VARICOSE
VEIN
SURGERY
WHAT IS
VARICOSE VEIN
Varicose veins are caused by increased blood
pressure in the veins. Varicose veins happen in the
veins near the surface of the skin (superficial).
The blood moves towards the heart by one-way
valves in the veins. When the valves become
weakened or damaged, blood can collect in the
veins. This causes the veins to become enlarged.
Sitting or standing for long periods can cause blood
to pool in the leg veins, increasing the pressure
within the veins. The veins can stretch from the
increased pressure. This may weaken the walls of the
veins and damage the valves.
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TREATMENT
Varicose veins do not always need
treatment. If your varicose veins are not
causing you discomfort, you may not need
to have treatment.
Treatment of varicose veins is usually only
necessary to:
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ease symptoms – if your varicose
veins are causing you pain or
discomfort
treat complications – such as leg
ulcers, swelling or skin
discolouration
If you don't respond to self-care or compression stockings, or if your condition is more severe, your doctor may suggest
one of these varicose vein treatments:
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Sclerotherapy., Foam sclerotherapy of large veins. , Laser treatment., Catheter-assisted procedures using radiofrequency
laser energy., High ligation and vein stripping. , Ambulatory phlebectomy, Endoscopic vein surgery.
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MICROSCLEROT
HERAPY
PRE OP CARE
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The liquid or foam sclerosing agent is injected into the vein
to cause localised damage to the inner lining (endothelium)
of the vein. This leads to inflammation, a blood clot,
collapse and thickening or scarring of the vessel. The blood
stops flowing and the vein loses its red or purple
appearance.
Larger varicose veins may also be treated by sclerotherapy
especially if they are tortuous or recurrent (endovenous
laser treatment may be preferred for straight veins or on
the first occasion). First, a Duplex ultrasound scan should
be performed to map out the path of superficial, perforator
and deep veins. Those greater than 5 mm in width and
demonstrating reflux are the most suitable for treatment.
Sclerotherapy of larger superficial veins and perforator
vessels is usually performed with ultrasound (echo)
guidance. Best results are achieved using a foam sclerosant,
where the sclerosant solution is mixed with air in a ratio of
1:4 to form minute bubbles. This provides a greater volume
to push the blood away so the sclerosant may adhere more
effectively to the blood vessel wall.
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Sclerosant chemicals include:
Hypertonic saline (20% NaCl i.e. strong salt
solution)
Sodium tetradecyl sulphate
Polidocanol.
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No aspirin or blood-thinning
products for 7-9 days before the
procedure
Bring heavy, thigh-high support
hose to wear when you leave the
office and seven days after
treatment
Do not shave or use depilatories
on legs the day of the procedure.
Do not apply lotion to your legs on
the day of the procedure.
POST OP CARE
Avoid aspirin, ibuprofen, and other
anti-inflammatory medications.
Tylenol® may be used if needed for
pain relief.
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Do not take hot baths or sit in a
whirlpool or sauna. You may take
showers, but the water should be
cooler than usual.
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Wash the injection sites with a mild
soap and lukewarm water.
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Do not apply hot compresses or any
form of heat to the injected areas.
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LASER
SURGERY
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endovenous laser treatment involves having a catheter inserted into your vein and
using an ultrasound scan to guide it into the correct position. A tiny laser is passed
through the catheter and positioned at the top of your varicose vein. The laser delivers
short bursts of energy that heat up the vein and seal it closed. The laser is slowly pulled
along the vein using the ultrasound scan to guide it, allowing the entire length of the
vein to be closed. Endovenous laser treatment is carried out under either local or
general anaesthetic.
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After the procedure you may feel some tightness in your legs, and the affected
areas may be bruised and painful. Nerve injury is also possible, but it's usually
only temporary.
ENDOVENOUS
ABLATION
THERAPY
Ultrasound is used to visualize the
vein. A fiber or electrode is moved to
the desired location within the vein
through a small incision. Local
anesthesia is injected into the tissues
around the vein to collapse the vein
around the fiber or electrode and act
as insulation for the energy's heat. The
energy heats the vessel and causes it
to close. Following the procedure, the
faulty vein will shrink and "scar
down."
This procedure is often done on an
outpatient basis. Your radiologist may
first apply a numbing cream to the
area over the abnormal vein to reduce
discomfort..
The doctor will clean, sterilize and
cover the area with a surgical drape.
Your doctor will numb the area where
the catheter enters the abnormal vein
with a local anesthetic. The doctor will
use the ultrasound transducer to study
the vein and track its path. The doctor
will make a very small skin incision at
the site.
Using ultrasound guidance, the doctor
inserts a catheter through the skin and
positions it within the abnormal vein.
The fiber or electrode is inserted
through the catheter. The fiber or
electrode tip is exposed by pulling the
catheter back slightly.
Local anesthetic is injected around the
abnormal vein with ultrasound
guidance. Energy heats the vein as the
catheter is slowly withdrawn.The doctor
applies pressure to prevent any
bleeding and covers the opening in the
skin with a bandage. No sutures are
necessary.
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ENDOSCOPIC
VEIN SURGERY
small cut is made in your skin near a
varicose vein. Then doctor uses a tiny
camera at the end of a thin tube to
move through the vein. A surgical
device at the end of the camera is used
to close the vein. Endoscopic vein
surgery is usually only used in severe
cases when varicose veins are causing
skin ulcers. After the procedure, you
can usually return to your normal
activities within a few weeks.
