Surgery of varicose veins

The varicose veins can not only pose a cosmetic problem, they can also lead to heavy legs and evening leg edema, i.e. water retention.

Heredity plays a very important role in the appearance of varicose veins, but varicose veins also occur more frequently during pregnancy.

Read more on the topic: Varicose veins in pregnancy

When do varicose veins need to be removed?

Varicose veins often set cosmetic problem If the suffering is great enough, the affected veins can be removed through an operation.

Also at symptomatic varicose veinse.g. due to edema (water retention), surgical removal may be indicated.

Furthermore, varicose veins can also become Complications to lead. One complication is the recurring occurrence of Inflammation of the veins or the emergence of Thrombi, so small Blood clotsthat obstruct the vein.
In such a case, an operation is advisable.

However, there are cases in which the veins cannot be surgically removed. In about 5% of the cases the varicose vein disease is one secondary varicosis underlying.
This initially results in a flow obstruction in the deep venous system. Therefore, the blood has to be increasingly transported back to the body via the superficial leg veins. This can then lead to the formation of varicose veins.
The superficial veins now represent the Main part of the blood return and must therefore not be removed.

You can find more information on this topic here: Remove varicose veins

preparation

As before any surgery, the first thing you should do is Doctor-patient conversation and a physical examination be made by the doctor.
Then using the Ultrasound the veins displayed and examined.

In some cases a so-called Venography occur. With the help of Contrast media and one imaging proceduree.g. the MRI showing the veins.
This Preliminary examinations are important in order to rule out other diseases or to determine concomitant diseases.

It also examines the extent of the varicose veins and plans which veins to remove.

The corresponding veins are marked on the standing patient immediately before the operation.
Also should blood-thinning drugs as Marcumar are previously discontinued by the attending physician.

procedure

The Standard surgical procedures is this Variceal stripping. Here the affected vein is pulled out.
In detail, the end of the vein near the trunk is first found via a small incision, prepared and cut at the confluence with the deep leg vein.

Then a probe introduced, which is advanced to the planned extraction point of the vein. Now even larger side branches are cut.
Finally, the lower part of the vein is exposed through a small incision so that the probe now protrudes from the vein at the bottom of the leg.
With the help of the probe, the entire vein is pulled out of the lower incision site. Before doing this, small side branches can be pulled out using very small cuts.

Aftercare

The leg is tied up tightly immediately after the operation.
A elastic compression treatment, so wearing a compression stocking, should still be for at least three to four weeks to be continued.

The compression should Post-bleeding, swelling and bruising reduce. It takes place on the one hand with Tie and on the other hand with Compression stockings.

Furthermore is physical movement important. Exercise should be avoided initially, but regular walking will also help prevent swelling and bruising. It also stimulates them Blood circulation on.

However, the leg should right after the operation enough time to recreation are given. The leg can be put up for relief, which facilitates the venous return flow.
Long walking and standing should be avoided.

The stitches are removed after about two weeks. Since the actual cause was not treated by the operation, further veins can be affected by the varicosis (varicose vein disease) later in life.

Therefore, after sufficient recovery from the operation, preventive measures should be taken. Which includes exercise, especially endurance sports like jogging or swimming.
Additionally help Compression stockingswhich are especially recommended when sitting or standing for long periods of time.
Furthermore, you should pay attention to well-fitting shoes.

How long does the operation take?

The duration of the operation depends on the extent of the varicose veins. Usually the actual surgery is within one hour completed.
Of course, you still have to allow for time to induce anesthesia and to prepare for the operation.
Often the patients can be discharged home with an escort just two to three hours after the operation.

Which anesthesia do I need?

Various anesthetic methods can be used for variceal stripping.

The anesthetic procedure should be discussed individually with the doctor.
You can choose between general anesthesia, local anesthesia and spinal anesthesia.

With general anesthesia, the patient is given a sleeping pill, pain reliever and medicine to relax the muscles. It is the standard procedure for these operations.

With local anesthesia, the anesthetic is injected locally onto the nerves that supply the operating area, thus preventing the perception of pain.

