Surgical treatment for varicose veins is designed to ligate points of venous valve failure and extract or obliterate the varicose veins in the limb(s). The techniques are known as “ligation, puncture and extraction”. Surgical removal of the surface thigh vein or calf vein, when done, is performed by invaginating the vein. This technique allows for reduced trauma and a faster recovery than the old technique of “stripping”. Preoperative ultrasound (duplex scan) is used to identify all points of valve failure so as few as possible valve leaks are missed at surgery.When you have an operation you can expect an incision, approximately 1 – 3 cm long, over the site of leaking valves. These are generally at each groin and less frequently behind the knee. Incisions over the veins themselves will be approximately ½ – 1 mm in length and will be closed by single suture or adhesive tape. Most extraction sites are small punctures (less than 1 mm) and will not require any suture or closure at all. Firm compression bandages are applied at completion of surgery. Only minimal blood loss occurs with this surgery so transfusion is not considered a possibility. If additional valves require ligation an incision over these sites is about 3mm in length.
All treatments are 99.9% safe, there being a 1:1000 chance of further hospital admission for thrombosis or infection. All treatment modalities are of similar risk. The risk of loss of life or limb from complications of venous surgery is extremely small (less than 1:100,000).
The hospital time for surgery is in the range of 1 – 3 days, depending on comfort. The leg(s) are firmly bandaged from toes to groin and this may impede walking to a mild degree for 2 days. Driving a car may be challenging during the first 2 days post op. Re-bandaging of leg(s) takes place on the second day after surgery and this is usually a transfer into stockings. Stockings are used for 2 days to 2 weeks.
Large varicose veins are usually “curable” with surgery for a 10 year interval. Injection treatment alone is not normally able to eliminate large varicose veins. With ultrasound mapping, surgery is now able to “cure” large varicose veins in 95% of patients for at least 5 years. Varicose veins do tend to recur with pregnancy, obesity, other illnesses and with time. Recurrences are often manageable by sclerotherapy. New treatment, yet to be proven in the long term, involves glue occlusion of varicose veins . Smaller “spider veins” (venules) and surface varices recur throughout life and are only manageable by repeated treatment with injections. Injections are usually good at clearing veins for a couple of years at a time.
At present surgical techniques have resulted in a 95% rate of “cure” for high-pressure varicose veins over 5 years. Follow up ultrasound and/or injection therapy is sometimes required.