Varicose Veins Surgery

Mr. Peter Y. Milne
F.R.A.C.S., F.R.C.S., (ENG), F.A.C.S.

You have decided to undertake VARICOSE VEINS SURGERY!

You should have already read advice about varicose veins from Mr Milne and understand the purpose of your planned procedure.  Varicose veins surgery has risks and benefits so you should be aware of the outcomes possible. 

AIM OF VARICOSE VEINS SURGERY:

The operation for varicose veins is designed to ligate points of venous valve failure and extract the varicose veins from the leg, by means of multiple small incisions.  The technique is known as "ligation, puncture and extraction".  Sometimes removal of the surface thigh vein or calf vein is required and this is performed by invagination of the vein rather than "stripping”.  This technique allows for minimal trauma and a faster recovery than the old technique of "stripping".  A preoperative ultrasound (duplex scan) is used to identify all the points of valve failure so as few as possible valve leaks are missed at surgery.  At present, varicose veins surgery has resulted in a 90% rate of "cure" for high pressure varicose veins.  Follow up ultrasound and/or injection therapy is sometimes required. Small surface veins are not treated by surgery and they often become more prominent after surgery.

BEFORE VARICOSE VEINS SURGERY:

Prior to varicose veins surgery you will be seen by both the Anaesthetist and Mr. Milne.  The anaesthetist will discuss the type of anaesthesia for you and answer any questions regarding same.  It is important that you tell the anaesthetist of any drug therapy or allergies so bring any regular medication with you to hospital.

The surgeon will mark out your legs with red ink at this visit and any further questions about your surgery will be answered.

An Assistant surgeon is employed on all occasions for venous surgery, as it shortens the operation time, thus making the procedure safer.  The assistant will be introduced to you prior to anaesthesia.

SURGERY:

When you have your varicose veins surgery, you can expect an incision, approximately one half to three centimetres long, over the site(s) of leaking valves.  These are generally at each groin and less frequently behind the knee.  Some of the incisions for extraction of the varicose veins themselves will be approximately 1/2 to 2 millimetres in length and will be closed by single suture or adhesive tape.  Most extraction sites are small punctures (less than 1 mm) and will not require any suture or closure at all.  Firm compression bandages are applied at completion of varicose veins surgery.  Only minimal blood loss occurs with this surgery so blood transfusion is not a consideration. When varicose veins surgery is complete you will be confined to bed for 4-6 hours with the legs elevated and very firm bandages in place.

AFTER VARICOSE VEINS SURGERY:

After varicose veins surgery you can expect some mild stinging discomfort for a few hours, which should be easily controlled by oral analgesia (pain tablets e.g. Paracetamol or Codeine). Tight bandages, causing severe pain or inability to sleep, should be reported to the nursing staff. Sometimes blood thinning injections are used, as a precaution against thrombosis, but most medication is in tablet form only.

Some bleeding may occur through the bandages and should be reported to the nursing staff.

After discharge from hospital any bleeding from wounds can be managed by direct pressure with a tissue for a few minutes. In the rare event of major bleeding elevate the legs vertically and bleeding will immediately cease.

The hospital time for varicose veins surgery is in the range of one to three days, depending on comfort.  A change from the bandages to compression stockings of takes place on the second or third day after surgery.  Mr. Milne will see you in hospital and Mr. Milne or the practice nurse will arrange for your bandaging and appointments. Skin closure adhesive tapes and soluble buried sutures are used so no suture removal is required after surgery.

Scars after varicose veins surgery are initially red as they heal.  This redness fades after 6 weeks to 18 months depending on the individual.  The puncture site scars have the appearance of mosquito bites during this time.  Occasionally a thread of fibre is seen at these sites and can be cut off with a nail scissor. The legs are bruised and sometimes lumpy. The thighs may feel bruised, also, and these problems resolve over one to six weeks.  Most thigh discomfort settles after 10 days. Any bruising, swelling or lumps that you feel are alarming contact the office.

If you are prone to small spider veins or burst capillaries then these will often become more numerous.  Follow up treatment is available by means of injection therapy to clear these if required.

There are no restrictions following varicose veins surgery and you may drive, walk or do most chores in the light stockings from 2 days post surgery.  Activity is encouraged and walking is the best activity to look after your body at this time.  When you are not active you will find it more comfortable to put your legs up. Standing, however, does no harm.  The bandages/stockings will control swelling and can be used for extended periods if desired.  One week is the usual time for stockings.  There is no need to elevate your feet in bed after the second post op. Day.

COMPLICATIONS/RISKS:

The chances of a complication requiring re-admission to hospital, or delay in discharge, are less than 0.1% or 1 in 1,000. 

The special risks are:          

Infection 1:3000 risk

Thrombosis of the deep veins. 1:2000 chance

Infection is evidenced by a discharge or fever with redness and pain of a wound.

Thrombosis is evidenced by excess pain and/or severe swelling

Minor Risks:

Numb patches, bruising, minor infection, inflammation, lumps or solid segments of vein causing discomfort. Disabling pain lasting more than 2 weeks is uncommon and should be reported.

After your varicose veins surgery any complications or difficulties regarding same should be referred immediately to Mr. Milne's office or his call service.  Telephone numbers are on your post-operative instruction sheet.  Any other unrelated medical condition should of course be referred back to your local doctor.

ACCOUNTS:

The anaesthetic and surgical bills are currently charged at between A.M.A.  and schedule fee rate. There may be gaps between your rebates from your fund, Medicare and the fee charged.  Advice on “Gap Cover” and total charges can be obtained from this office.  You may also receive an account from the assistant surgeon and anaesthetist which will be mainly covered by your fund and Medicare.  Public hospital access is available for varicose veins surgery but the waiting time is between 6 months and 4 years depending on urgency

© PETER Y. MILNE
F.R.A.C.S., F.R.C.S., (ENG), F.A.C.S.
VASCULAR SURGEON


Mr. Peter Y. Milne, vascular surgeon, vascular surgery. | Transient ischaemic attacks (TIA's), stroke, stroke prevention, carotid endarterectomy, carotid stents, carotid stenting. | Aortic aneurysm, abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), dissecting aortic aneurysm, conventional aortic aneurysm repair, open aortic aneurysm repair, stent grafts, stent grafting, intraluminal grafts, intraluminal grafting, endoluminal grafts, endoluminal grafting | Cardiovascular disease, atherosclerosis, arterial disease, arterial blockage, arterial occlusion, intermittent claudication, diabetes, diabetic foot, ulcers, gangrene, arterial bypass, leg artery bypass, balloon angioplasty | Varicose veins, sclerotherapy, coil occlusion, varicose veins surgery | Hyperhidrosis, chemical sympathectomy.
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