What are varicose veins?

Varicose veins are enlarged and twisted veins in your leg.

Varicose veins tend to run in families and are made worse by pregnancy and standing up a lot.

Both legs contain a system of deep veins, which are buried within the muscles of your leg, and a system of superficial veins which run just underneath your skin.

Sometimes weaknesses in the walls of the superficial veins cause them to enlarge.

The result is a build-up of pressure in the veins, which bulge out as varicose veins.

What are the benefits of surgery?

Your symptoms should improve.

Are there any alternatives to EVA?

Support stockings can often help the symptoms caused by varicose veins and reduce the risk of complications that varicose veins can cause.

Foam sclerotherapy is a similar technique that uses an injection of chemicals to treat the veins.

Varicose veins surgery involves disconnecting and removing the superficial veins from the deep veins, using a cut on your groin or the back of your knee.

For the following treatments, research is still being carried out and we do not yet know how effective they are in the long term.

• cyanoacrylate glue occlusion
• high-intensity focused ultrasound

What does the operation involve?

The operation is performed under a general anaesthetic, local anaesthetic or spinal anaesthetic. The operation usually takes about 45 minutes.

Laser ablation

Your surgeon will insert a catheter (tube) into the great or small saphenous vein. They will pass a laser fibre through the catheter and up to the point where the saphenous and deep veins meet. Your surgeon will slowly remove the catheter and laser fibre while laser energy pulses are sent down the fibre. The laser energy causes the saphenous vein to close.

Radiofrequency ablation

Your surgeon will insert a radiofrequency ablation catheter into the great or small saphenous vein.

Your surgeon will slowly remove the catheter while radiofrequency energy is sent down the electrode. The radiofrequency energy causes the saphenous vein to close.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

If you are on the oral contraceptive pill or hormone replacement therapy, you should consider stopping the tablets 4 weeks before the operation. This is to reduce the risk of a deep vein thrombosis (DVT). If relevant, you will need to use alternative contraception. Your surgeon can discuss the options with you. If you do not want to stop the tablets then you may need to have injections or tablets for up to a week after surgery, in order to thin the blood and reduce the chance of a DVT.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• bleeding
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• blood clot in your leg
• blood clot in your lung
• chest infection

Specific complications of this operation

• superficial thrombophlebitis, where one of the superficial veins becomes inflamed
• developing a lump under a wound
• numbness or a tingling sensation along the line of the vein that has been treated
• burns to your skin
• ablation device cracking or breaking
• damage to nerves
• damage to arteries
• heat-induced thrombosis causing a DVT
• continued varicose veins

Consequences of this procedure

• pain
• unsightly scarring of your skin

How soon will I recover?

You should be able to go home the same day.

Try to return to normal activities as soon as possible, unless you are told otherwise.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a full recovery.

Summary

Varicose veins are a common problem and can lead to complications if left untreated. Support stockings can help to control symptoms but will not remove the varicose veins.

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