Varicose vein surgery in Cairns
Conventional varicose vein surgery — ligation and stripping — ties off the faulty vein where it joins the deep system and removes it. It has been largely displaced by ablation and glue closure for straightforward cases, but it remains the better option in several specific situations, and it is not an outdated operation.
When surgery is the right choice
The duplex ultrasound determines this. Surgery is generally preferred where:
- The refluxing vein is large, very tortuous, or lies immediately beneath the skin, making a catheter-based technique difficult or likely to injure the skin
- There is recurrent disease at the groin or behind the knee, where a network of veins has re-formed after previous treatment
- The pattern of reflux does not suit a catheter approach
- Extensive branch varicosities need removing at the same time
- A previous endovenous treatment has not achieved closure
The choice between techniques is made on anatomy and on the clinical picture, not on which one is newer.
What the operation involves
Surgery is performed in hospital under general anaesthetic, usually as a day procedure.
The vein is tied off — ligated — at the point where it joins the deep vein, at the groin for the great saphenous vein or behind the knee for the small saphenous vein. A fine device is then passed inside the vein and used to withdraw it, through a small incision below.
Prominent branch veins are removed through a series of very small incisions along their course, usually a few millimetres each. These are marked with you standing before the anaesthetic, because the veins are far harder to identify once you are lying down.
Incisions are closed with dissolving sutures and adhesive strips, and the leg is bandaged.
Recovery
Recovery after surgery takes longer than after the minimally invasive options, and it is worth planning for.
The bandage stays on for 24 to 48 hours, then is replaced with a compression stocking worn during the day for up to a month after your review.
Walking is encouraged from the day of the operation — thirty minutes a day. Avoid hot baths and gym work until you have been reviewed. Avoid long periods of sitting or standing still.
Bruising is more extensive than after ablation or glue, particularly along the inner thigh where the vein has been removed, and takes several weeks to clear. Tenderness in the leg commonly persists for longer than after the catheter-based treatments.
Simple pain relief is usually adequate; avoid aspirin-based products unless specifically advised.
Time off work depends on your occupation. Desk-based work is often manageable within several days; heavy manual work and long standing shifts take longer. Discuss this at the consultation so it can be planned around your work.
You will be reviewed between one and two weeks after surgery, with an ultrasound scan to check for deep vein thrombosis.
Contact the rooms promptly if you develop a temperature above 38°C, or pain or swelling that is severe or worsening.
Risks
Bruising and tenderness are expected, and are more pronounced than after endovenous treatment.
Bleeding and wound infection can occur. Collections of blood under the skin at the groin occasionally need to be drained.
Numbness in a patch of skin is relatively common where a small sensory nerve runs alongside the vein — most often over the inner calf or the outer foot depending on which vein has been treated. It usually improves but can be permanent.
Deep vein thrombosis and pulmonary embolism are uncommon but recognised complications of any operation on the leg veins, and preventive measures are used.
Injury to a deep vein, artery or motor nerve is rare.
Scars from the incisions are small but permanent, and there are usually several of them.
Recurrence occurs in a proportion of patients over the years, as it does with all venous treatments.
The risks of general anaesthesia apply and are discussed separately by the anaesthetist. All of this is discussed with you in full before the operation is agreed, and written information is provided.
Common questions
Is stripping an outdated operation?
No. It is used less often than it was, because catheter-based techniques suit most straightforward cases and recovery is quicker. But there are anatomical patterns and recurrent presentations where surgery gives the better result, and in those cases it remains the appropriate operation.
Will the vein grow back?
The vein that has been removed does not grow back. New veins can develop reflux over the years, and at the site of previous groin surgery a network of small vessels sometimes forms — neovascularisation — which is the usual reason for recurrence after stripping.
Do I need to stop my medications beforehand?
Blood thinners and some other medications need planning around. Bring a complete list of everything you take to the consultation, including anything bought over the counter and any supplements.
Can both legs be done at once?
This depends on the extent of the disease and on your general health, and it is a decision for the consultation.
Referral and appointments
GPs and referrers: referrals can be sent to the rooms by fax or through the online referral form.
Patients: phone the rooms on (07) 4254 5006. Suite 9, Level 1, 193 Lake Street, Cairns.