The thought of having varicose vein surgery can be scary. “Surgery,” after all, calls to mind images of sterile rooms, sedation, scalpels, stitches, and scars. If you’re feeling apprehensive about getting your veins treated, that’s OK. But you might be surprised to learn just how varicose veins surgery is done…and that it’s probably not like you imagine.
What causes varicose veins?
Before we get into how varicose vein surgery is done, it’s important to first understand what causes varicose veins. That’s because the bulging veins you see under your skin are just a symptom of something deeper.
Inside your legs are two veins called the greater saphenous vein and the lesser saphenous vein. These veins carry deoxygenated blood from your lower body, back up toward your heart. In healthy veins, tiny, one-way valves keep your blood flowing upwards. But with varicose veins, some of these valves have become damaged due to age, heredity, or injury, allowing gravity to pull blood back down towards your feet.
Since your veins are like a river system—with smaller veins flowing into larger ones—as blood backs up in the big veins, it begins to overflow into the smaller, surface ones. These smaller veins are what you can see. However, when you have varicose vein surgery, it is those big veins deep inside your leg that get treated (at least at first).
How is varicose vein surgery performed?
Varicose veins are treated with a procedure called venous closure. As the name implies, the procedure involves closing the damaged saphenous vein so that blood no longer flows through it. Your body then reabsorbs the tissue and naturally reroutes blood flow to nearby, healthy veins. This stops blood from backflowing in your legs.
There are three different methods that can be used to close your saphenous vein, all of which achieve the same end result. You should talk to your doctor about which one is best for you.
Thermal (heat) ablation
This procedure uses heat to scar the saphenous vein closed. Your doctor will inject an anesthetic solution at several points along your leg to numb it and also protect surrounding tissues from the heat. You’ll then receive a very small incision either in your lower calf (for the lesser saphenous vein) or your mid calf (for the greater saphenous vein). This incision is so small that it doesn’t require any stitches to close.
The incision allows your doctor to insert a catheter (thin tube) with tiny instruments into your vein and thread it either to the back of your knee (for the lesser saphenous vein) or your groin (for the greater saphenous vein). Then, either laser energy or radio waves are used to generate heat. As the catheter is slowly withdrawn from your leg, the heat damages the length of the vein causing it to permanently close.
Once this is done, your doctor will cover the incision site with an adhesive dressing, wrap your legs in compression bandages, provide you with instructions for follow up care, and send you on your way. There will be virtually no blood nor scarring.
This treatment is similar to thermal ablation, but uses a medical-grade adhesive to literally glue the vein shut. Because your veins don’t have nerves and there’s no need to protect surrounding tissues from heat, this procedure requires only a single injection of anesthetic at the incision site.
Just like with thermal ablation, your doctor will use the incision to thread a small catheter into your saphenous vein. Then, they will inject a small amount of adhesive and apply pressure to the outside of your leg to help it set. This process is repeated down the entire length of the damaged vein.
Once the vein is glued shut, the incision is closed with an adhesive dressing and you’ll be provided with after-care instructions. With this procedure there is no need for compression bandages.
Ultrasound guided sclerotherapy
This varicose vein treatment is a bit different. It involves injecting a medicine called a sclerosing agent into your vein(s) which irritates the vein wall, causing it to collapse. Because this procedure uses injections, there is no incision.
Your doctor will first numb your leg at one or more injection sites. They will then use ultrasound to see the saphenous vein. Using a long, thin needle, they’ll inject the sclerosing agent directly into the damaged saphenous vein(s). Once this is done, they’ll wrap your legs with compression bandages and provide you with follow up instructions. Once again, there will be no blood, no stitches, and no scars.
How long are you at the hospital after vein surgery?
Venous closure is considered an outpatient procedure, meaning there is no hospital stay. In fact, you are unlikely to go to the hospital at all. Typically, you’ll see your doctor right in their office for treatment.
How long does varicose vein surgery take?
Regardless of which method your doctor uses, these minimally invasive treatments are quick. Typically, you’ll be in and out of your doctor’s office in about an hour, including check in and check out. The procedure itself can take as little as 15 minutes.
Are you awake during varicose vein surgery?
Yes. Venous closure is minimally invasive, so there is no need for general anesthesia. That means you won’t be put to sleep and won’t feel groggy after. The local anesthetic that your doctor uses to numb your leg will ensure you don’t feel any pain during your procedure and its effects should wear off after about an hour. You should be able to return to your normal daily activities almost immediately and many patients return to work the same day.
How painful is varicose vein surgery?
This is a difficult question to answer because everyone experiences pain differently. However, the vast majority of patients describe the procedure as “uncomfortable” rather than “painful.”
Your doctor will use a needle to administer the local anesthetic which numbs your leg ahead of surgery. This is usually the most unpleasant part for patients. After that, you may experience pressure during the varicose vein surgery, but you shouldn’t feel anything sharp or intense. If you do feel any pain, tell your doctor right away.
After your varicose vein surgery, your leg will likely be tender. Bruising is common, particularly with thermal ablation procedures due to the protective fluid that gets injected. This should heal in a few weeks. As you’re recovering, you may experience tightness or pulling in your leg as your saphenous vein begins to shrink and get reabsorbed. Over-the-counter medications like Tylenol or Motrin should be sufficient to treat any post-surgical pain.
Can you walk after varicose vein surgery?
Yes! In fact, it’s important to make regular use of your leg muscles during your recovery to promote circulation.
Immediately after your venous closure, your doctor will ask you to walk for 15 minutes to help start the healing process. You should continue to walk frequently (at least once every waking hour) for at least a week after surgery.
How long does it take to recover from varicose vein surgery
You should recover from your varicose vein surgery quickly with little disruption to your daily routine. Most patients report that they experience the greatest discomfort in the first 2-3 days after their procedure. Again, over-the-counter pain killers should be sufficient to make you more comfortable. Your body will take about 2-3 months to heal completely during which time your varicose veins may remain visible. It’s a good idea to take before and after photos so you can track your progress.
If you’d like to know more about how varicose vein surgery is done, you can book an appointment with Dr. Ian Katz, the vein expert at DeKalb Vein Center.