Vein surgery

Oxygen rich blood is transferred by the arteries coming from the heart to the tissues, which is necessary for them for functioning. Then once the tissues absorbed the oxygen and the nutrients, it is the veins’ responsibility to return the blood to the heart. The majority of diseases affecting the venous system involve the lower limbs, and their cause is an upright lifestyle.

Insufficient closure of venous valves plays a key role in the dilatation of superficial veins. Pressure increases in a venous segment that is farther from the heart due to the valves not closing; therefore, veins dilate and become winding in these areas. Damage to the vein wall causes that the walls of the capillaries and smaller veins become permeable, letting through even more fluids and waste products into the adjacent tissues (Figure 1). There is a superficial and a deep venous network in the lower limb, and there are also perforator veins, which connect the two systems. The deep network consists of the vessels running between the muscles, and the superficial network consists of the vessels running under the skin. In healthy conditions, blood flows from superficial veins to deep veins, from where it flows in the direction of the heart. Muscle contraction encourages this as a pump, and backflow is prevented by the valves in the vessels. 

The primary form of varicosity is caused by the insufficient function of the valves. It can originate from an inherited tendency, the congenital weakness of connective tissues. In this case, patients experience other symptoms of having weak connective tissues, such as having flat feet, hemorrhoidal lumps, hernias, furthermore, the accumulation, more frequent incidence of these pathologies can be observed in the given family. The secondary form of varicosity is when the insufficient closure of the valves develops due to the occlusion of the deep venous system. The symptoms are the same in both cases.

Which are the main symptoms of the disease?

Initially, smaller dilatations develop in a few veins, then this intensifies. Symptoms other than esthetic ones will develop over time:

• Pain
• Inflammation
• Edema (limb swelling)
• Skin discoloration
• Lower leg ulcer
• Vein rupture

What are the treatment options?

Sclerotization can be used to treat moderate varicosity, spiderweb, reticular or branch veins, which means the direct administration of a coagulation inducing medicine into the veins, so the dilated vein gets occluded. Nowadays, a modern surgical procedure to treat more extensive and advanced varicosity is the complete eradication of the main superficial vein and its branches, the removal of dilated veins (excision), and the ligation of insufficient perforating veins, which connect the deep and the superficial venous system (crossectomy, stripping, local phlebectomy, ligation of insufficient perforating veins). The treatment can be complemented by sclerotherapy after the surgery.

Ablation using laser or radiofrequency, and the adhesive technique are also modern treatment options. In case of the two former methods, the sick vascular segment is not removed, but it is burned by a fiber with laser or radiofrequency, which was inserted into the affected vascular segment. Sclerotherapy should be used on the branch veins with this method too, or they should be removed (excision).

What happens if the treatment is not performed?

Blood clotting, which may lead to superficial or deep vein thrombosis and embolism, is enhanced by the inflammation of the venous wall, the constant congestion, and the consequent turbulent flow. Embolism means the loose blood clots that broke off of the thrombus, and these may lead to even fatal pulmonary embolism.

What happens to you in the operating room?

Short description of the intervention: 
The confluence point of the superficial and the deep venous systems is explored from a small incision made under the inguinal ligament. The superficial veins are ligated and cut. The main superficial vein is located above the medial ankle, and a stripper (a sterile, single use wire) is inserted in it, by which the vessel is removed.  The previously marked branch veins are removed with a device that is similar to a crochet hook. The two wounds are closed with 1 2 stitches. Elastic bandage is applied.

What happens to you after the surgery? 

Once the surgery is completed, you will stay in the operating room for a certain period of time.
You will be transferred to the post anesthesia care unit (recovery room), or to an intensive care unit, depending on your condition.
Anesthesia wears off gradually a few hours later, and your pain will be reduced by injections, and tablets after that.

Despite the pain, it is important that you shortly start to perform breathing, vascular, and movement exercises!

Injections preventing blood clotting (thrombosis) are routinely administered.

On the evening of the surgery, you may start to consume water given that you do not have nausea. It is important to consume sufficient amount of fluids in the forms of fruit juices, soups, and non carbonated mineral water.

Patients may get up with the help of a physiotherapist usually in the evening, or in the morning next day. It is important to comply with the physiotherapist’s instructions!

In a non problematic case, you may leave our institution 1 2 days after the surgery.
You will receive dietary advice before discharge.

At discharge:

• 1. You will receive the discharge summary and a justification for sickness benefit.
• 2. Please ask your treating physician if you have any questions!

After surgery, please protect the wounds from water for 5 days during your personal hygiene routine, and make sure to change the dressing on the wounds every day and keep them clean by using a solution called Betadine. Following this, you may take a shower without the dressing, unless your treating physician orders otherwise!

Suture removal and a follow up examination is due 7 10 days after the surgery, but if you have any symptoms, please immediately contact your treating physician!

Patients may get up on the day of the surgery, and it is recommended that they wear the elastic bandage for about 4 weeks. A long term solution can only be expected from the surgery if you comply with our lifestyle advice (e.g., weight loss, regular exercise). Venous circulation of the limb is compromised by sitting and standing, but it is improved by walking. The removed varicose veins cannot relapse, but evidently, other veins may dilate to a pathological extent and become varicose the same way in the future. Rarely, another surgery may become necessary for that years later.