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The North Hampshire Hospitals NHS TrustAldermaston RoadBasingstokeHantsRG24 9NA

01256 473202

www.northhampshire.nhs.uk

General surgeryOctober 2004

Varicose Vein Surgery

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Prior To Admission

Prior to any varicose veins operation you will be fittedwith a special support stocking (This is not an ordinarystocking. This is usually done at the Pre assessment clinic.

This stocking is extremely important. Please bring yourstocking with you.

The operation may be either under GeneralAnaesthetic (asleep) or local anaesthetic (awake with

an injection to numb the skin). This is usually decidedwhen you are first seen in the Varicose Vein Clinic butthe operation itself is the same.

Before surgery we usually mark with a pen the positionof the vein to be tied. Sometimes ultrasound is usedto show the feeding vein if it is difficult to feel.

After the vein is marked we can advise you where toshave if it is necessary.

Stockings

You will go to the operating theatre with the stockingon your foot and as soon as the operation iscompleted we pull it up to give immediate support tothe veins.

We ask you to wear the stocking all the time (day andnight) for 3 days and then when you are up, for afurther 10 days.

Please replace the stocking before getting out of bedin the morning. This supports the dilated veins, givesthem the best possible chance of returning to normal

size and also helps to prevent phlebitis. (Inflammationof the vein).

More often though, injections are needed to closedown the worst dilated veins.

The walking and support stockings give optimalconditions.

If you have any further queries please contact the DTCReception on 01256 313332

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Wound Care

The dressing on your wound is best left-undisturbed for 48hours to allow the wound to seal.

After 3 days when you take the stocking off and have abath you have the choice of keeping the wound dry andleaving the dressing on.

OR

You can submerge the wound and remove the wetdressing.

The wound does not need to be re-covered but is liable torub on clothes or stockings and most people prefer to re-cover it with a dressing of their own.

Some surgeons use dissolvable stitches, others preferones which have to be removed and you need to make anappointment for this with the Nurse at you GP Surgery(usually about one week later).

Pain

After the operation the wound will be uncomfortable butsevere pain is seldom a problem with varicose veinsurgery.

When you return home Paracetamol or some other mildpainkiller which you are used to taking is usually all that isneeded.

The wound will be tender for a week or two but shouldsteadily improve.

Increasing pain may indicate an infection or phlebitis and

you should consult your GP.

An explanation about veins

Arteries carry blood into the legs .

Veins return the blood from the legs to the heart.

Some of the veins are deep within the muscles whichsupport and massage them during walking.

Other veins are nearer the surface, in the layer of fatunder the skin. These veins have little support and if theybecome dilated are called varicose veins.

Normally one-way valves within the veins help to keep theblood flowing back to the heart even against gravity.

A major cause of varicose veins is a failure of one ofthese valves.

The common large valves to fail are the ones in the groinand behind the knee. The back pressure this causes,results in varicose veins further down the leg.

If there is a major failure of an important valve, justinjecting the veins is seldom successful without first tyingoff the vein with the faulty valve. This is similar to puttingup a diversion sign on a motorway which is blocked.Other routes take over and the return of the blood fromthe legs is improved

Sometimes the dilated veins improve so much when thebackflow is stopped that no further treatment is needed.

The 6 weeks between operation and re-assessment givesopportunity for this to happen

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Bleeding

Oozing from the wound edges is harmless andcommon

Dried blood in the dressing is hard and uncomfortableand you may wish to change it after 48 hours.

Bruising is harmless but can take a week or two tofade.

Severe bleeding occurs very rarely but can happen inthe first 24 hours if a tie in a vein slips or breads Dont Panic

Lie down and put light pressure over the wound with abunched up pad of bedclothes or towel. The bleedingis easily controlled while medical help is summoned.

Walking On the day of the operation do not do too much but

keep your feet moving to encourage the circulation.Try pretending to draw large circles with your big toes.

The day after the operation try to take 3 walks of half amile.

By the third day you should be aiming a 3 5 mileseach day. This means that for 2 hours each day theveins in your legs benefit from the massaging effect ofthe muscles.

Keep up the walking if you can until your 6 weekappointment.

Returning to normal

Most people take a week off work. Some need a littlelonger, especially if they develop a complication suchas an infection. Many return in less than a week andunless your job is very physically demanding will do noharm.

You may resume driving when the wound is sufficientlycomfortable to allow you to react quickly and safely inan emergency. For many people this is about a week.

Sport can be reintroduced in the second week butsome caution is advised until 14 days.

Follow-up

A follow-up appointment will be arranged for theVaricose Vein Clinic, six weeks after your operation.

Please bring your stocking with you at theappointment.

Anaesthetic Advice

The anaesthetic is in your system for 48 hours,therefore you MUST be accompanied home by aresponsible adult, and have an adult with you for theremainder of the 48 hours.

You are advised to rest lying down when you gethome.

Do not drink alcohol Do not drive a motor vehicle for 48 hours Do not operate machinery

You may drink normally and have a light diet if you feellike eating.