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CONSERVATIVE MEASURES FOR VARICOSE VEINS

Weight: Being overweight increases symptoms from varicose veins and may make the veins get worse more quickly.

Exercise: Regular exercise of any kind is a good idea. Walking is sufficient, but any leg exercise is beneficial jogging, cycling, swimming, etc.). Long periods of activity are not necessary, shorter yet frequent activity is quite adequate.

Work: Jobs that involve prolonged standing make varicose veins worse. If you have to stand for long periods, then wearing support, moving your legs, or going for short walks during the working day may help your symptoms.

Elevation: Putting your feet up helps to relieve symptoms, especially at the end of the day. You should aim to get your feet at least the same level as your hips like up on a sofa or bed or resting on another chair.

Support stockings or tights: Support hosiery helps to counteract the high pressure in the veins and relieves symptoms, but it must be well fitted and comfortable. Various kinds of support stockings and tights are available at chemists and other shops. For men, below knee compression stockings are made in a variety of colours, which look like ordinary long socks. Stronger stockings (graduated compression stockings) are available either on prescription, or on sale at chemists and surgical appliance stores. Below knee graduated compression stockings are usually adequate, but full length ones are available.

Pregnancy: Varicose veins often appear in pregnancy and further preanancies tend to make them worse. If varicose veins are treated bv surgery or injections, subsequent pregnancy may cause them to come back.

"Remember: Varicose veins are generally harmless and seldom cause serious medical problems. Following the advise above may be quite enough to control your symptoms."

Although varicose veins can get worse over the years, this often happens very slowly.

SURGERY FOR VARICOSE VEINS

Most varicose vein operations are performed as a day-patient ( i.e - you will be allowed to go home the same day). If you have particular medical problems, or no-one at home to look after you, then in-patient treatment may be required. In this case, you will usually be admitted on the day of the operation and go home the day after. We normally only operate on one leg at a time as a day case to ensure that the operation does not last too long. Otherwise you might not have enough time to fully recover and go home the same day.

What happens before the operation?

You will be usually seen a few weeks prior to surgery. You will have a number of pre-operative checks, including blood tests, to check that you are fit for the operation.

Before the operation, the surgeon will check all the necessary preparations, including the consent form, have been made and will mark your varicose veins with a felt tip pen. Be sure that all the veins you would like dealt with have been marked and ask about any that have not. You will also be seen by the anaesthetist who will discuss the anaesthetic with you. Most varicose vein operations are performed under a light general anaesthetic. A spinal anaesthetic ( by a needle in the back) is sometimes an alternative. If you are going to have a cut in the groin this area will need to be shaved, but there will be no need to shave all your pubic hair.

You should have nothing to eat for at least 6 hours before the operation. This is because an empty stomach is required for a general anaesthetic.

What happens during the operation?

A small cut is made over the top of the main varicose vein in the groin and it is tied off just where it joins the deep vein. This is called a saphenofemoral disconnection. Usually the cut is closed with stitches which are hidden under the skin and dissolve by themselves. The main vein under the skin in the thigh is stripped out. This helps to reduce varicose veins forming again. Blood flows up the deeper veins in the leg after this vein has been removed. The varicose veins marked before the operation are removed through tiny cuts (multiple avulsions). These cuts are usually closed with adhesive strips. Other veins with connections to the deep veins may also need to be tied off, in particular one behind the knee. This is called a saphenopopliteal disconnection. At the end of the operation, the leg is wrapped up in an adhesive compression bandage to reduce the amount of bruising. The operation normally takes about one hour.

What happens after the operation?

Pain relief: People vary a lot in the amount of pain they experience after the operation, though most experience discomfort only. We inject a long acting local anaesthetic into the groin wound during the operation, which greatly reduces any pain you might feel. Pain killers will be prescribed for you to take after the operation. If you experience any pain you should ask the nurse for these while in hospital. You should take them yourself at home if you are uncomfortable. You should not need to take them for more than a few days but the duration of discomfort does vary from person to person.

Day patient: After two or three hours you should feel fit enough to go home. Before you leave the nurses will check your leg. They will give you some painkillers to take home with you. You will also be given an advice sheet. Please feel free to ask any questions about anything you did not understand.

