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Advice to patients about your varicose vein operation

Coming into hospital: please bring with you any medicines you are taking and show them to the nurse on the ward who will check your personal details. Your surgeon will visit to mark the position of your veins and complete the Consent Form. Many people are concerned about anaesthetics do please ask your anaesthetist if you have any specific questions. Everyone is happy to answer any questions you may have, so please ask. Most patients can go home on the same day but sometimes a night or longer in hospital is necessary at the doctor’s request.

The operation:  is usually performed under a general anaesthetic. The commonest operation is where a cut is made in the groin where the main varicose vein is then tied off where it meets the deeper veins. If possible, the main varicose vein is then stripped out of the thigh. Blood can still flow up the leg along deeper, unaffected veins. The cut in the groin is closed with a hidden stitch which dissolves. The other veins may be affected , especially one behind the knee which is treated like the vein in the groin. One or both legs may be treated at the same time. Airstrip dressings are   placed on the wounds and a bandage is applied to your leg.

Going home:  the morning after surgery, the bandage is removed   and replaced by elastic stockings supplied by the hospital. You should wear the stockings day and night for the first week, after which you may leave them off at night. You will need to wear them during the day for three more weeks until all bruising and swelling has gone and the wounds have healed soundly. Shower or bathe in the usual way after the first week and remove the wet dressings. For the first week sit with the legs elevated so that your feet are higher than your hips to reduce swelling and assist healing. At least every half hour take a short walk (or more if you wish) to encourage the circulation and to avoid stiffness of the muscles and joints. Some discomfort is normal but occasionally severe local twinges of pain may occur and may persist for some months. After the operation you may need to take a mild painkiller such as Paracetamol to relieve discomfort.

What next? Avoid driving for at least one week from the operation because your response time may be prolonged in an emergency; it is essential that you can perform an emergency stop without pain. If in doubt, check this with your doctor. Swimming, cycling and other activities are allowed after the first week if you are comfortable. You may return to work when you feel sufficiently well and comfortable, generally after one to four weeks depending how severe your veins were and whether your job involves much standing or manual labour. If in doubt your General Practitioner or the hospital or surgeon will advise you about returning to work. You will have been warned that not every visible vein will disappear at surgery and there is a 30% chance that in the future, further varicose veins may develop, as you are clearly disposed to them. Regular exercise, avoiding excess weight and wearing light support hose will all help prevent you being troubled by varicose veins in the future. You do not usually need to return to the hospital after the surgery but you can arrange to see the surgeon if necessary by telephoning the hospital for an appointment.

Complications to look out for: sometimes bleeding may occur from the wounds, this usually stops if pressure is kept on the bleeding wound for ten minutes. If bleeding continues after doing this twice, go to the nearest hospital Casualty. Occasionally, hard , tender lumps appear near the operation scars or in the line of the removed veins. These need not to be a cause for concern but, if accompanied by excess swelling, redness and pain, may represent a wound infection and you should see your General Practitioner. Rarely, there is numbness or pain around a wound or ankle due to unavoidable damage to skin nerves during the operation, it usually settles after some weeks or months. The scars on your legs will continue to fade for many months. Occasionally more thread veins occur after surgery. Around 1 in 200 patients will suffer a thrombosis(DVT), a blood clot in the deeper veins, which may lead later on to chronic pain or swelling in a venous ulcer of the leg after 1 in 3 DVT’. A DVT can be dangerous if the clot moves to the lungs (pulmonary embolus or PE) which happens to around 1 in 1000, fatal for 1 in 10. If your leg becomes more swollen and painful after the operation or if you develop chest pain or shortness of breath, call the hospital or surgeon without delay because you may need treatment if a thrombosis has occurred.

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