Open surgery is the traditional form of treatment for varicose veins. It is normally performed under a general anaesthetic as a day case procedure. However, if both legs require surgery or if this is treatment of recurrent veins an overnight stay may be required. This treatment uses surgical techniques to expose the superficial vein and then disconnect it from where it joins deep veins. The superficial vein is then removed. The operation takes from 30 to 90 minutes depending on the extent of the varicose veins.
Before you Procedure
As you will have a general anaesthetic, you should not eat for 6 hours prior to treatment. However, you may drink “clear fluids” like water up to 2 hours before.
Your surgeon will visit you before the operation and ask you to sign a consent form once he has explained the procedure to you. They will then mark the skin overlying your varicose veins with a pen whilst you are standing.
How is open surgery performed?
Depending on the pattern of your varicose veins an incision is made in the groin & or behind the knee. The superficial vein (long saphenous vein or short saphenous vein) is then disconnected from the point where it joins the deeper vein (femoral or popliteal vein). This prevents the backwards flow of blood from deep to superficial veins that has caused the varicose veins to form. Once disconnected a long length of the superficial vein (usually from groin to knee) is removed by a second small cut on the inside of the knee. The remaining visible varicose veins that have been marked before the operation will be removed through multiple small cuts (“avulsions”). Small adhesive strips are put over the avulsion wounds.
Dissolvable stitches will be left in the cuts to the groin and knee. Local anaesthetic will also be injected around the cuts to minimise pain after surgery.
Once surgery is finished, crepe and cotton wool bandages will be wrapped around your leg(s). If you have had a day case procedure, you will be allowed to go home 2 – 3 hours after surgery. You will be given something to eat and drink and must be mobile before you leave the hospital. If you are staying overnight, you will be asked to elevate your legs in bed until the next morning.
After the Operation
If you go home the same day, you will need to apply the stockings yourself the next day.
Unwrap the crepe and wool bandages and then replace with the elastic stockings provided to you.
Don’t worry if any of the paper plasters come off during this.
If you stay in overnight the nurse will replace the bandages on your legs with stockings before you go home.
In either case, the elastic stockings should be kept on day and night if possible for the first week, and then through the day for the following 3 weeks.
Rest with your legs elevated to eye level for the first few days. Try to walk for 15 minutes each hour, gradually building this up till you are fully mobile. You should avoid standing still or sitting with your legs down for the first week.
You can shower 2 days after the procedure. Take your compression stockings off, but put them on again as soon as you have finished and the leg is dry.
You should not drive for the 1st week, and not begin to do so until you can perform an emergency stop without hesitating.
You can return to work when you feel comfortable to do so, generally 2 weeks after surgery.
Swimming and cycling are allowed after adhesive strips have been removed (5 – 7 days)
You can fly 6 weeks after your procedure.
Your consultant will organise a follow–up appointment with you after 3 weeks to discuss your treatment and assess your recovery.
Success rates with open surgery
Open surgery is an older proven treatment method. Studies to date suggest it is as effective as EVLA (over 95% success). It can be used for almost all cases of varicose veins (unlike EVLA which is only suitable for 65% of patients) and is usually a day case procedure.
Unfortunately, varicose veins can recur after any method of treatment. However, surgery can be repeated or other forms of treatment such as EVLA can occasionally be used in these circumstances.
Risks of open surgery
Complications following open surgery are relatively rare. Wound infections occur in about 2% of patients. Surgery will remove most of the varicose veins but 5 – 10% of patients will develop further varicosities over a 10 year period. The cosmetic result is usually very good but incisions (cuts in the skin) are often red over the first 6 – 9 months but they subsequently fade. Skin pigmentation secondary to varicose veins will not disappear after treatment. Furthermore, a small nerve to the skin can be injured during the operation causing numbness in the outer aspect of the lower calf. It is permanent but patients rarely notice the lack of sensation after the first 2 – 3 weeks.
Below are a few of the more common problems patients may experience:
1. What if one of the wounds starts bleeding?
If bleeding occurs from any of the puncture sites lie down, raise the leg and over the bleeding point apply pressure for 7 minutes with a towel of handkerchief. The vast majority of post–operative bleeding stops very quickly but if it persists you should attend A&E at your nearest hospital.
2. What if the wounds become tender, red or begin to discharge mucky fluid?
There may be tenderness, lumpiness and bruising over the inner thigh for about a week after open surgery and this is normal. However, if swollen, red and painful lumps appear at any of the puncture sites or if they begin to discharge thick creamy fluid, you should see your GP in case there is an infection which is easily treated with antibiotics.
3. What can I take for pain or discomfort in the leg after open surgery?
Aching in the thigh can occur for up to 1 week after the procedure. Paracetamol is often sufficient but occasionally some people require ibuprofen or codeine preparations which can be purchased over the counter without prescription from any pharmacist.
4. What if I develop pain or swelling of my calf or lower leg?
If there is pain or swelling of the calf or lower leg it should be reported to your GP immediately. These symptoms may represent a clot in the deep veins of the leg (a “DVT”). This is rare (less than 0.5% of patients) but if a DVT is proven after an ultrasound scan it requires blood thinning treatment.