it is usual to remain in hospital overnight.

Coming into hospital

You will be asked to come in 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 the surgeon who is to perform your operation, who will mark the position of the veins, and the doctor who will give your anaesthetic.

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.

The Operation

This is performed under a general or local 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 a stitch, usually hidden under the skin.

The other veins marked before the operation are then removed through tiny cuts. (Some surgeons may use injections for this part of the operation.) These are then closed with adhesive strips or stitches. Some other veins may be affected, especially one behind the knee. Special scans may be needed before the operation, and this will be explained to you.

A dressing will be placed on the cut in the groin, and your leg will be bandaged up to the top of the thigh. The bandages put on at the operation will stay on your leg until you are advised to remove them by your specialist.

What are the risks associated with this procedure?

Bleeding, and some bruising is always expected. There is a three percent of wound infection. However, if the groin is being redone this risk increases to five percent.

Thrombosis occurs in only approximately 1 in 100 cases.

An area of numbness may occur, and very occasionally a nerve pain or neuralgia may occur if a nerve near a vein is irritated or damaged.

What are the benefits?

Improved symptoms. Healing of skin damage. Removal of unsightly varicose veins.

What are the alternatives?

There are several methods of treatment – support hosiery, sclerotherapy (injections), ablation of the vessels with electrical or laser surgery and operation. It is always important to consider the pros and cons carefully before deciding on treatment. You also have the option not to accept treatment.

Going Home

For the first week, sitting with your feet elevated so that your heels so that your heels are higher than your hips is advisable. This aids drainage. Three times a day take a short walk (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. You should not get the adhesive strips on your leg wet for the first seven days. Care will be needed when washing.

You should wear the stocking bandage day and night for the first week, after which you may leave it off at night. You will need to wear it during the day for about six weeks. Shower or bath in the usual way after removing the stocking bandage.

Complications to look out for

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.

Rarely there is numbness around the wound or ankle. This is unavoidable and is due to pulling on nerves during the operation. It usually settles after some weeks or months. The scars on your legs will continue to fade for many months.

What happens next?

You will need to arrange an appointment to attend your GP's surgery to see the nurse for removal of the dressings and stitches if there are any to remove. You should 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.

Returning to normal activity

You can return to work when you feel sufficiently well and comfortable, generally about a week to ten 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 three weeks before you are able to undertake most normal activities, especially if you have a job that involves much standing and your varicose veins were particularly severe. Your General Practitioner will advise you about returning to work in the light of your progress after the operation.

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. Taking regular exercise, avoiding becoming overweight, and wearing light support tights or stockings will all help prevent you being troubled by varicose veins in the future.

Contact us:

If you are going to have an operation you may be asked to attend the hospital for a pre-operative assessment. Please ask our staff any questions you may have about your treatment. Alternatively, you can phone the main hospital switchboard on 0121 424 2000 and ask to speak to your consultant's secretary.

Additional Information

This leaflet is based on one designed by The Vascular Surgical Society of Great Britain and Ireland, but has been modified (with permission) by us to reflect local policies. The Vascular Surgical Society of Great Britain and Ireland web site ( ) has further information on vascular surgical procedures.

Go online and view NHS Choices website for more information about a wide range of health topics

You may want to visit one of our Health Information Centres located in:

• Main Entrance at Birmingham Heartlands Hospital Tel: 0121 424 2280

• Treatment Centre at Good Hope Hospital Tel: 0121 424 9946

or contact us by email: healthinfo.centre@heartofengland.nhs.uk.

Our commitment to confidentiality

We keep personal and clinical information about you to ensure you receive appropriate care and treatment. Everyone working in the NHS has a legal duty to keep information about you confidential. We will always ask you for your consent if we need to use information that identifies you. We will share information with other parts of the NHS to support your healthcare needs, and we will inform your GP of your progress unless you ask us not to. You can help us by pointing out any information in your records which is wrong or needs updating.

Dear Patient

We welcome your views on what you liked and suggestions for how things could be improved at this hospital. If you would like to tell us and others about your experience please make your comments through one of the following sites:-

• NHS Choice:-           nhs.uk

• Patient Opinion:-      .uk

• I want great care:-    (Here you can leave feedback about your doctor)

Be helpful and respectful: think about what people might want to know about this hospital or how your experiences might benefit others. Remember your words must be polite and respectful, and you cannot name individuals on the NHS Choice or Patient Opinion sites.

If you have any questions you may want to ask about your condition or treatment, or anything you do not understand or wish to know more about, write them down and your doctor will be more than happy to try and answer them for you.

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