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Varicose vein removal

What is the Varicose vein removal?

Varicose veins are abnormally enlarged veins that bulge beneath the skin. They can be flesh colored, dark purple or blue and are usually found on the backs of the calves or the inside of the leg. Although most people seek treatment for cosmetic reasons, varicose veins can also cause aching, itchiness, a feeling of heaviness in the leg and night cramps.

Several surgical techniques are used for varicose vein removal, from the more invasive saphenous stripping, to less invasive procedures like ambulatory phlebectomy, transilluminated powered phlebectomy, endovenous laser treatment and radiofrequency ablation.

What is the procedure?

Most surgeons use a technique called ligation and stripping, which involves tying off the vein in the affected leg and then removing it.

Two small cuts (incisions) will be made, approximately 5cm (2in) in diameter. The first cut is made near your groin, at the top of the varicose vein. The second cut is made further down your leg, usually around your knee or ankle. The top of the vein (near your groin) is tied up and sealed.

A thin flexible wire is passed through the bottom of the vein and then carefully pulled out and removed through the lower cut in your leg.

The blood flow in your legs will not be affected by the surgery. This is because the veins that are situated deep within your legs will take over the role of the damaged veins.

Ambulatory phlebectomy is the most common surgical procedure for treating medium-sized varicose veins. An ambulatory phlebectomy is performed under local anesthesia. After the patient's leg has been anesthetized, the surgeon makes a series of very small vertical incisions 1–3 mm in length along the length of the affected vein. These incisions do not require stitches or tape closure afterward. Beginning with the more heavily involved areas of the leg, the surgeon inserts a phlebectomy hook through each micro-incision. The vein segment is drawn through the incision, held with a mosquito clamp, and pulled out through the incision.

There are a number of new treatments that have been developed to treat varicose veins, like radiofrequency ablation , endovenous laser treatment and transilluminated powered phlebectomy.

These treatments are less invasive than traditional surgery because they require fewer or smaller incisions.

Radiofrequency ablation involves heating the wall of your varicose vein using radiofrequency energy. The vein is accessed through a small cut that is made just above or below the knee.

A narrow tube, called a catheter, is guided into the vein using an ultrasound scan. A probe is inserted into the catheter that sends out radiofrequency energy. This heats the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins. Radiofrequency ablation is carried out under local anesthetic.

As with radiofrequency ablation, 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 and allowing the entire length of the vein to be closed. Endovenous laser treatment is carried out under local anesthetic.

During transilluminated powered phlebectomy, one or two small incisions are made in your leg. Your surgeon will place a special light, called an endoscopic transilluminator, underneath your skin so that they are able to see which veins need to be removed. The affected veins are cut before being removed through the incisions using a suction device.

Transilluminated powered phlebectomy can either be carried out under general anesthetic or local anesthetic.

What kind of result can you expect?

Normal results of vein removal surgery include reduction in the size and number of varicose veins in the leg. Most of patients also experience significant relief of pain.

Recovery period and recommendations

Vein stripping and ligation typically do not require a hospital stay or hospitalizations is very short (a day or two). Aftercare following surgical treatment of varicose veins includes wearing medical compression stockings that apply appropriate pressure for two to six weeks after the procedure. Wearing compression stockings minimizes the risk of edema, discoloration, and pain.

Patients are encouraged to walk, ride a bicycle, or participate in other low-impact forms of exercise to prevent the formation of blood clots in the deep veins of the legs. They should lie down with the legs elevated above heart level for 15 minutes at least twice a day, and use a foot stool when sitting to keep the legs raised.

Most likely, you will be able to return to work within a few days. After several weeks, you can resume normal leisure and recreational activities.

Transilluminated powered phlebectomy procedures need roughly 4 to 6 weeks of recovery time. Patients can continue with most daily activities during this time, but typically wear bandages for several days, followed by compression stockings for 1 to 2 weeks after the procedure. It may take a few weeks for bruising to fade.

As endovenous laser treatment and radiofrequency ablation are less invasive procedures, the recovery period usually is relatively short and easy - patients can return back to work and their normal activities the next day or within a few days after the procedure.

Possible side effects and complications

Vein ligation and stripping surgery has some risks, such as scarring and varicose veins recurring. Ligation and stripping can cause pain, bruising and/or bleeding. More serious complications are rare, but could include nerve damage or deep vein thrombosis, which is where a blood clot forms in one of the deep veins of the body.

Radiofrequency ablation may cause some short-term side effects, such as minor burns to the skin or pins and needles (paraesthesia).

After the endovenous laser treatment or transilluminated powered phlebectomy you may feel some tightness in your legs and the affected areas may be bruised and painful. Nerve injury is also possible, but is usually only temporary.

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