Surgical removal of varicose veins

What does the traditional operation involve?

"Stripping" of varicose veins, which used to be the mainstay of treatment, is now a rare operation, but occasionally is still performed if less invasive methods are not available or if your veins are not suitable for them. The "traditional" operation works well but does take longer to recover from than the newer methods. Please note that the details of an operation, for example, what kind of stitch or bandage is used may vary from surgeon to surgeon.

Most commonly, the source of the problem is at the top of the leg (groin). In this situation you will require a cut in the groin and small nicks over the veins in the leg and calf. The varicose veins will be removed. You will have some self-absorbing stitches in the cut in the groin and usually no stitches are required in the other small incisions.

The leg will be bandaged up at the end of the operation. If the main source of the problem is behind the knee then the cut will be here. Occasionally both the groin and the back of the knee are involved.

What will it be like after the traditional operation?

Normally you come into hospital on the day of the operation and go home the on the same day (day case) or on the following day. The leg will be bandaged up. There is bound to be some bruising and although every effort is made to minimise this the amount of bruising varies from person to person and according to how many and large the veins are.

You will be able to walk around from the day after the operation and are encouraged to do so. You are welcome to walk as far as you like but are not obliged to walk miles as people used to be advised many years ago. You would certainly be expected to walk around and mobilise several times per day as a minimum.

When you are not walking around it is a good idea to try and keep the leg up, for example when watching television put the leg up on the arm-rest of the sofa as avoiding hanging the leg down reduces any tendency to swelling or bruising.

After some days the bandage is removed. You can have a bath at this time. You will notice some bruising in the leg. This will gradually fade over a period of time just like any other bruise.

To start with the places where the veins were may feel a bit hard and lumpy under the skin. The stitches in the groin are self-absorbing and do not need to be removed.

It is recommended that you get a compression stocking or support tights prior to your surgery and you wear these once the bandage has been removed. This will make the leg more comfortable.

How long do I need off work after a traditional operation?

People vary quite considerably as to how much bruising they have in their leg and how this affects them. It is certainly recommended that you should have a week off following your surgery during which the bandage is in position.

After this time you will be more mobile but there is bound to be some bruising of the leg. People vary as to how much they feel able to do at this point. You would certainly be able to walk around and are encouraged to do this. You may be well enough to go back to work a week after your surgery but most people prefer to take some more time before going back to work.

If your job is particularly physical and you need to be in very good physical condition before going back to work then you may require several weeks off. If both legs are operated on at the same time, again it may take a little longer.

Many people are able to go back to work after a week. Most are able to go back after a couple of weeks, but if there are very extensive varicose veins, both legs are operated on, or you need to be particularly fit for major physical activity, you may require a couple of weeks longer still.

When can I drive?

The important thing is to be able to drive as safely following your operation as you did before it. You should certainly not drive for 48 hours after a general anaesthetic and I would recommend you not to drive for the first week while you have your bandage on.

After this you may drive providing your leg is comfortable and you can do an emergency stop, etc. I would recommend that you wear a support stocking for driving and try to avoid long drives early on as this tends to mean that you are sitting with the leg down which encourages swelling.

Can the veins come back? Getting the right operation done

Although your doctor will wish to examine your varicose veins, examination alone is not always a reliable way to work out which veins are causing the problem. If the choice of operation is based solely on physical examination then there is bound to be an element of guesswork involved.

One of the advantages of seeing a specialist vascular surgeon is that he/she is more likely to have access to more specialised techniques such as Doppler or venous duplex scanning (see picture).

This picture shows a duplex scan of some veins you can see a surface vein joining a deeper vein (the veins are seen in blue). A duplex scan is an ultrasound test (like the ones used to scan babies in the womb). It gives clear pictures of the veins and shows whether they are damaged and whether the one-way valves in the veins are working properly.

This helps the surgeon make sure that the correct veins are removed at the time of the operation. It is obvious that if the choice of operation is based on an element of guesswork, then there is more chance of having further veins after the operation. However, no matter how well your operation is planned and performed, it is unrealistic to expect every single vein to be removed every time, particularly if you have large numbers of veins.

Making new varicose veins

The veins that have been removed at the time of your operation are physically taken away and cannot come back. However, the tendency to form varicose veins is part of the way you are, otherwise you would not have varicose veins in the first place. Having had a varicose vein removed from one part of your leg will not prevent you forming a new varicose vein if that is what you are destined to do. However, once the major feeding veins are dealt with, the chances of the veins being as bad as they were originally are small.

Only about one in ten people ever get further varicose veins that are bad enough to require a second operation. In other words, sooner or later, you almost certainly will form some further varicose veins and the operation should not be regarded as a cure. On the other hand, the chances are that the varicose veins will not be as bad as before your operation and probably won't require anything doing about them.

It is important to realise that varicose vein surgery, no matter how well it is done and which method is used, is not perfect. It is certainly not a permanent cure for varicose veins. Provided people are aware of that the aim is a major improvement over a reasonable period of time rather than perfection for ever, most people are satisfied with their operation and report an improved quality of life.

How will the blood get out of my leg once the veins have been removed?

This question is often asked; because there are two systems of veins in the leg and the operation only involves some of the veins on the surface, the deep veins which are by far the most important are left untouched.

In fact since the varicose veins are allowing blood to flow in the wrong direction they are actually making the venous circulation slightly worse and varicose vein operations if anything improve the return of blood to the heart rather than making it worse.

Please note that this website is intended to give you some background information and answer some of the more commonly arising questions about varicose veins. It is not supposed to cover every possible aspect of venous disease or every possible complication. If you have any further questions you should discuss them with your specialist.

Are there any risks to an operation?

All operations have a risk. If you want a zero risk then do not have an operation. The traditional surgery will normally require a general anaesthetic the risk of which in otherwise well people is nowadays extremely small.

Whatever treatment you choose with any operation there is the potential for bleeding or infection but the risk of this happening is low. As mentioned above, bruising is inevitable to some degree as the veins which are removed have some blood inside them.

People sometimes worry about getting blood clots (deep venous thrombosis) following varicose vein surgery. Although it is natural to consider this as the surgery involves the vein it is in fact an unusual complication. Nonetheless, it is prudent to stop the combined contraceptive pill six weeks prior to surgery as being on the pill slightly increases the risk of a blood clot.

HRT is acceptable but it is helpful to know if this is being taken. If people have a past history of deep venous thrombosis it is very important that this is brought to the surgeons' and anaesthetist's attention as special precautions will need to be taken.

The veins sometimes runs very close to a nerves supplying the skin around in this situation removing the vein can sometimes produce some numbness in the skin. This does not usually trouble people and often they don't notice it, but if it is looked for there will be some degree of numbness around the ankle approximately once in every ten operations. It usually recovers to some extent but not totally.

This is not intended to be a comprehensive list of everything possible that could happen but merely to cover more common problems or the ones that are more commonly asked about. It is worth pointing out that the large majority of people having varicose vein surgery have no complications.