EVLA Surgery Information

varicose vein treatment image

Most people undergo this procedure under local anaesthetic.

Before you leave Home

Please attend the clinic at the arranged time having eaten your normal meals (it is easier to be relaxed if you are not hungry).

  • Please do not use any oil or moisturiser on your legs (I need to mark your veins with an indelible pen).
  • Please wear loose clothing that will accommodate your legs being bandaged.
  • Take two co-codamol. Remember you cannot drive for at least 24 hours after your op.

At the Clinic

I will see you again to mark your veins.

When we are ready for you I will come and get you from the reception area. There is a nurse as well as you and me in the treatment room. We will be chatting to you throughout your surgery. We usually have music as background to help create a relaxed environment for you.

We will prepare your leg(s) by painting an antiseptic solution and placing sticky sterile surgical drapes. I will use local anaesthetic to numb the specific areas where I will insert the laser catheter and remove your veins. If you feel any discomfort, please let me know so that I can rectify this using more local anaesthetic.

Once I have finished your operation we will bandage your leg(s) and then you may return to the reception area and be picked up to go home.

Sometimes the local anaesthetic that I have injected into your leg leaks back out of the tiny incisions through the bandages. Elevation of the legs will help this to stop quickly. You may decide to sleep with your leg on an old towel the first night.

The next couple of days

During your recovery the most important thing you can do is remain as mobile as possible. This reduces your likelihood of a DVT, reduces stiffness and helps bruising to clear as soon as possible.

A couple of days after your procedure the bandages can be removed and compression stocking(s) fitted. Most people cut off their bandages and have a shower at this stage. Once dried, you will find it easier to apply the stocking if you talc your leg and use washing up gloves which grip the stocking very well.

Once this has been done, your legs will be freer and all traces of your sedative medication vanished, so by all means recommence driving. The minimum time before driving is 24 hours.

The next two weeks

As mentioned before, please keep as mobile as possible. Please walk every day for at least ten to fifteen minutes, ideally several times a day. After each walk it is helpful to elevate your legs (above heart level) for ten to fifteen minutes.

Usually there is little discomfort for the first four or five days. Then for about a week the vein(s) that have been “lasered” will be uncomfortable before settling down again. Regular pain-killing medication will maintain your mobility.  Nurofen/Ibuprofen is a good choice since it is an anti-inflammatory drug and may be taken in combination with paracetamol.

Please leave the compression stockings in place during this time. You may choose to remove them to shower but if you use a “limbo” this will keep it dry in the shower. Allowing the stocking to get wet and drying it with a hair dryer is also an option.

Supplier of Surgical Stockings:

Suggested stocking is Duomed Soft, full length class 2 compression stockings.

W: https://www.mediuk.co.uk/shop/duomed-soft-thigh-length-compression-stockings.html  
T: 01432 373500

compression socks

Problems with stockings

Patients often have niggles with the stockings – these are the commonest issues:

Keep coming down – try wearing the waistband (if you chose that design) over your opposite shoulder, try wearing tights or cycling shorts over the stockings to keep them in place.

Foot pains at night – make sure that the double seam has not ridden up onto your foot, pull it out so that this is free. If the foot is still too tight then please make multiple small vertical nicks in the stocking with scissors – these expand into a diamond shape and help provide relief. If this is still a problem please contact the clinic. Some patients just find they cannot tolerate the stockings at night and wear them during the day only which is an acceptable minor compromise.

Complications / side effects

Bruising etc. (always)

As with any surgery you will experience some bruising and tender lumpiness. This settles gradually – usually at the two week check there is still some lumpiness but much of it will have dispersed already. By all means massage the lumpiness with moisturiser or oil. If you are a user of arnica please do use that.

Lymph leak (rare)

Sometimes a lymphatic channel may be disrupted as a vein is removed (especially just above the ankle on the inside). Straw coloured fluid may discharge. This will stop but sometimes can take days or even weeks. Very rarely the fluid will continue to collect and form a small swelling – this will also eventually resolve but is a slow process.

Numb patch (approx. 1:10)

Tiny skin nerves can be bruised or disturbed by the surgery and this can make a patch of skin feel odd (rather like the lip feels when recovering after a dental injection). The sensation normally recovers but often takes a long time (months).

Deep vein thrombosis (very rare)

Deep vein thrombosis (DVT) is a serious complication that can be dangerous. It needs urgent investigation and treatment. The signs are severe pain in the muscles of the leg with intense swelling. Fortunately this is extremely rare (less than 1:1000). The more you walk after your surgery, the lower the chances of a clot forming. The stockings also improve blood flow and hence reduce the chance of this complication.

Brown skin staining (rare)

Some people are prone to forming brown marks if the skin has been inflamed. Whilst this sort of brown mark is fairly common (30%) after chemical injection treatments, it is fairly rare after laser vein surgery. Nevertheless it can happen but fortunately it does fade with time (usually a few months).

Thread vein formation (occasional) 

Many patients will initially present with tiny broken capillaries known as spider or thread veins in association with their larger varicose veins. The bruising associated with vein surgery can encourage the development of some more thread veins, particularly in these people who already have shown this tendency. This is not a serious concern (aside from the cosmetic aspect) and the thread veins can be treated by microinjection or radio-frequency and indeed there may already be a plan in place to treat existing capillaries once the main surgery has been done.

Residual varicose veins (occasional)

Sometimes, in spite of my best efforts significant varicose veins may remain after your surgery. If they are persistent I will offer to carry out an injection treatment without additional charge. The treatment of thread veins however is not included (whether present pre-operatively or post-operatively).

Infection (rare)

Sometimes the leg may become red along the line of the vein which has been “lasered” (often in the second post-operative week). This does not necessarily indicate an infection – there is always some inflammation because the vein has been treated. You can expect it to settle with time, compression and anti-inflammatory drugs (e.g. Nurofen). If you are feverish, it should be checked and it may be necessary to administer antibiotics.

Sometimes one or two of the tiny incisions may become red due to a very low grade infection – this usually resolves (please apply savlon or similar) but if it is spreading beyond a few mm, please contact us.

Swelling (common)

It is fairly common for there to be some swelling and sometimes puffiness can persist for a few months afterwards (although that is not so common).

Unrealistic expectations (uncommon)

I have listed this under “complications”!  During your consultation process I try my best to ensure that I have explained exactly what can be achieved by your surgery (and that you have understood). Sometimes leg pains are not caused by varicose veins and if I strongly suspect another cause, I will discuss this with you.

I will strive for the best cosmetic result that I can achieve. Cosmesis is partly a subjective matter though and people can vary in their level of satisfaction.  Having mentioned that though, almost everyone is happy with their result and pleased that they had their veins treated.

              

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