In spinal anesthesia, an anesthetic is injected close to the spinal cord. This disturbs the perception of pain but at the same time restricts the motor skills of the legs. This returns a few hours after the operation.

The patient is conscious with both spinal and local anesthesia.

How long have I been on sick leave?

After the operation, patients are mostly for one week on sick leave. However, the duration of the illness can vary from person to person.
At uncomplicated, small interventions and faster wound healing it may also be possible that you can go back to work after two days.
In contrast, it can with larger, more complicated interventions the illness lasts for two weeks or more.
So it cannot be said in general how long you are on sick leave after the procedure.

Of course, the patient's occupation also plays a role. Office workers can go back to work sooner than construction workers or factory workers who have to stand a lot.

Pain after varicose vein surgery

As a rule, the pain after varicose vein surgery is not very severe.
It is usually sufficient to take painkillers prescribed by a doctor (such as ibuprofen 400). This can be taken as needed.

Some patients don't need pain medication at all after surgery, others are more sensitive and need more. The pain should go away or have subsided significantly after a few days.

Very severe pain are atypical and should be understood as a warning signal. One that occurs in addition to the pain severe swelling and Redness should not go unnoticed. In such cases, a doctor should be consulted again.

Complications

Overall that is Vein stripping a very surgery with few complications.
It can get too after surgery Pain and swelling of the affected leg, which can usually be adequately treated with pain relievers.
At the point of the skin incision it can be more or less pronounced Scarring come, in worse cases too Wound healing disorders.
Wounds in the groin are primarily affected by wound healing disorders. Their wound healing can be supported by avoiding frequent or constant bending in the hip joint.

As with any operation, there is a Risk of thrombosis. However, since it is a minor procedure, the risk is low.
With a sufficient Thrombosis prophylaxishow to wear Compression stockings and heparin, thrombosis can usually be prevented.

Also are Secondary bleeding possible. In exceptional cases, others will Vessels or nerves hurt, leading to temporary or permanent Sensory disturbance leads on the leg.

Since the operation is not a causal therapy, it can Relapses come to other leg veins, which means that varicose veins can develop again.
However, a varicose vein cannot reappear where the vein was removed.

When can you start exercising again?

When you can go back to sports after the operation depends primarily on the person Size of the intervention and the sport from.
Usually after two weeks with light exercisee.g. Nordic walkingto be started.
The training load can then be increased slowly so that after about 4 weeks almost all sports are possible.
With extreme sports or Contact sports however, one should wait until everything has healed well, which takes about 6 weeks.

The times given are only rough guide values and can be individually different.

Laser surgery

The Laser operation will also be endovenous therapy called. In this therapy, a catheter is inserted into the vein through a small incision. The vein is then irradiated from the inside with the laser at the affected area. This closes the vessel so that no more blood flow is possible.
Alternatively, this process can also be carried out with radio frequency energy instead of laser energy.
The laser therapy is gentler than conventional vein stripping, however, it is not possible in all cases.

How expensive is varicose vein surgery

While that Vein stripping usually from the Health insurance is paid, is endovenous laser therapy only covered by a few statutory health insurance companies.

The assumption of the costs must be asked individually after the diagnosis.
From private health insurances endovenous laser therapye often adopted. If the laser therapy is not covered by the health insurance, costs of around € 1,000 to € 1,500 must be expected.

The costs are of course dependent on the Size of the intervention and only refer to one leg. In appropriate cases, the costs can exceed € 1,500.

Can varicose vein surgery be carried out on an outpatient basis?

Today are outpatient varicose vein operations even very often. Patients can leave the hospital a few hours after the operation.
As a rule, patients are only used in exceptional cases stationary either if difficulties or complications due to the individual constitution of the patient are anticipated prior to the operation or if it occurs during an outpatient operation Complications comes that make hospitalization necessary.
Also at major interventions, poor patient condition or complex Comorbidities the supply is in-patient.

Which doctor will perform the operation?

The surgery of varicose veins falls into the specialty of Vascular surgery. There are several specialized hospitals for vascular surgery in Germany.
However, the operation can be performed by any vascular surgeon. An anesthetist is responsible for the anesthesia.