Varicose Veins

Varicose Veins are swollen and twisted veins just under the skin that appear most typically on the legs and feet. There are valves inside our veins which are designed to prevent blood from flowing backwards. When these don’t work properly, blood flows in the reverse direction, collect in the veins, weakens the wall of the veins and make them appear swollen or bulging. It is unclear why most people develop varicose veins (idiopathic), but certain factors can increase your risk- such as pregnancy, having a family history, gender, being overweight or older, and having a job that requires a lot of standing.

For many people, varicose veins are simply a cosmetic concern. For majority of people however, they can also be uncomfortable causing cramps, aches, itching and swollen legs. Sometimes varicose veins can lead to more serious problems like skin eczema, skin discoloration, inflammation (phlebitis), bleeding and leg ulcers.

There is no way to completely prevent varicose veins, but exercising, watching your weight, elevating your legs, constantly changing your standing and sitting position may reduce your risk of developing varicose veins or additional ones.

There are several options for treatment. During your initial consultation, Mr Oluwole will be able to advise on the risks and benefits of each approach to find the best option for you. No treatment is guaranteed to remove all your varicose veins and the risk of recurrence is something to be aware of.

Foam Sclerotherapy

Foam Sclerotherapy is a minimally invasive procedure done under local anaesthetic. A foam solution (sclerosant) is injected into the problem vein with the guidance of ultrasound, which closes off the faulty vessels and reroutes blood to the healthy surrounding veins. The procedure generally takes around 20 – 30 minutes, depending on the number of veins to be treated.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmHg). You will need to bring it with you on the day of the procedure.

You will wear a firm bandage for five following the procedure, and then a compression stocking for an additional 10 days to minimise recurrence and aid healing. Depending on the severity of the varicose veins, you may need further or top-up treatments down the line.

After the Procedure

Following local anaesthetic, sensation should begin to return to the area after several hours, and tingling is quite normal in this time. The majority of patients find over-the-counter painkillers sufficient to deal with any discomfort following the procedure, but if you feel you need something stronger it is recommended you contact your GP or local pharmacy.

After surgery, your legs will be tightly bandaged and will need to be kept dry for five days. If you notice any bleeding, immediately elevate the leg and place a clean towel over the dressing and apply firm pressure for up to 30 minutes or until the bleeding stops. You must not remove the original bandage before the five days, unless in discomfort.

After 5 days, you may shower and bathe as normal, but you must re-apply the compression stocking and continue to wear it for 10 days as this helps support healing and prevents complications.

If there is no bleeding, most patients can gradually return to normal activities. Regular exercise after 5 days should help you to do this, but please only do what feels comfortable and stop if there is any pain. This includes having sex. You may find it difficult to drive while the bandage is on, but if you are able to perform an emergency stop it is safe to do so. You may also return to work from the next day.

Mr Oluwole will see you for a follow-up appointment in about 6 – 8 weeks after the procedure.

Risks

Bruising is uncommon, but possible after foam sclerotherapy. Brown pigmentation of the skin occurs in around 20-30% of patients but usually fades after a few months. A feeling of lumpiness in the area is normal, and usually also fades after a few months. If the varicose veins were particularly large, inflammation in the area may result in a painful red lump developing. This is called superficial thrombophlebitis and can be treated with anti-inflammatories like ibuprofen.

Please visit your local A&E or GP if you have any serious concerns, or experience any of the following: increased redness, persistent swelling, increasing pain and tenderness in the calf region; shortness of breath associated with chest pains or tightness in the chest.

Avulsions / Phlebectomy

Unlike Foam Sclerotherapy, which seals the veins but leaves them in place, avulsions involve the physical removal of the varicose veins and offer much faster results. The varicose veins are marked on the skin and a local anaesthetic is injected to minimise discomfort during the procedure. It can also be done under general anaesthetic. Small incisions will be made in the skin, and the varicose veins are then hooked out and removed. Due to the small size of the incisions (less than 1mm), stitches are not necessary, and scarring is extremely minimal. Finally, the site is dressed and bandaged to aid healing, and a compression stocking will need to be worn for a week following to prevent the formation of clots.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmHg). You will need to bring it with you on the day of the procedure.

