ABC of Vascular Disease

Varicose Veins

1. What are varicose veins?
Varicose veins are dilated, tortuous leg veins that are visible under the skin, particularly when standing. They may have a bluish colour, but are not usually painful to touch.

2. What causes varicose veins?
Veins are part of the blood circulation system. Leg veins have flexible valves inside that help the blood flow back to the heart when standing and walking. If the valves stop working the leg veins become varicose. Why this happens in some people and not others is not really understood.

3. How do you diagnose varicose veins?
An examination of the legs by an experienced surgeon is usually all that is required to diagnose varicose veins. This examination may include the use of a small machine that detects the blood flowing the wrong way in the varicose veins. There is usually no need for X-rays or blood tests. If varicose veins are diagnosed it may be necessary to arrange a more detailed assessment with an ultrasound machine that can take pictures of the veins. This is done to ensure that the appropriate treatment can be planned.

4. What will happen if I have varicose veins and I do nothing about them?
Many people have varicose veins that never cause any problems. Some people with varicose veins notice aching in the leg after standing for long periods of time; other people get ankle swelling. A few patients eventually develop fragile, discoloured skin around the ankle that may develop into an ulcer (venous ulcer). A small number of people get bleeding from their varicose veins.

5. What treatment is required for varicose veins?
Varicose veins that are not causing any symptoms do not require urgent treatment. Many patients find that graduated support stockings help to relieve the symptoms of aching and swelling (compression) but stockings do not cure the underlying problem. If there are only a small number of small varicose veins then a course of injections can be of benefit. Patients with more extensive veins now have two options: varicose vein surgery and foam sclerotherapy.

6. What will happen if I need an operation on my varicose veins?
If your specialist advises surgery for varicose veins it is necessary to be admitted to hospital for the operation. Varicose veins are common and not usually a serious threat to health so to have NHS treatment means waiting your turn. Varicose vein surgery can be done as a day case procedure in most cases. This means that you only come to hospital for the operation and go home later the same day. If your specialist feels that a day case procedure is not appropriate then you will be admitted to hospital, usually the day before the operation, and discharged usually the day after the operation. Varicose vein surgery requires a full (general) anaesthetic.

7. What does the operation involve?
There are two forms of varicose veins. The commonest requires a small incision at the top of the leg, removal of the vein from the thigh combined with removal of some of the veins below the knee through a number of small incisions. The less common form of varicose veins requires a small operation behind the knee. Some patients require operations on both legs and this can be done under the same anaesthetic. The larger incisions are closed with stitches that dissolve and do not need to be removed. Smaller incisions are closed with sticky paper strips (“steristrips”) that come off themselves after a few days.

8. What are the possible complications of a varicose vein operation?
Varicose vein surgery is low risk but complications can occasionally occur. Bruising of the leg is expected after this type of surgery is and occasionally a small amount of bleeding can occur immediately after the operation. Infection can sometimes get into the wounds in the leg and may require treatment with antibiotics. Small scars on the leg are expected after healing is complete. Your surgeon will discuss these issues with you and answer any questions before you sign a consent form for the operation.

9. What will happen after the operation?
After the operation you are asked to remain in bed with the bandaged legs elevated for a few hours to reduce the chance of bleeding. Before discharge the bandages are removed and replaced with a firm support stocking. All surgery involves a degree of discomfort afterwards and you will be discharged with a short course of mild pain-killers which you are advised to take according to the instructions. You can eat and drink as normal as soon as you have recovered from the effects of the anaesthetic. After discharge the support stocking should be worn day and night for at least two weeks. During this time you can walk freely but are advised not to attempt strenuous exercise, running or heavy lifting. The dressings only need to be changed if any soiling occurs. After two weeks the wounds should be healed and any bruising almost gone. You can remove all dressings and bathe normally but you can continue to wear the support stockings during the day for a further two weeks if you wish.

10. How long does it take to recover?
Most patients find that one to two weeks are all that is required to recover fully after varicose vein surgery. When you return to work is dependent on the type of work that you do. Common sense says “if it hurts don’t do it”, and that is your best guide. If you are a driver you are safe to drive again when you can do an emergency stop without significant discomfort.

11. What can I do to speed up my recovery?
Common sense tells you that a good diet, plenty of sleep and a sensible amount of exercise will allow the natural healing process do its job.

12. Where can I go for help if I think there is a problem after the operation?
Most problems that can occur are minor and can be easily remedied. Before you are discharged you should be given a telephone number at the hospital that you can call to ask for advice if you are still worried. Only consider calling your GP if you are advised or you cannot contact the hospital help line.

13. Will I need to come back to hospital after the operation?
Most patients do not need to be seen again in the outpatient clinic after their varicose vein operation. If your specialist feels that you should be seen then an appointment will be made for you before you are discharged from hospital. If you cannot attend for any reason please inform the hospital so that your appointment can be offered to someone else.

14. Will the operation cure all the symptoms?
It is always difficult to predict the exact outcome of surgery but most patients get substantial or complete relief of their symptoms and an improvement in the cosmetic appearance after surgery for varicose veins.

15. Will the varicose veins come back?
In most patients varicose veins do not come back. Surgery on one leg will not prevent varicose veins from developing in the other leg. In a few patients the veins may recur and if this happens further assessment and surgery may become necessary.

16. What is foam sclerotherapy?
Foam sclerotherapy is a technique that has been used for many years as an alternative to surgery bu a small number of surgeons and in now becoming more widely available. It involves injection of a special foam into the vein using ultrasound as a guide. The foam causes the vein to shrink and the walls to stick together. The advantage of foam sclerotherapy is that is id done as an outpatient procedure, it is quick, requires no anaesthetic and works well in the majority of cases.

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