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Treatment of Varicose Veins of the Leg

Definition

This procedure involves taking out or causing damage to varicose veins just under the skin.

Dirfferent approaches may involve:

  • Sclerotherapy—injects the varicose veins with a chemical to shrink them
  • Radiofrequency ablation—collapses and seals varicose veins using radiofrequency energy
  • Adhesive sealing—seals the affected veins that are close to the skin using an adhesive
  • Vein stripping
  • Phlebectomy

Varicose Veins

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Reasons for Procedure    TOP

Veins have one-way valves to keep blood moving toward the heart. Damage to the valves can cause blood to pool in the veins. This makes them larger. It also makes the veins just under the skin easier to see. Clots can form in the pooled blood. This can cause burning, aching, or throbbing.

The skin can also turn dark purple or brown because. In some cases, the discolored skin may break down and cause ulcers.

These procedures can be cosmetic or for health reasons.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems such as:

  • Return of varicose veins
  • Bleeding
  • Infection
  • Skin discoloration at the surgical site
  • Deep vein thrombosis

Smoking may raise the chances of having these problems.

What to Expect    TOP

Prior to Procedure

You may have a:

  • Physical exam—includes carefully checking the veins
  • Doppler ultrasound

Leading up to the procedure:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to 1 week in advance.
  • You may need to wear special support stockings.
  • If you have an ulcer, wear Unna boots. This is a type of cast that helps with healing.

Anesthesia

The anesthesia depends on the type of procedure that you are having. It may be:

  • General—blocks pain and keeps you asleep
  • Epidural—numbs the area from the chest down to the legs

Description of the Procedure    TOP

Sclerotherapy

A chemical will be injected into each of the damaged veins. It will scar the vein so that it can’t move blood.

Adhesive Sealing

A catheter is inserted into the damaged vein. An ultrasound is used to view the placement of the catheter. An adhesive is injected into the catheter to seal the vein.

Radiofrequency or Laser Ablation

This is done on one of the largest superficial vein. The vein will be viewed using an ultrasound. Then, the vein will be punctured near the knee. A catheter will be threaded up to the groin. The space between the vein and the skin will be filled with a special solution. This solution will provide local anesthesia. The catheter will then be attached to a radiofrequency generator or a laser. Heat or light energy will seal the vein closed so that there is no longer any backflow of blood.

Vein Stripping

The veins will be removed by threading a long wire into them. Each vein will be tied to this wire and then stripped out. This will leave the smaller side branches broken off and in place. This procedure is usually not used on the largest vein.

Phlebectomy

This surgery is used to remove larger veins that cannot be injected. Many small incisions will be made to access each varicose vein. The vein will either be tied off or removed.

After the Procedure    TOP

If vein stripping is done, you will have many loose vein ends in your leg. Your leg will be tightly wrapped. This is to prevent blood from leaking out of the veins.

How Long Will It Take?    TOP

  • Sclerotherapy—short office visit
  • Adhesive sealing—short office visit
  • Radiofrequency or laser ablation—1 hour
  • Vein stripping—1-1½ hours
  • Phlebectomy—2-4 hours

Will It Hurt?    TOP

You will have pain and discomfort with the procedure. Stripping is more painful. Ask your doctor about pain medicine.

Post-procedure Care    TOP

You may need to have an ultrasound in the future.

Call Your Doctor    TOP

Call your doctor if any of these occur:

  • Fever or chills
  • Redness, swelling, pain, excess bleeding, or pus from the wound
  • Pain that you cannot control with the medicines you were given
  • Pain, burning, urgency or frequency of urination, or blood in the urine
  • Coughing, breathing problems, or chest pain
  • Leg swelling

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American College of Phlebology
http://www.phlebology.org
Society for Vascular Surgery
https://vascular.org

CANADIAN RESOURCES:

Canadian Society for Vascular Surgery
https://vascular.ca

References:

Varicose veins. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116699/Varicose-veins. Updated March 30, 2018. Accessed July 11, 2018.
Varicose veins. Society for Vascular surgery website. Available at: https://vascular.org/patient-resources/vascular-conditions/varicose-veins. Accessed July 11, 2018.
Varicose veins and spider veins. Office on Women's Health website. Available at: https://www.womenshealth.gov/a-z-topics/varicose-veins-and-spider-veins. Updated March 16, 2018. Accessed July 11, 2018.
6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed...: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
Last reviewed June 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 7/11/2018

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