Risks

There is a minor risk of infection, blood clots, thread veins, and damage to the nerves that provide sensation. This can result in a feeling of numbness in the area, though it resolves itself in most patients within a few months. Please visit your local A&E or GP if you have any serious concerns, or experience any of the following: increased redness, persistent swelling, increasing pain and tenderness in the calf region; shortness of breath associated with chest pains or tightness in the chest.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.

Endovenous Radiofrequency Ablation

Endovenous radiofrequency ablation uses heat to seal the faulty vein. The area to be treated will be cleaned and numbed, and then a thin tube called a catheter will be placed inside the affected section of vein with the guidance of ultrasound. A radiofrequency tip will be fed through the catheter to seal up the vein using heat. After the procedure is complete, the catheter and tip will be removed, and a firm bandage will be applied to control any bleeding. A compression stocking will need to be worn afterwards, and the soreness will usually resolve within a few days.

The procedure generally takes an hour to complete, and patients can resume normal activities immediately afterwards, though it is advised that patients do not drive themselves home after the procedure.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmhg). You will need to bring it with you on the day of the procedure.

After the Treatment

The first day

The day after your procedure the local anaesthetic will have worn off so your bandaged leg may feel a little more uncomfortable and may be slightly swollen. You should take painkillers (paracetamol and/or ibuprofen) as prescribed for the first few days if needed. Pain is unpredictable and can vary from patient to patient.

The second day

The bandage should stay on for 48 hours after the procedure. You should then remove the bandage and gauze and wear the compression stockings for 2 weeks, removing it when taking a bath or shower.

The next two weeks

You should wear your compression stockings for the next two weeks: day and night for the first week, and only during the day in the second week.

The stockings may be uncomfortable and difficult to get on and off, but it is important to get them on correctly in order to get the most benefit from them. They are supposed to be tight, and you may need someone to help you put them on and take them off.

You can try using a plastic bag to make it easier: slide your foot into a small plastic bag, grasp the top of the stocking, slide the stocking over the plastic bag and up the leg, and then smooth it out evenly, making sure that the stocking is not twisted or unduly stretched. Pull the plastic bag through the open toes to remove it, and make sure to pull the stockings all the way up so the correct level of compression is applied to each part of your leg.

Don’t allow the stockings to roll down as they can form a tight band and dig into your skin. For the best results you should wear your stockings for the full two weeks, but if they become uncomfortable and painful, you can stop wearing them.

Often it is a natural reaction to limp when your leg is bandaged and a bit sore however as your muscles, bones and joints are not affected by this procedure, we advise you to walk as normally as possible. Walking is important because it keeps blood flowing in the deep veins of your leg and being inactive can increase your risk of Deep Vein Thrombosis (DVT). DVT is a blood clot that develops within a deep vein in the body, usually in the leg. We recommend a minimum of three 20-minute walks each day after the procedure for two weeks to minimise the risk of this occurring.

Please do not throw away the stockings as you may need them later if you get pain.

Most patients recover from radiofrequency ablation and foam sclerotherapy without any problems. It is normal to feel a tightening sensation in your leg after a couple of days, which may last for a few days. It is also common to experience cramping, bruising and swelling. You should take your painkillers as prescribed. 

You can carry out your normal day to day activities immediately after your treatment and do not need to avoid anything in particular. However, you should avoid strenuous exercise for the first few days and then gradually build up the amount you do. Do not exert yourself initially and be guided by how well you feel. 

You can return to work when you feel well and comfortable. We usually advise taking between two days to one week off work, depending on the type of work you do. If your job involves prolonged standing, driving or if you’ve had both legs treated at the same time you may need to take longer off work.       

We advise that you do not drive for at least 48 hours after your procedure. You should only drive again when you are free of pain and able to perform an emergency stop comfortably. 

Sitting down for long periods with the knees bent increases the risk of DVT (a blood clot deep in the legs). You should avoid flying long haul (any flight over four hours long) for at least four weeks after your procedure. 

There are potential complications with any medical procedure, however only minimal complications have been reported with radiofrequency ablation. Some of the common problems are listed below.

 

Bruising

Some bruising is normal and occasionally the leg will become very bruised. This may occur during the first few days following the procedure but will disappear after a few weeks.

