This information explains varicose and spider vein treatments in the United Kingdom. This article is excerpted with credit at the end of this article.
Varicose Vein Treatment benefits and risks described in this article are based on research studies. Before drawing any conclusion about varicose or spider vein treatment, consult your physician.

Surgery to remove varicose veins?
An operation can remove varicose veins in your legs. Varicose veins don’t usually cause serious health problems, but they can be uncomfortable, and many people don’t like the way they look.
You get varicose veins when the valves in your veins don’t close properly. Valves let blood flow in only one direction through your blood vessels. But if the valves don’t close, blood can trickle backwards and pool in your veins. This causes the bulging, twisted veins that you can see through your skin. In the operation to remove varicose veins, your surgeon will make a cut in your leg and remove the vein with the faulty valves.
The faulty valves are usually found in one of the two large veins that run just under the skin along the length of your leg. These are called surface veins. One surface vein runs up your inside leg from your ankle to your groin. The other runs up the back of your leg from your ankle to your knee.

Varicose Veins – Why do I need surgery to remove varicose veins?
Doctors usually remove varicose veins to:
• Improve the way your legs look
• Help with symptoms such as swollen, achy legs
• Treat problems such as bleeding or open sores (ulcers).
Each year, about 50,000 people in England and Wales have surgery to remove varicose veins. But not everyone is able to have their varicose veins removed on the NHS. Guidelines from the National Institute for Health and Clinical Excellence (NICE), the government body that advises doctors about treatments, says that people whose varicose veins bleed or cause ulcers should be the top priority.
What happens during surgery to remove varicose veins?
The operation usually takes between one hour and two hours. You should be able to go home the same day. If you have varicose veins in both legs, it’s usual to have two separate operations on different days.
Preparing for the operation
You will probably have tests, such as an ultrasound, to find out which valves are faulty. You will also need to stand up for a while so your doctor can see where blood is pooling in your veins. Your varicose veins will be marked with a pen because the bulges are harder to see when you’re lying down for surgery. You may have to shave your legs.
If you have a general anaesthetic, you won’t be able to eat anything for eight hours before the operation or drink anything for up to two hours before.

The operation
Surgeons can remove varicose veins in several different ways. You can talk to your surgeon about how they plan to do your operation.
The most common operation involves tying off and pulling out the main surface vein that runs up the inside of your leg. Doctors call this ligation and stripping.
Surgeons usually remove only the section of vein between the groin and knee. Less often, the whole vein is taken out from the groin to the ankle.

• Your surgeon makes two cuts: a 5-centimetre (two-inch) cut along the crease in your groin, and a 1-centimetre (half-inch) cut lower down your leg, usually on the inside of your knee. If you’re having the whole vein removed, the lower cut is made at the ankle.
• Your surgeon then looks inside your groin and finds the top of the main surface vein in your leg. This vein is tied off at the top (and sometimes at the lower end) to stop blood flowing through it. This is called ligation.
• A thin, bendy wire is then passed down through the vein to the lower cut. There’s a stripping tool at the upper end of the wire.
• Your surgeon pulls the wire out through the lower cut. The vein and its branches bunch up on the stripping tool and are pulled out from the knee or ankle. This is called stripping.
• Sometimes, instead of pulling out the vein through a cut lower down your leg, the surgeon makes only one cut at the top of your leg and removes the vein through this top cut. This is called inversion stripping. Surgeons use a special instrument to pull the vein out. As the vein comes out it turns inside out (inverts). Because there is only one cut with this operation, it should be less painful than standard stripping. And you should recover more quickly.
• The surgeon then sews up the groin and the lower cut using stitches that will dissolve.
• The surgeon will probably also make lots of tiny cuts (about 5 millimetres, or a fifth of an inch long) down your leg and use a hook to pull out smaller bits of bulging vein. This is called avulsion or phlebectomy. The cuts don’t need stitches, but the surgeon may seal them using paper strips.
• Surgeons can use an electric device that sucks small bits of vein out of your leg. The surgeon uses a light, which goes under your skin to see the veins that need to be removed. This operation is called transilluminated powered phlebectomy. It’s sometimes used instead of pulling out varicose veins with a hook because it needs fewer cuts. NICE says that there hasn’t been enough research to say how safe this technique is or how well it works. If your doctor want to do this operation, they should make sure you understand what is involved. You also need to know that doctors still aren’t certain how safe this operation is. You should only agree to have transilluminated powered phlebectomy after you have discussed these things with your doctor.
• Your whole leg is bandaged at the end of the operation.
Varicose veins in your lower leg can be removed in a similar operation. The main vein is tied off and removed through a small cut made on the back of your knee. Varicose veins can also be tied off instead of pulled out. They are left in your leg, but don’t bulge because blood can’t flow through them.
Having a vein taken out or tied off won’t affect the circulation of blood in your body. Blood will flow through other veins instead.