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SUBFASCIAL ENDOSCOPIC
PERFORATOR LIGATION SURGERY
(SEPS)
a tourniquet is placed
above the knee or an
esmarch band is placed
tightly around the lower
extremity to empty the
blood from the surgical
site
a tourniquet is inflated to
supra systolic blood
pressure (usually 300mm
Hg)
frequently a second
incision is placed inferior
and posterior to the first
allowing insertion of the
instruments that perform
the vein ligation
an incision is made one
bands width below the
tibial prominence and 2
finger’s breadth posterior
to the anterior border of
the tibia . this provides
access for the camera and
co2 insufflation
the camera follows the
instruments in a caudal
direction and perforating
vein are identified traversing
the subfascial space. the veins
are divided and the
instruments are
removed,.incision is closed
a large balloon trocar is
placed through this
incision into the
subfascial plane and filled
with 180cc of saline to
expand the space. the
balloon is emptied and
removed
pressure dressing is
applied and left in place
for 2-5days. lower
extremity activity is
limited 7-7 days . fully
recovery is usually
attained in 2 weeks
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AMBULATORY
PHLEBECTOMY
A phlebectomy procedure–also called an ambulatory phlebectomy–is a
minimally invasive procedure performed under local anesthesia that
effectively removes varicose veins from the body.
This is an advanced technique that is superior to traditional vein stripping,
which involves invasive surgery. Ambulatory phlebectomy might be an ideal
alternative for those who are not qualified to use sclerotherapy to collapse
protruding varicose veins.
This procedure is performed through a series of small incisions made on the
skin over the varicose vein being treated. A small phlebectomy hook is eased
through the small incision to physically remove the distressed vein from the
body. The body will naturally redirect blood flow to surrounding healthy veins.
Ambulatory phlebectomy is a procedure that requires 30 to 60 minutes to
complete, depending on the severity and number of varicose veins that are
being removed. Although this procedure will involve a local anesthetic, it’s
considered safe for most patients and requires less recovery time than more
invasive treatments.
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VEIN LIGATION
AND STRIPPING
The procedure will take approximately one to two hours. two small incisions (cuts) should be made—one in the groin area
(near the top of the damaged vein) and another in your thigh or calf (at the bottom of the vein).
We should tie off the top of the vein to stop blood flow. A thin, flexible device will be threaded through the damaged vein.
next use the device to pull the entire vein out through the incision (cut) at the bottom of the vein.
Once the vein is removed, the surgeon will stitch up your incisions and apply bandages to them. If you have other varicose
veins in the same leg, your surgeon may make additional incisions (cuts) to remove these damaged veins. This procedure is
called phlebectomy or microphlebectomy and can be done at the same time as vein stripping and ligation surgery.
After the surgery is complete, your surgeon will put gauze and an ACE compression wrap on your treated leg(s). You will be
taken to a recovery room to rest and wake up from your anesthesia. You will stay in the recovery room for one to two hours
before your family member or friend can take you home. Your surgeon will give you compression socks to wear the next
1
day after the bandages come off.
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STRIPPING AND
LIGATION
The conventional way of removing
the saphenous vein is with a
Babcock stripper. Babcock stripper
or a rigid metal 'pin stripper' consists
of a flexible wire that is passed
down the long saphenous vein End
is identified in the the upper third of
the calf and a 2mm incision made to
retrieve the stripper An olive of
about 8mm in diameter is attached
to the upper end and the saphenous
vein is removed by firm traction on
the wire in the calf Closure: incision
sutured and limb elevated
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Vein Problems
Related to
Varicose Veins
01
Telangiectasias
Telangiectasias are small clusters of
blood vessels. They're usually found
on the upper body, including the face.
02
Spider veins
Spider veins are a smaller version of varicose
veins and a less serious type of telangiectasias.
Spider veins involve the capillaries, the smallest
blood vessels in the body.
03
Varicoceles
Varicoceles are varicose veins in the
scrotum (the skin over the testicles).
Varicoceles may be linked to male
infertility. If you think you have
varicoceles, see your doctor.
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Other Related Vein Problems
Other types of varicose veins include
venous lakes, reticular veins, and
hemorrhoids. Venous lakes are varicose
veins that appear on the face and neck.
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Reticular veins
Reticular veins are flat blue veins often
seen behind the knees. Hemorrhoids
are varicose veins in and around the
anus
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COMPLICATION
Bleeding
Blood clots
Varicose veins near the surface of your skin can
sometimes bleed if you cut or bump your leg. The
bleeding may be difficult to stop.
If blood clots form in veins located just under the surface of your skin
(superficial veins), it could lead to conditions such as:
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You should lie down, raise your leg and apply direct
pressure to the wound. Seek immediate medical
advice if this does not stop the bleeding.
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thrombophlebitis – swelling (inflammation) of the veins in
your leg
deep vein thrombosis – which can cause pain and swelling in
the leg, and may lead to serious complications like pulmonary
embolism
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REFERENCE
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Treatments for varicose veins - Royal Australasian
College of
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Clinical Surgery Made Easy
Systematic Review of Treatments for Varicose Veins
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https://surgery.ucsf.edu/conditions-procedures/varicose-veins.aspx
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https://www.mayoclinic.org/diseasesconditions/varicose-veins/diagnosis-treatment/drc20350649#:~:text=Sclerotherapy.,is%20effective%20i
f%20done%20correctly.
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https://www.nhs.uk/conditions/varicoseveins/treatment/
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