Patient information on Open varicose vein surgery on the Great & Small Saphenous Varicose Veins (in the leg)

Who this leaflet is for and what is its aim?

This leaflet is for patients who have been diagnosed with varicose veins and have been recommended to have open varicose vein surgery.

This leaflet aims to explain the procedure and its risks.

Background information

Varicose veins are very common, affecting at least 20-40% of the adult population in the UK. This condition can be painful and in certain cases if untreated, can lead to leg swelling, pigmentation of the skin of the lower leg, and ulcers. There are a number of ways that varicose veins can be treated – endothermal treatment, sclerotherapy, open surgery and conservative treatment.

You have been recommended to have open surgery to remove these varicose veins. It is assumed that you have had a conversation about the suitability of these different techniques of treating your veins in the clinic with the vascular surgery team in charge of your care (see below).

The great saphenous vein starts at the ankle, runs underneath the skin of the calf and thigh, and ends in the groin. In the groin, the great saphenous vein connects with the femoral vein (in the deep system of veins).

The small saphenous vein starts at the back of the foot, runs underneath the skin of the calf, ending behind the knee (at a variable level) . Behind the knee, the vein connects with the popliteal vein (in the deep system of veins).

Veins in the legs drain blood from the foot back to the heart. This is driven by your muscles pumping the blood up against gravity, and the veins have delicate one-way valves that prevent blood flowing back to the foot.

In varicose veins these valves become incompetent, and blood flows back to the foot leading to higher vein pressure and the signs and symptoms of varicose veins.

The procedure

The first part of the operation is to make an incision (cut) in the skin crease of the groin and find the junction of the great saphenous and femoral veins and then disconnect them.

Great Saphenous Vein

The great saphenous vein is then stripped (removed) to just below the knee. Research studies have shown that this reduces the chance of the varicose veins growing back (called recurrent varicose veins). Surgeons no longer strip the vein to the ankle because in the lower calf the vein runs very close to a nerve that can be damaged by the procedure and can cause a numb foot. Instead, it is safer to remove any varicose veins in the lower leg by using multiple small incisions (2 to 5mm long) known as avulsions.

The groin wounds are then closed using self-dissolving sutures (stitches), which are inserted underneath the skin so they cannot be seen. The much smaller avulsion wounds usually heal well without any sutures; however, depending on your skin and your surgeon’s preference, non-absorbabale sutures, paper ‘Steristrips’ or glue are used to close these wounds.

Small Saphenous Vein

The first part of the operation is to make an incision (cut) in the skin crease behind the knee and find where the short saphenous and popliteal veins join, and then disconnect them. At this point, there are many branching veins coming off the short saphenous vein, which also has to be disconnected.

The short saphenous vein may be removed by either stripping (pulling the vein down to the low calf) or removed in sections through small incisions (2 to 5 mm long), known as avulsions. The varicose branches are removed by avulsions

The wounds are then closed using self-dissolving sutures (stitches), which are inserted underneath the skin so they cannot be seen. The much smaller avulsion wounds usually heal well without any sutures; however, depending on your skin and your surgeon’s preference, non-absorbable sutures, paper ‘Steristrips’ or glue are used to close these wounds.

At the end of this operation, compression bandages are applied to the leg to reduce bleeding and bruising. The operation usually takes about 30 to 60 minutes for each leg, but you might be away from the ward longer because all patients spend a minimum of half an hour in the recovery room while they wake up from the anaesthetic.

Getting about after the procedure

As explained above, your leg will be bandaged firmly. You should remain in bed for the first hour, and if you require anything, use the nurse-call button. Later, when the nursing staff are happy with your progress, you may sit up and, later get out of bed under supervision.

Leaving hospital

The operation is usually performed as a day case. Sometimes patients may require an overnight stay for logistical reasons or due to other medical conditions.

Resuming normal activities including work

You may need up to seven days off work. Please return when you feel comfortable. Avoid driving until you are pain-free and in full control of the vehicle (usually three to five days).

Walk as much as possible to keep the blood circulating in the leg. Avoid standing for any long period of time, avoid crossing your legs and elevate the legs when resting.

You may resume sex when it is comfortable.

Special measures after the procedure

Self-adherent compression bandages, or non-adherent crepe bandages, can be removed usually after 24-48 hours (this will be guided by the surgeon performing the procedure).

Once the bandages are removed, you will be given a pair of compression stockings to wear for the weeks, or until the legs feel comfortable. The purpose of the stockings is to support the leg, to help blood flow through the deep veins of the leg and to reduce the amount of bruising and tenderness.

At night, the stockings can be removed if this is more comfortable.

Bleeding through the bandages or stockings can occur; this is not unusual and is nothing to worry about. If this happens, please elevate the legs, apply continuous pressure to the point of bleeding for 10 to 20 minutes and it should stop.

If you are still concerned, please call the daytime number for the hospital given to you on the information sheet, the Cambridge Vascular Unit Vascular Specialist Nurses, or you can call your GP.

The small avulsion wounds on your leg(s) may be be closed with non-absorbable sutures, tape sutures (steri-strips) or skin glue.

The main wound at the top of the leg will be closed by dissolvable sutures underneath the skin.

Try to keep these wounds dry for 48 hours. After that, you may take a shower but try to avoid soaking the wounds in a bath until after seven days.

In water, the tape will come off the leg wounds but do not worry about this.

If there are non-absorbable sutures to remove, information will be given to you for removal with your GP Practice nurse.

Intended benefits

To remove the prominent and incompetent superficial veins from your leg, improve your symptoms and reduce the risk of complications associated with varicose veins.

Risks

Removing varicose veins always produces some bruising and soreness. The severity of this depends on how many veins are removed. Sometimes, it can take several weeks for all the bruising to settle completely. It usually gets worse before it gets better.

Because the main wound is in the groin, this area can become infected. If the wound becomes painful and red this can indicate infection, which can usually be treated by a course of antibiotics. The same applies to other wounds on the leg (avulsions). These wounds will leave scars which usually heal very well.

Small nerves lying next to the veins can be disturbed, which can lead to patches of numbness in the lower leg and foot in 10 to 20% of patients. This usually resolves over the first year after surgery but occasionally, it is permanent.

Rarely, a deep vein thrombosis (blood clot; DVT) can occur in the deeper veins of the leg and, occasionally, this can lead to a pulmonary embolus (blood clot to the lung). Blood clots on the lung can be fatal. Thrombosis occurs in less than 1% of patients.

Varicose veins can grow back (recur), usually by regrowth of the veins. After five years, 10% of patients can have this recurrence.

Alternatives

Foam sclerotherapy:

An injection can be used to cause scarring and eventual blockage to the faulty vein causing the varicosities. This avoids surgical stripping. The injection technique may not last as long as surgery, and can have other side effects (phlebitis, staining).

Thermal ablation (laser or radiofrequency):

The faulty vein in the leg can be treated with heat, which damages the vein and causes it to seal off (block). This is more effective than foam injection and can be performed under local anaesthetic. For very large, superficial or extensive veins it may not be appropriate.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Please tell the ward staff about all of the medicines you use. During your stay If you wish to take your medication yourself (self-medicate) please speak with your nurse. Pharmacists visit the wards regularly and can help with any medicine queries.

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on the My Chart section on our website.

Contacts

Do feel free to contact the Cambridge Vascular Unit Vascular Specialist Nurses on 01223 596382 or email the Cambridge Vascular Unit Vascular Specialist Nurses if you have any questions or anxieties.

Sources of evidence

The Vascular Society website (opens in a new tab)

The Circulation Foundation website (opens in a new tab)