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Varicose Veins (cont.)

Several surgical procedures are available to relieve varicose veins, but not everyone with varicose veins is a candidate for surgery.

If you are pregnant or recently pregnant, it is advisable to wait at least 6 weeks after delivery before considering this option, because many of the varicose veins you have during pregnancy will fade.
If your veins bother you only because of the way they look, and you are not bothered by pain or inflammation, then surgery may not be your best option.
Surgery is usually reserved for people who either do not get relief from the home care techniques or lifestyle changes, or who for cosmetic reasons want to try methods other than sclerotherapy or laser treatment to make their veins less prominent.

Most of the surgical procedures are performed on an outpatient basis.

The surgery involves either vein ligation (tying) or stripping or avulsion (pulling away) of the smaller branches.
With any surgery, risks and benefits exist. These should be discussed with the health care provider and with the specialist involved.
Recurrence of varicose veins does occur and may be due to incompetent perforator veins or failure to ligate the vein more proximally in the groin.

Ligation

This usually involves an incision at the groin. The incision measures about 2-4 cm, and the saphenous vein is identified where it enters the femoral vein. It is tied just at the entrance. The procedure can be performed under local anesthesia.
When the varicosities occur behind the lower leg, the incision is made behind the knee joint to access the lesser saphenous vein.
Ligation alone carries a low rate of recurrence of varicose veins, as long as the valves of the perforator veins are competent. Stripping of the veins is usually performed for the very large, thick, and tortuous veins that are unsightly. Vein stripping is being performed less often now, so that the veins can be preserved if the patient requires coronary artery bypass surgery in the future.

Avulsion: This requires many tiny incisions and removal of the varicose veins that have been outlined on the skin.

Stripping

This involves at least 2 incisions, 1 at the groin and 1 at the knee.
A tunneling device is placed under the skin between the 2 points, and the saphenous vein is dragged or pulled out of the tunnel.
This technique will leave not only scars from the incisions but also a significant amount of bruising and possibly bleeding. The bleeding is easily controlled by pressure dressings and stops immediately. The bruising is usually noticeable for a few weeks.
For vein stripping, a recovery period of 5-10 days is needed before returning to a regular routine. For just vein ligation, a few days off is more than adequate.
A possibility of persistent numbness from damage to the nerves in the skin exists (for this reason, usually only the vein to the knee is stripped, not the vein below the knee). The numbness is only mild in nature and does not cause any future problems.

Endovascular laser therapy

Endovenous laser therapy is a new technique that uses a laser to destroy the vein. The procedure is usually performed in a doctor's office and takes about 30-45 minutes. The small laser is passed into the vein with guidance from the ultrasound machine. The laser is then fired up and the entire vein is fibrosed. The laser is fired at multiple locations and the entire procedure is performed with some local anesthesia.
Recovery is rapid and involves minimal pain. The procedure is relatively new and except for some mild bruising and a numbing sensation, no other effects have been seen in the short term.

Radiofrequency ablation

Radiofrequency ablation is a similar technique to endovascular laser, but it uses heat to destroy the vein. The probe is placed in the vein under ultrasound and once in position, the vein is heated along the entire length. The procedure is performed under local anesthesia and takes about 30 minutes. It is a relatively new procedure and short-term results are excellent.