It's not a pretty subject, but it is an important one: varicose veins affect a large proportion of the UK population at some point in their lives. Surgical treatment of varicose veins is my business, so I notice many recurring questions from patients about the condition and its treatment.
I see and treat hundreds of patients every year with vein disorders. Varicose veins cause a wide spectrum of problems, from the purely cosmetic dissatisfaction and embarrassment, to painful aching and 'heavy legs' and ultimately severe skin damage and ulceration. There is often some confusion about the solutions available.
Until the turn of the century, the only surgical option was the high tie and strip operation, with prolonged post operative recovery times and quite high recurrence rates. The exciting news, though, is that we've come a long way from only a single choice in resolving the varicose veins problem.
The treatment methods developed over the last decade are minimally-invasive and can be performed largely under local anaesthetic with no scars and rapid recovery from treatment. Look out for Endovenous Laser Treatment, radiofrequency ablation and foam sclerotherapy as examples of innovative procedures with good long-term results in experienced hands. Patients considering treatment for varicose veins should seek a consultant who has experience in most or all of these options. Surgeons who can only provide open surgery (the high tie and strip) are out of date and well behind the times.
Veins are blood pipes that allow blood to flow back from the legs to the body. Patients often ask whether treating faulty varicose veins will cause a problem with the blood flow from the leg. This is absolutely not the case- we have enough veins in our legs to make a pair of fishnet stockings- we just can't see them all on the skin surface. The vast majority of the blood flow back to the body goes back in the deep leg veins which are not affected by varicose veins surgery, and the blood from the legs is 're-routed' into the deep veins after surgery.
Deep vein thrombosis, or DVT, is a common worry, too. A DVT is a serious matter, and is a possibility after any kind of surgery. After vein surgery though, the risk is very low when compared to other types of surgery, such as knee replacement or abdominal operations.
As a rough guide, the risk of DVT after vein surgery is about one in 1,000 cases and every possible precaution should be taken to prevent this serious complication. Using anticoagulant "blood thinning" drugs before treatment and preferring local rather than general anesthesia to reduce immobility time after surgery, are both common practices which reduce the risk to an absolute minimum. Sadly there is no way of eliminating the risk entirely.
For patients who consider themselves to be at a particularly high risk of DVT- for example, those who have had a previous DVT, or have known risk factors for DVT- it's sensible to request prolonged anticoagulant injections for 3 to 5 days after vein surgery.
Probably the most voiced varicose veins treatment question I get is about flying, particularly after surgery and the risk of DVT. We do know that there is an association between flying and the risk of DVT, but again the risk is quite low and largely confined to long haul flight. For this reason, it is sensible for patients to avoid long-haul flights for about a month after treatment. For patients who absolutely have to fly, again anticoagulant injections close to the time of the flights reduce risk as much as possible.
In short, varicose veins treatment in the 21st century is simple, effective, and though not without a small element of risk, pretty much as safe as surgery can ever be.
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