Keyhole treatments include Radiofrequency ablation (RFA), VNUS, Endovenous laser Ablation (EVLA). Newer treatment options such as Clarivein and Sapheon will be described separately.
The video below describes a case of severe varicose veins treates by EVLA as shown on Embarrassing Bodies.
This will be explained in detail by your consultant. The faulty vein in the thigh or behind the knee is cannulated under ultrasound guidance with a needle. A laser fibre or VNUS catheter is introduced into the veiin. The vein is then ablated from within by activating the fibre whilst it is withdrawn. All the pre-marked visible varicose veins are then removed (avulsed) through a series of small incisions (<2mm in length). The entire procedure can be performed under local anaesthetic (often with sedation). It can be performed under a general anaesthetic (asleep) if the patient is keen not to have a local anaesthetic.
At the end of the operation you will have a bandage on your treated leg(s). A wool bandage and stocking will be underneath the outer bandage.
If you had traditional surgery, you will have dissolvable stitches in your groin wound and/or knee wound. If you had EVLT or Radiofrequency ablation, there will not be any groin or knee incisions. The avulsion sites will have adhesive paper strips. You will usually be asked to elevate your legs in bed initially but very soon afterwards you will be able to mobilise. A little discomfort is to be expected and you will be provided painkillers if required.
Stockings: You will be provided compression stockings to take home. You will need to take your bandage off the day after surgery and apply your stocking. Don't worry if any paper stitches come off at the same time. This stocking is to be kept on day and night for the first week.
Pain: Most people describe the leg as "a bit uncomfortable" when they get home but it tends to imporve over the first couple of days. There may occasionally be mild discomfort again a week after the procedure but all this usually resolves by 12-14 days after the operation. There may be tenderness, lumpiness and bruising over the inner thigh and calf for first couple of weeks. This is normal. However in the rare event that red and painful lumps appear near the operation scars you should see your GP in case there is an infection.
Exercise: Walking for fifteen minutes every hour is good, gradually building this up until you are fully mobile. You should avoid standing still or sitting with your legs down for the first week. Keep active in general in order to reduce your risk of developing a deep vein thrombosis.
Shower: It should be fine to shower after 2 days when your wounds have dried and settled. You can take your stockings off for the time you shower then reapply them once you have dried your legs gently. (Don't worry if any paper stitches come off as the tiny wounds will heal well either way). If bleeding occurs from any of the tiny wound sites, then lie down, raise the leg, and apply pressure for seven minutes over bleeding point with a towel or handkerchief. Bleeding is always easy to stop. The paper stitches should be removed after 7 days but don't be worried if any come off sooner (even 1st day following surgery).
Driving: You can drive as soon as you can apply emergency brakes without hesitation. It is likely that following endovenous treatments like EVLA or VNUS, driving should be possible the next day.
Work: You can return to work when you feel sufficiently well and comfortable. Usually this takes a week or two if you had traditional after surgery. With keyhole treatments, you should be able to return to work within the 1st week depending on your occupation and if you can return to light duties.
Sports: Swimming and cycling are usually comfortable after the adhesive strips have been removed (roughly after 7 days).
Flying: You should take advice from your airline but it is not advisable to take a long haul flight for at least 4 weeks following your operation (EVLA or VNUS). Short haul flights following "keyhole" procedures may be possible within a few days.