Dr Arthur Richardson - Hepato-Biliary, Upper Gastro-Intestinal and General Surgeon Associate Professor,University of Sydney
 
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Patient Info

Varicose Vein Surgery

Varicose veins are veins that become enlarged and tortuous. They most commonly occur in the legs. There are two systems of veins in the legs – the deep venous system which is most important functionally and the superficial venous system from which varicose veins mostly arise.

Causes

Varicose veins are more common in women and are often hereditary. Other related causes include obesity and pregnancy. Varicose veins arise because of leakage (incompetence) in the valves of the superficial venous system.

Symptoms and complications

In some patients symptoms will be minimal but patients may be concerned about the appearance of varicose veins. Aching, heavy legs are common symptoms and ankles may swell. In the longer term, patients may develop discolouration in the skin around the ankle which may predispose to leg ulcers.

Investigations

Most patients will require a venous incompetence study, which is done with ultrasound.

Treatment

  • Graduated compression stockings: these will often relieve the discomfort and have been shown to improve the swelling and microcirculation in the leg. Their disadvantages include the need to wear them long term, difficulty in applying them and the discomfort of wearing them in the hot weather. They may be contraindicated in patients with arterial disease.
  • Sclerotherapy: this is the injection of medicines into the veins to cause them to shrink. It is a doctor’s office procedure which does not require an anaesthetic. It may not be suitable for large veins or where there is significant leakage of the valves in the veins. It is often used in addition to surgery. Foam may occasionally be injected into the veins to cause them to disappear.
  • Minimally invasive surgery: laser or radiofrequency ablation of veins is a recent technique with significant promise. It involves ablation of one of the superficial veins by a laser or radiofrequency probe, which is inserted under ultrasound. Follow up sclerotherapy is often required.
  • Conventional surgery: this involves tying and removal of the veins under light general anaesthetic. It is done either as a day stay or overnight hospital admission. Most patients are able to return to work in a few days depending on the extent of the veins and will need to wear compression stockings for around three weeks postoperatively.

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