What are the Surgical Procedures for Varicose Veins

Surgical procedures can be used to treat varicose veins. Varicose veins are swollen, twisted veins that are visible under the skin. They occur most often in the legs. These veins may appear blue and bulging.

Varicose veins are caused by damage to the valves in veins. All veins have a valve that keeps blood flowing in only one direction. If a valve gets weak or damaged, blood can pool and cause varicose veins.

You may need surgery to treat your varicose veins if they are causing symptoms or complications, or if lifestyle changes have not helped. These procedures can lower the risk of bleeding and blood clots, and reduce pain and aching. They can also improve the way the affected area looks (cosmetic appearance).

Two common surgical procedures are:

• Phlebectomy. The vein is surgically removed through a small incision. This procedure is used to remove the veins closest to the skin.
• Vein ligation and stripping. The vein is surgically removed through incisions after the vein has been tied off. This procedure is used to treat severe cases.

Based on your overall condition, your health care provider will discuss the method that is best for you.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Damage to nearby nerves, tissues, or veins.
• Skin irritation, sores, or dark spots.
• Numbness.
• Clotting.
• Infection.
• Allergic reactions to medicines.
• Scarring.
• Leg swelling.
• Need for additional treatments.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• You may have an exam or testing. This can include a test to:
  • Check for clots and check blood flow using sound waves (Doppler ultrasound).
  • Observe how blood flows through your veins by injecting a dye that outlines your veins on X-rays (angiogram). This test is used in rare cases.
• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.
• You may be asked to shower with a germ-killing soap.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• One of the following procedures will be performed:

Phlebectomy

• You will be given a medicine to numb the area (local anesthetic).
• A small puncture will be made close to each of the varicose veins.
• A tiny hook will be used to pull out the vein.
• Bandages (dressings) or adhesive strips will be used to cover the puncture sites.

Vein ligation and stripping

• You will be given a medicine to make you fall asleep (general anesthetic).
• A small incision will be made near the vein in your groin (saphenous vein).
• The surgeon will tie off (ligate) the vein.
• Several more incisions will then be made along the vein.
• The vein will be removed (stripped).
• The incisions will be closed with stitches (sutures) under the skin.
• Bandages or adhesive strips will be used to cover the incision sites.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.

Summary

• Varicose veins are swollen, twisted veins that are visible under the skin. They occur most often in the legs.
• You may need surgery to treat your varicose veins if they are causing symptoms or complications, or if lifestyle changes have not helped.
• Your health care provider will discuss the method that is best for you based on your condition.

Surgical Procedures for Varicose Veins, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Swelling.
• Bruising.
• Soreness.
• Mild skin discoloration.
• Slight bleeding at incision sites.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision or puncture area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Get regular daily exercise. Walk or ride a stationary bike daily, or as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Wear loose-fitting clothing.
• Be patient with your recovery. It can take up to 4 weeks to recover completely.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have redness, swelling, or pain around your incision.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You develop a cough.

Get help right away if:

• You pass out.
• You have very bad pain in your leg.
• You have leg pain that gets worse when you walk.
• You have redness or swelling in your leg that is getting worse.
• You have trouble breathing.
• You cough up blood.

Summary

• After the procedure, it is common to have swelling, bruising, soreness, and mild skin discoloration.
• Follow instructions from your health care provider about how to take care of your incisions.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Get regular exercise daily. Walk or ride a stationary bike as told by your health care provider.