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Varicose Veins Surgery

The latest minimally invasive procedures are suitable for almost all patients, but there will still be the occasional one who, given the choices, will opt for traditional treatment. Given the wealth of evidence in favour of minimally invasive treatment, we strongly advise against the surgical route, but we always accept that the final decision is yours as the patient. It is vital, however, to be informed about all the options, specifically their risks and benefits.

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Sadly, many patients are still only offered surgical stripping to remove their varicose veins, and many are not even told about the minimally invasive options. Many of these patients are told that their cases are somehow too complex, and that surgery is the only option. This is never the case.

Before looking at the different types of traditional treatment, there are several simple, generally sensible steps that you can take in an effort to ease your symptoms slightly, or prevent them from getting worse. These include the following:

  • Try to maintain a healthy weight
  • Engage in regular exercise
  • Eat a balanced diet, including plenty of fibre to prevent constipation
  • Avoid long periods of sitting or standing
  • When resting, keep your feet up
  • Avoid very tight clothing around the waist and thighs

None of these actions, however, will make existing varicose veins disappear. The traditional treatments for varicose veins include the following:

  • Support stockings
  • Injections
  • Surgery
  • Alternative remedies

Support stockings

Support stockings are elastic stockings that are designed to be worn for the entirety of the waking day. They apply compression to the leg in a graduated way, i.e. greater at the ankle than the thigh, thus helping blood to pass back up the leg. They must be fitted correctly to have any chance of helping.

Although support stockings cannot make varicose veins disappear, some patients do get relief from their symptoms while wearing them and are happy with this solution. Most patients, however, do not like the way support stockings look or feel. Your legs can get hot and sweaty and can blister. Some patients are allergic to the material. They can be difficult to put on, especially for the elderly or infirm.

Injections

The following description does not apply to foam sclerotherapy.

Injections of irritant chemicals into varicose veins to close them off has been used for many years; and although not in vogue in the United Kingdom, it is still used extensively in Europe. Injections are quick and usually painless, but they do not work as effectively as surgery. Most people who have injection treatment will need further treatment within 5 years. They will also have to wear support stockings or bandages for 1 week following each injection session, and may need up to 3 sessions in succession.

Injections can have side effects: your skin can become discoloured and this can take a long time to recover. Inadvertent injection into arteries can lead to serious ulceration. Bruising is common but does not last long. Blood clots are common and can cause sore lumps but these can be dealt with fairly easily by squeezing them out through a small needle puncture like a zit. Some patients are allergic to the chemical but this is rarely serious. Despite, or perhaps, because of the fact that injections have been used for so long there has been little good research on their value. It has been shown that most people having injection therapy need another treatment within 5 years and that laser and RF are far more effective treatments with less recurrence.

Traditional varicose veins surgery (AKA surgical stripping)

Until the development of minimally invasive, non-surgical varicose vein treatments about 20 years ago, varicose veins had been treated for the previous hundred years or so by physical removal, known as “stripping”.

Surgery is still a common treatment of varicose veins in most countries. In most parts of the UK, however, it is not available to patients on the National Health Service unless they have obvious signs of skin changes or leg ulcers.

 

It is a pretty brutal operation, whereby the saphenous veins – which we now treat using EVLA – were stripped out. It involves a cut about 2.5cm to 5cm long in the groin (at the top of the thigh), and then another cut, about 1.5cm long, either inside the knee or at the ankle. The major venous branches in the groin are tied off with sutures. The main surface vein running down the inside of the thigh is then stripped out with a special stripping tool. Many smaller cuts are also often made along the leg, especially in the calf, to pull out smaller varicose veins.

The photograph below shows the result, with the stripped vein surrounding the cable – which you can see is bent and twisted from the applied forces.

Following this procedure, the actual varicose veins were avulsed (avulsions/phlebectomies) – again, often through quite large incisions.

The incisions were all then stitched back together but inevitably left scars on the legs, which could be quite unsightly. Sadly, some surgeons in those days were not concerned about the cosmetic outcome of their work and often prided themselves on the long lengths of their patients’ scars. We are amazed and saddened by some of the awful scars we occasionally see on patients who had surgery many years ago.

Over recent years, the incisions through which the avulsions/phlebectomies have been performed have been drastically reduced in size, leading to a much better cosmetic result.

 

To see the theory in action, watch these third-party YouTube videos:

We do not have equivalent videos of our own, because we never perform such surgery on our patients. We manage all of our patients, however large the veins are, using minimally invasive techniques.

 

As you can imagine from the above videos, the stripping of the saphenous veins was a very painful procedure and, in most cases, had to be performed under a general anaesthetic. You can also imagine how traumatic it was to the body – and it was this trauma that led to extensive new veins growing as part of the wound-healing process, and over the years leading to recurrence of the varicose veins.

Most such surgery is carried out as a day case. You would need to wear tight bandages and stockings for several weeks afterwards, and you may need injections to treat any residual veins not adequately dealt with by the surgery. You would also need some time off work, often many weeks.

Despite surgery for varicose veins being so common, there is little good research on how effective it really is. It is fairly well accepted that surgery is the most effective traditional means of dealing with varicose veins, and most patients are pleased with the results; however, there are problems:

  • Scars
  • Bruising
  • Pain
  • Time off work
  • Risk of DVT (deep venous thrombosis)
  • Nerve injury (patches of skin numbness)
  • Recurrence
  • In extreme, rare cases, accidental stripping of arteries rather than veins, leading to loss of a leg

Recurrence is much rarer following modern treatments such as EVLA.

 

Our modern techniques also eliminate reflux and remove incompetent veins and superficial varices – just like surgery – but, by being performed under image guidance using microinstruments through tiny pinhole incisions, all of this can be achieved on an outpatient basis, without anaesthetic cuts or scars, with excellent success rates and patient satisfaction – and, for most patients, instant return to work and play.

For the reasons explained above and illustrated in the third-party videos, we never perform traditional varicose vein surgery at Veincentre. Very occasionally, one of our surgeons may feel that the size and anatomy of the veins is such that surgery is the only option, and may recommend transfer to a hospital if this is the case. This happens less than once a year.

Alternative remedies

As would be expected for such a common condition, there is a whole host of different alternative remedies proposed. These include butcher’s broom (box holly, knee holly, pettigree, sweet broom), witch hazel, gotu kola, water therapy, flavonoids and a high-fibre diet.

A high-fibre diet is likely to be generally helpful to your health and may prevent you from straining through constipation, but it is not proven to help varicose vein symptoms. There is no good evidence that any of the other treatments work, and some may cause harm through allergies and side effects.

Treatment Risks

With all medical treatments it’s important to weigh up the benefits versus the risks. With that in mind, we have provided you with a full outline of the known vein treatment risks.

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