Will it be painful?
You shouldn’t feel any pain while your varicose veins are being removed. Your groin and leg will be sore afterwards, but you will be given painkillers to help. If your painkillers don’t work, you should tell the nurse, who will be able to give you a higher dose or a different type of painkiller.

How can surgery for varicose veins help me?
There isn’t much good research on how well surgery for varicose veins works. However, after your operation, it’s likely that:
• Your legs will look better.
• Symptoms such as aching or tired legs will improve.
• You’ll enjoy life more.
Most people say they feel happier after surgery. In one study of 100 people, nearly 9 in 10 said their legs were much better or cured a few months after their operation. After 10 years, two-thirds of these people said that their legs still looked or felt better. In another study, 8 in 10 people said that their quality of life had improved in the six months after their operation. They enjoyed life more, felt less self-conscious, could wear clothes that showed their legs, and could do daily tasks and play sport more comfortably.
However, it’s important to know that surgery may not make all of your varicose veins disappear. Some people are disappointed with how their legs look or feel. Also, varicose veins can come back. There isn’t much research to tell us how likely it is that your varicose veins will come back. One good study of people who had surgery found that:
• About 3 in 10 people had varicose veins again five years later
• About 4 in 10 people had varicose veins again 10 years later.
Another study of people who had surgery using different methods found that:
• About 2 in 10 people who had veins stripped out had varicose veins again four years later
• Between 4 in 10 and 5 in 10 people whose veins were just tied off, or who had injections to block the veins, had varicose veins again four years later.
Your varicose veins are more likely to come back if your veins are tied off but not removed, or if only part of the vein between your knee and ankle is removed. Removing the whole vein lowers the chance of varicose veins coming back. But it also increases the risk of nerve injury.

Which type of surgery is best?
The research on the different types of surgery to remove varicose veins is mixed, so we can’t say for certain whether one type of surgery works better than another one. Here’s what the research tells us.
• One study found that varicose veins are less likely to come back if you have a combination of stripping the vein and pulling out small veins through small cuts (avulsion) rather than an operation that just pulls out small veins. But having both techniques may be more painful.
• Taking the vein out through a cut at the top of your leg (inversion stripping) may be less painful than standard stripping with two cuts.
• Sucking out the small veins with a special device (powered phlebectomy) may work as well as making lots of small cuts and pulling them out with a hook (called avulsion or hook phlebectomy). But you’re more likely to get pain and bruising after powered phlebectomy than after hook phlebectomy.
What are the risks of surgery to remove varicose veins?
All operations have risks, and your surgeon should talk to you about the risks of surgery to remove varicose veins. If you have a medical condition such as a heart problem or have had a blood clot, surgery may be more risky for you.
Anaesthetics can have side effects. These are more likely with a general anaesthetic. You may have an allergic reaction to the anaesthetic or get breathing or heart problems. These problems are serious but rare. If you have any allergies, you must tell your doctor.
It’s hard to say exactly how often problems happen, because the research isn’t very good. You can use the statistics we give below as a guide, but it’s important to discuss with your doctor how often problems happen in your hospital.
One large study involving 600 people found that about 1 in 6 people had a problem after their operation. These were mostly minor, such as bruising or swelling, or blisters caused by the bandages rubbing against the skin.
Here are some of the other problems that can happen.
• Nerve damage
• An infection
• Bleeding
• Fluid build-up
• Hard, tender lumps of tissue.
• Brown stains.
• Patches of tiny red veins
• A blood clot.
• Scars
More serious problems relating to varicose vein treatments.
Serious problems are possible, but are very rare. They may not have happened to any of the people your surgeon has treated.
• If the big nerve that runs down the back of your thigh is damaged, it can make your foot floppy and weak. Doctors call this foot drop. In a study of 600 people, only one person got foot drop.
• Very rarely, surgery goes wrong and damages deeper veins. This may make your problems with blood flow worse and lead to more surgery.
• There is a very small chance that you could die from surgery to remove varicose veins. The chance is less than 1 in 1,000.