In-Patient: You will usually be able to get up within a few hours of the operation once the nurses have checked your legs. You will be able to go home as soon as you and the doctors agree you are sufficiently well and mobile, usually on the day after the operation. You will be given some painkillers to take home with you.

What happens after I have gone home?

Wounds and bruising: Sometimes a little blood will ooze from the wounds during the first 12 - 24 hours after the operation. The amount is likely to be very small and the bleeding usually stops on its own if you elevate the leg. If necessary, press on the area for ten minutes with a pad of paper tissue. If the bleeding continues after doing this, you will need to contact the doctor/ hospital. If you cannot contact anyone, then come to the Accident and Emergency Department. It is usual for the wounds to feel tender and thickened for several weeks due to the normal healing process. Bruising and lumpiness is common after varicose vein operations and may take a month or more to disappear.

Dressings and stitches: Often we do not use dressings in the groin or behind the knee but if there is one it can generally be taken off after 2-3 days. After this time these wounds can be washed gently with soap and water. Avoid talcum powder for the first few days. The stitches under the skin do not have to be removed as they will simply dissolve. The small cuts further down the leg are closed with adhesive strips. You should not bathe or shower for 7-10 days, unless you can do so without getting the adhesive bandages wet. After this time the doctor or nurse will remove the bandages and adhesive strips. This is often easiest after a bath or shower which helps to loosen them. A simple adhesive plaster can be applied to any cut that is not quite healed.

Bandages and stockings: Your bandages will be changed for special support stockings 7 - 10 days after the operation, this varies from hospital to hospital. These stockings should be worn during the daytime but you can remove them at night if you find them uncomfortable. Remember to put them on again in the morning. They are intended to support the leg whilst you are up and about during the day. You can stop wearing the stockings after a week or so but you can wear them for longer if find it more comfortable.

Walking and returning to normal: You can start to walk about as soon as you have recovered from the anaesthetic. Getting up the next day is sometimes a little uncomfortable, particularly when the groin has been operated on. Take the painkillers if you need them. You will not damage any of the wounds by walking. You should aim to walk at least twice a day for the first week or two. Frequent walking is more important then walking long distances. This often simply means getting back to your normal routine as rapidly as possible. When you are not walking try and put your foot up, otherwise your foot will swell. You should not drive while the bandages are in place as they may impair your ability to control the car. Do not return to work for two weeks if this

requires prolonged sitting, standing or heavy manual work. You should not take long-haul flights for one month.

What about any complications?

Nerve damage: Damage to the small nerves that supply feeling to the skin is quite common (1 in 10 risk), as these are can be cut or stretched when the varicose veins are removed. This may result in a patch of numbness and tingling, especially around the ankle. The affected area often becomes better with time. Damage to the major arteries, veins and nerves in the leg have all occurred during varicose vein operations. These are very rare complications, which we take great care to avoid. Operations behind the knee have a very small risk of foot drop due to nerve damage less than 1 in 100 risk). This problem usually improves as nerve function returns.

Deep vein thrombosis: DVT is a complication of any operation but is very uncommon after varicose vein surgery (less than 1 in 100 risk). You will be given an injection of heparin at the time of the operation if you have an increased risk of DVT. Heparin makes the blood clot less than normal but it does increase the amount of bruising. If you are taking the contraceptive pill your risk of thrombosis is increased. Please discuss with you the pros and cons of stopping the pill, or continuing it and having heparin, with your surgeon or GP.

Other complications: Wound problems such as infection and haematoma, can occur after varicose vein surgery but are rarely severe enough to require antibiotic treatment or drainage (1 in 50 risk). Tenderness and inflammation of any veins left behind (phlebitis) can be treated with anti-inflammatory gel. Thread veins can sometimes develop at the site of scars or bruising.

Will my varicose veins come back?

Some people develop new varicose veins but this is uncommon after thorough surgery (10% risk after 10 years). If varicose veins develop again they can be treated with injections or further surgery should they become troublesome. You can help to avoid them by taking regular exercise and avoiding excessive weight.

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