Published by Bupa's Health Information Team, April 2011.
This factsheet is for people who are having varicose vein surgery, or who would like information about it.
Varicose vein surgery involves removing the swollen, lumpy and dark blue or purple veins that lie under the skin in the legs (varicose veins).
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
Varicose veins don't get better without treatment. The most common treatment for varicose veins is surgery. In the past the techniques most often used to remove varicose veins were ligation and stripping and phlebectomy. Alternative techniques such as sclerotherapy, endovenous laser and radiofrequency ablation are now commonly used.
There are a number of different techniques for varicose vein surgery. These are described below.
Ligation and stripping is done under general anaesthesia. This means you will be asleep during the procedure. It's used to remove the long or short saphenous veins in the legs. Your surgeon will make two cuts about 5cm long, one in your groin and the second in your lower leg either close to the knee or ankle. Your surgeon will tie off the faulty vein (this is called ligation) through the cut in your groin to stop blood flowing through it. Using a thin flexible wire, your surgeon will carefully pull (strip) out the varicose vein through the cut in your knee or ankle.
These procedures are performed under local anaesthesia. This completely blocks pain from the area and you will stay awake during the procedure. Your surgeon will insert a fine plastic tube called a catheter into your vein, using an ultrasound scan to guide it to the correct position. He or she will then pass a fine laser or a probe through the catheter and inside your vein. This will be used to heat the wall of the vein. The vein is destroyed and your body absorbs the dead tissue.
Phlebectomy is used to remove the smaller surface veins that lie under the skin. Your surgeon will make smaller cuts about 5mm long on your leg and use hooks to pull out the affected veins. This procedure may be done with ligation and stripping or with the endovenous laser and radiofrequency techniques. It can be used on its own if you're only having surface veins treated.
Transilluminated powered phlebectomy is also used to remove the smaller surface veins. Your surgeon will make small cuts in your leg and place a tiny light under your skin to highlight the affected veins. Using a special suction device with blades, your surgeon will cut and remove the varicose vein by suction. As with phlebectomy, this procedure may be done with ligation and stripping or on its own to treat surface veins alone.
The larger cuts are closed with dissolvable stitches. Smaller cuts may be closed with paper stitches (steri-strips). Your legs will be tightly bandaged.
There is limited evidence for the long-term benefits of this treatment. It's important to discuss the safety of this procedure with your surgeon.
This procedure is performed under local anaesthesia. Sclerotherapy involves injecting a chemical into your varicose veins. This will damage the veins and close them. Liquid sclerotherapy is often used to treat smaller veins below the knee. Foam sclerotherapy is used to treat the larger veins. Your legs will be tightly bandaged afterwards or you may be asked to wear compression stockings.
Studies have shown that this treatment is effective at treating varicose veins in the short-term. However, its long-term benefits aren't yet known. The procedure also has potentially serious complications, such as a stroke or heart problems, and shouldn’t be performed if you have had deep vein thrombosis in the past. It's important to discuss the safety of ultrasound guided foam sclerotherapy with your surgeon.
Your surgeon will explain your options to you and help you decide which treatment is best for you.
Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
Your nurse will prepare you for theatre. You may need to have an injection of an anti-clotting medicine called heparin.
The operation may take between 30 minutes and two hours, depending on the type of veins being removed, the technique used and whether one or both of your legs are being treated. For more information about the different techniques used for varicose vein surgery, see What are the different types of surgery?
You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You may need to wear compression stockings on your legs to help maintain circulation for up to two weeks after your operation.
You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wounds before you go home. You will be given a date for a follow-up appointment.
The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about one to three weeks. Usually, the endovenous laser and radiofrequency techniques don’t use any stitches.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.
You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.
The recovery time for your operation will depend on whether you have had one or both of your legs treated and the exact procedure used.
There are some important things to remember while recovering from having varicose vein surgery.
As with every procedure, there are some risks associated with having varicose vein surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example feeling sick as a result of the general anaesthetic. Side-effects of varicose vein surgery include:
Complications are when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis).
Specific complications of having varicose vein surgery are uncommon but can include the following.
Although many people won't need any further treatment after surgery, it's possible varicose veins may re-occur.
For answers to frequently asked questions on this topic, see Common questions.
For sources and links to further information, see Resources.
We can help you detect any problems early with our Complete Health Assessment which involves up to 32 individual tests including breast and cervical checks for women or call 0845 600 3458 quoting ref. HFS100.
See a Private GP in confidence to discuss any concerns you may have about your health or your family's health or call 0845 600 3458 quoting ref. HFS GP.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the About our Health Information page.
Publication date: April 2011
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