Varicose vein and spider veins – Other Treatments there?
Surgery is the only way to get rid of varicose veins completely. But it’s a big operation and there are risks. Newer treatments, such as injections, aim to treat varicose veins without the side effects of surgery. But there isn’t enough research for doctors to know if the new treatments are really better.
Varicose Vein Treatment – Injections (sclerotherapy)
Varicose veins can be injected with a chemical that damages the lining of the vein and makes it collapse inwards. A scar forms inside and blocks off the vein. The vein then fades within a few weeks. If you have large varicose veins, the chemical to close the vein may be mixed with a chemical that froths to make a foam. Foam injections spread faster and further through your veins. NICE says ultrasound-guided foam injections can be used to treat people with varicose veins in the NHS. But there isn’t a lot of information yet about how well this treatment works, how safe it is and which patients will benefit most from it.
Varicose Veins – Closing the vein with heat
There are a couple ways a surgeon can do this. In laser treatment, a very thin tube (called a catheter) is threaded through a small hole in your skin into the vein. A laser is then placed in the tube. The intense light from the laser heats your vein and makes it close up.
In radiofrequency ablation, a special heating device is put into the catheter instead. This heats the vein and seals it off.
NICE, the government body that advises doctors, says that both of these treatments are safe enough and work well enough for use in the NHS. But we don’t know the long-term effects of these treatments and you should talk to your doctor about the risks and benefits.
In one study, people were more likely to have unwanted effects from laser treatment than from radiofrequency ablation. Problems included blood clots, pain, swelling and infection of the skin.
Problems were usually short-term. They happened to 2 in 10 people who had laser treatment, compared to less than 1 in 10 people who had radiofrequency ablation.
Stockings, diet and staying active
Your legs may feel better if you stay active, keep your weight down, wear loose clothes and put your legs up when you rest. Some people find that wearing special support stockings (called compression stockings) help achy legs. But there’s no good research to say whether they stop varicose veins getting worse or improve the way legs look.

What will happen if I don’t have surgery?
Varicose veins won’t go away without treatment. They tend to get worse over time, but this normally happens very slowly. If you get varicose veins while you are pregnant, they may go after you have your baby.
It’s unlikely that your varicose veins will cause any serious medical problems. But a small number of people with varicose veins do get complications. This is much more likely to happen if you have problems in your deep veins.
Skin problems affect about 6 in 100 people with varicose veins. Problems include brown, blotchy patches on your legs and ankles, a scaly, dry rash similar to eczema, itchy skin, and thin, papery skin that is easily bruised. Skin problems can lead to open sores (ulcers). Ulcers can be painful and slow to heal, and can get infected. But they aren’t common in people under 60.
Varicose veins can also bleed, even if you don’t knock or bump your leg. The area around your varicose vein may feel tender, red and hot. Doctors call this thrombophlebitis. It is uncomfortable, but not dangerous. You may also get small clots in the blood that pools in your varicose veins, especially after bumping your vein.
It’s unlikely that you will get deep vein thrombosis (DVT) because of your varicose veins. You can get varicose veins after having DVT, but there is no evidence that you can get DVT because of varicose veins.

What can I expect after surgery to remove varicose veins?
Immediately after your operation
When you leave the operating theatre, you will go to the recovery area until you are fully awake. You will probably have a tube in the back of your hand where you were given the anaesthetic. If you had a local anaesthetic, the parts of your leg where the cuts were made will feel numb for several hours. You’ll be able to get up and walk around as soon as the anaesthetic has worn off.
Your legs will be tightly bandaged or you will have special support stockings or tights to wear. You’ll need to wear these for a week to 10 days.
Bruising is normal. Sometimes, a little blood will ooze from the wounds. You may have some soreness and discomfort for several weeks. You will be given a painkiller.
The cuts on your leg will leave small, lumpy scars, but these should fade over time. You may feel tender lumps under the skin on parts of your leg where the varicose veins were removed. These will go away over a few weeks. See your doctor if the lumps become red, swollen and painful.
Going home
You should be able to go home the same day. You are likely to feel tired for the first few days after surgery, and longer if you had surgery on both legs.
You may find it uncomfortable to move around for a few days. If you’ve had surgery on both legs, it may take two weeks or three weeks before you are walking comfortably. But you should try to walk about every half hour or so each day for the first week or two. This helps to reduce your chances of getting a blood clot. When you aren’t walking you should try to put your feet up, with your heels lifted higher than your hips.
Your doctor will advise you on when you can go back to work. You’ll probably need a week or two off. One study showed that most people can get back to work within three weeks. You can have sex as soon as you feel able to. Avoid any strenuous activities or sports for several weeks. You should be able to drive again after a week to 10 days.

http://www.guardian.co.uk/lifeandstyle/besttreatments/surgery-to-remove-varicose-veins

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