Surgery for Varicose Veins
Several surgical procedures are available to relieve varicose veins, but not everyone with varicose veins is a candidate for surgery.
- If the patient is 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 that occurred during pregnancy will fade.
- If the veins bother the patient for cosmetic reasons only, and the patient is not bothered by pain or inflammation, then surgery may not be the 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 the 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 professional 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.
Avulsion: Avulsion requires many tiny incisions and removal of the varicose veins that have been outlined on the skin.
Stripping: Stripping involves at least two incisions, one at the groin and one at the knee. A tunneling device is placed under the skin between the two 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 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: Ablation is a similar technique to endovascular laser therapy, 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. Short-term results are excellent using radiofrequency ablation.
Ligation: This was formerly the surgical treatment for varicose veins before the newer treatment modalities described above became available. It usually involved an incision at the groin and tying off of the saphenous vein where it enters the femoral vein. It is tied just at the entrance. The procedure can be performed under local anesthesia.