Vein removal

A vein removal surgery is performed to remove or treat damaged veins in conditions such as varicose veins and other vein-related problems.

The two main types of blood vessels in your body are arteries and veins. Veins carry deoxygenated blood from the different body tissues to the heart. Veins located deep within the muscles are called deep veins, while those located just underneath the skin are called superficial veins. Veins have gates or valves to prevent the backflow of blood. However, certain conditions weaken or damage the valves of superficial veins, resulting in backflow and pooling of blood in them and in turn swelling or enlargement of veins, leading to a condition called varicose veins. Varicose veins mostly occur in the legs, but they can form in any part of the body. Other varicose veins-related conditions include:

• Varicoceles: These are varicose veins on the testicles.
• Venous lakes: Varicose veins in the neck and face.
• Telangiectasias: Small, red-coloured clusters of blood vessels on the face and upper body.
• Spider veins: Red or blue-coloured spider webs-like structures or tree branches on the face and legs.
• Haemorrhoids: Varicose veins around the anus.
• Reticular veins: Flat, blue veins that develop behind the knees.

Various factors can increase the risk of varicose veins such as pregnancy, obesity, gender, age, lack of movement, and family history. The following surgeries are currently performed to remove varicose veins:

• Ambulatory phlebotomy
• Vein stripping and ligation

Vein removal surgery does not hinder the flow of blood as blood continues to flow through other veins.

Surgeons recommend ambulatory phlebotomy in individuals with small varicose veins located close to the surface of the skin. On the other hand, vein stripping and ligation is recommended to treat serious cases of varicose veins. The symptoms of varicose veins include:

• Purple or blue-coloured lump in the feet and legs
• Swollen ankles and feet
• Itchy, thin, and dry skin over the affected area
• Heavy, aching, and uncomfortable legs
• Throbbing or burning sensation in legs
• Muscle cramps in legs, especially during the night

Surgeons do not perform vein removal surgery in individuals with the following conditions:

• Pregnancy
• Deep vein thrombosis
• Arterial insufficiency
• Enlarged superficial veins formed as a result of occluded (obstructed) deep veins

In addition, the surgery is performed with caution if you have any of the following:

• Venous reflux (reverse flow of blood in veins usually due to improper functioning of valves) along with arteriovenous fistula (an abnormal passage between an artery and a vein)
• Venous malformation (when veins do not grow properly)
• Post-thrombotic syndrome (a complication of deep vein thrombosis)

You will be asked to visit the hospital a few days prior to the surgery for preoperative assessment. During the evaluation, the doctor will conduct a physical examination to check for signs of swelling and also do an ultrasound scan to assess the condition. You will need the following preparations before the surgery:

• Inform your healthcare provider if you are pregnant.
• You will be asked to share a list of all the medications that you take, including herbs and over-the-counter medicines.
• Your healthcare provider will ask you to discontinue certain medications a few days before the surgery, including medicines that thin your blood like warfarin, aspirin, naproxen, and ibuprofen and give you a list of medications that you can consume till the scheduled day of surgery.
• You will need to remove make-up, nail polish, and body piercings if you have any, and take a shower before arriving at the hospital for the surgery.
• Arrange for a friend, family member, or responsible adult to drive you home after the procedure.
• Inform your surgeon if you experience flu, fever, or cold on the days leading to the surgery.
• If the surgery is performed under general anaesthesia (to make you fall asleep during the surgery), you will be asked to fast (no drinking or eating) for six to eight hours prior to the operation.
• You will need to sign an approval or consent form to give your permission for the surgery.

Once you arrive at the hospital, the medical staff will ask you to wear a hospital gown. In addition, they may insert a needle in a vein your hand to provide you essential fluids and medicines during the surgery.

Ambulatory phlebotomy surgery consists of the following:

• You will be given local anaesthesia to numb the surgical area.
• A surgeon will make small incisions (cuts) in the path of the varicose vein.
• He/she will insert a surgical hook through the incision, make a cut in the vein and remove the varicose vein with gentle traction.
• Stitches will not be required as the cuts are small. The surgeon will cover your incisions with a small bandage.

The surgery takes about an hour to complete. After the procedure, the medical team will cover your leg with a comfortable, snug compression wrap. You can leave the hospital on the same day of surgery.

The vein stripping and ligation surgery consists of the following:

• General or spinal anaesthesia (medicine to numb the area of the body down the waist) will be given to you.
• The surgeon will make two to three cuts around the varicose vein and at the top and the bottom of the vein to be removed. For varicose veins in the leg, one cut will be made in your groin, while the other cuts will be made near your ankle or calf.
• The surgeon will insert a thin wire made of plastic into the vein through the cut in your groin and push towards the other cut made in the lower part of your leg.
• He/she will then tie the wire to the affected vein and pull the wire along with the vein through the lower cut.
• In case of other varicose veins present near the surface of the skin, ambulatory phlebectomy may be performed to remove them.
• After the procedure, the surgeon will close the cuts with stitches and cover them with bandages.

The surgery lasts for an hour to an hour and a half. You will be given compression stockings to wear after the procedure, and you can go home on the same day. 

Once you reach home, you will need to take care of yourself in the following manner:

• You will be advised to wear compression stockings after the surgery. The stockings exert gentle pressure on the legs to prevent blood from pooling again in the veins and reduce swelling.
• Do not sit or stand for extended periods.
• Begin walking for a short duration from the day after the surgery. Gradually increase your pace and duration of walking over the next few days.
• Keep your operated leg in an elevated position while sitting and sleeping. Do not sit cross-legged. Moreover, try to move your feet in circles and to and fro while sitting.
• Do not wear high heels for a prolonged period.
• Consult your surgeon before you resume driving.
• Arrange for someone to assist you with your household chores for a few days after the surgery.

The ambulatory phlebotomy surgery has the benefit of not needing stitches as it requires a tiny incision. Vein removal surgery reduces the pain and other symptoms of varicose veins; besides, it also enhances the appearance of your affected leg.

When to see the doctor?

Visit your healthcare provider if you experience any of the following after the surgery:

• Increasing pain or swelling in the operated leg
• Fever
• Chills
• Severe bleeding from the incision site
• A numbing sensation in feet or legs
• Shortness of breath
• Chest pain
• Redness and soreness at the operated site

The potential risks and complications associated with this surgery include:

• Formation of blood clots
• Infection
• Bleeding
• Nerve injury
• Scarring or bruising
• Breathing problems
• Allergic reaction to anaesthesia
• Recurrence of varicose veins

A follow-up appointment will be scheduled for two weeks after the surgery wherein your surgeon will perform a physical examination, blood and imaging tests to check the improvement in your condition.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.