 

Superficial thrombophlebitis

Superficial thrombophlebitis are hard areas of blood clotting which feel like a lump and form in the treated veins. Most patients will experience some lumps- which may be inflamed and uncomfortable- but this is nothing to worry about. If this occurs, anti-inflammatory drugs such as ibuprofen will help. The lumps will eventually subside and disappear, but it may take weeks or several months to do so.

Usually when there is inflammation, the leg will be painful and this pain may last for up to a month. Also, severe twinges of pain may occur in some patients and may persist for some months; again you can take painkillers as prescribed.

Regular daily exercise such as walking, using an exercise bike or wearing your stockings for a few more days may help with the pain. Although this may be uncomfortable try not to rest your leg as this increases the risk of developing blood clots in the deep veins (DVT).

 

Brown pigmentation of the skin

This can occur following superficial thrombophlebitis. It usually fades over time but can be permanent. It is common with Foam Sclerotherapy but can also occur with RFA.

 

Nerve injuries

Some nerves run close to the vein so can get damaged by the procedure. This may cause numbness, tingling and paraesthesia (pins and needles). This reduced sensation may be very noticeable at first but normally diminishes with time.

 

Deep vein thrombosis (DVT)

This is a very rare complication of radiofrequency ablation. To lower this risk the most important advice is to move around when you can and avoid long periods of not moving.

 

Recurrent veins

No treatment for varicose veins can be completely guaranteed against it recurring. Some people can still grow new veins even when all previous veins have been treated correctly. Overall, the risk of recurrence after these procedures is thought to be about 1 in 10 cases.

Radiofrequency ablation significantly reduce the risk of recurrence. Regular exercise, weight control, and wearing light support stockings can all help prevent you from being troubled by varicose veins in the future.

It is important for you to understand that not every visible vein will disappear as a result of your treatment. Your treatment has been for symptoms, not overall appearance. There is usually the bonus of improved cosmetic result, but this is not guaranteed.

Yes, your payment includes a one-off follow up appointment with Mr Oluwole, usually 6 weeks after your treatment. This will be arranged before or soon after your discharge.

Ligation and stripping

Ligation involves the tying off the greater saphenous vein in the leg (which runs from the foot to the groin area) just before it joins the deep veins, and stripping involves the surgical removal of this vein. In both, the vein is accessed through a small incision in the groin or back of the knee and is usually performed when other less invasive treatments are unsuitable or unsuccessful. The area will be firmly bandaged, and a compression stocking will need to be worn for 2-6 weeks post-op.

Before your procedure, please visit www.daylong.co.uk and get a pair of Class 2 Above Knee Open Toe Compression Stockings (Moderate 18-24 mmhg). You will need to bring it with you on the day of the procedure.

The stockings may be uncomfortable and difficult to get on and off, but it is important to get them on correctly in order to get the most benefit from them. They are supposed to be tight, and you may need someone to help you put them on and take them off.

You can try using a plastic bag to make it easier: slide your foot into a small plastic bag, grasp the top of the stocking, slide the stocking over the plastic bag and up the leg, and then smooth it out evenly, making sure that the stocking is not twisted or unduly stretched. Pull the plastic bag through the open toes to remove it, and make sure to pull the stockings all the way up so the correct level of compression is applied to each part of your leg.

Don’t allow the stockings to roll down as they can form a tight band and dig into your skin. For the best results you should wear your stockings for the full length of time as advised by Mr Oluwole, but if they become uncomfortable and painful, you can stop wearing them.

Walking and staying mobile after vein surgery is important because it keeps blood flowing in the deep veins of your leg. Being inactive can increase your risk of Deep Vein Thrombosis (DVT). DVT is a blood clot that develops within a deep vein in the body, usually in the leg.

Please do not throw away the stockings as you may need them later if you get pain.

 

Risks

Most patients will go home same day though some may need to stay in hospital overnight. There is, like any surgical procedure, a small risk of infection, and a greater risk of permanent scar formation compared to foam sclerotherapy.

Severe pain is unlikely, but there is a possibility of burning or tingling in the leg (caused by disruption to the saphenous vein) for which over-the-counter painkillers are generally sufficient to resolve. Numbness and discolouration of the skin can sometimes also occur and usually resolves itself within a few months, and patients should continue to wear compression stockings and take frequent walks and low-impact exercise to reduce the risk of post-operative complications.

During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.