Varicose Veins - Laser and RFA
After My Operation
Laser or RFA with phlebectomies as a daycase
After two or three hours on the ward you should feel fit enough to go home. Before you leave the ward staff will check your leg. They will give you a note for your general practitioner, and some painkillers to take with you. You will also be provided with an advice sheet. Your bandages will be removed the next day and a special support stocking is worn.
What about my wounds?
Sometimes a little blood will ooze from the wounds during the first 12-24 hours after the operation. The amount is likely to be very small and bleeding usually stops on its own. If necessary, press on the wound for ten minutes with a dressing or a pad of paper tissues. If bleeding continues after doing this twice, phone the ward or your general practitioner.
Areas of tender lumpiness may be felt on the legs. This is caused by some bruising under the skin in the places where varicose veins were removed. It is not harmful and will gradually go away, but this may take several weeks.
Will my legs be bruised?
Some bruising always occurs after varicose vein operations. This is sometimes quite extensive and may take some weeks to settle.
Will I have dressings or stitches?
The small cuts down the leg are so small, they do not require stiches or adhesive strips, and your surgeon does not use no dressings on the tiny wounds. Depending on the exact nature of the surgery, occasionally stitches are used but these will be absorbable and will not need to be removed.
What about bandages and support stockings?
If you are advised to wear stockings during the days after the operation, these may be worn all the time, but if you find them uncomfortable at night, they can be taken off before you go to bed and then put on again in the morning. They are mainly intended to support the leg while you are up and about during the day. You should get clear advice about when to discard stockings – usually about ten days after the operation.
The early days
How far should I walk?
Walking helps to disperse bruising and stops the leg becoming stiff. You can start to walk about as soon after the operation as you are able. The whole leg may be stiff, and tender to the touch in places. You will not damage any of the wounds by walking. Take painkillers and anti-inflammatories if you need them. Topical anti-inflammatory creams or gels can ease tender lumpy areas. Arnica can help sensitive bruising.
You should aim to take walks every day for the first week or two. For many people this simply means getting back to their active daily routine as rapidly as possible. There is no special advantage in going for a single long walk during the day, although you may walk as far as you wish. Frequent walking is more important than walking a long distance.
When you are not walking about try to put your foot up - either on a couch or on your bed. Avoid standing, or sitting with the foot on the floor as much as you can for about two weeks after the operation.
When will I be fully back to normal?
This varies a lot between different people, and depends on how large and extensive your varicose veins were, which dictates the size of operation you will have had. In particular your recovery will depend on whether you have had an operation on one leg or both legs.
If you have had surgery to one leg only:
You are likely to feel tired for the first two or three days after the operation, and your leg will be stiff after walking long distances for about a week. By two weeks after the operation you are likely to be walking good distances with little discomfort, even though the leg may still be bruised and a little tender.
If you have had surgery to both legs:
You may need to rest two or three times a day for the first few days. It may be two or three weeks after operation before you are walking really comfortably. Your legs may be a little tender and bruised for a month or more.
When can I drive a car?
You can drive as soon as you feel confident that you can make an emergency stop without pain. This is often about a week after surgery. If you have an automatic car and surgery to the left leg then driving may pose little problem! If you are concerned, check with your insurance company.
When can I fly?
It is probably best not to fly for approximately one month after the operation. This is particularly important for long haul flights.
When can I return to work and play sports?
You can return to work and sporting activity as soon after the operation as you feel sufficiently well and comfortable. One week off all work and a clear social diary is essential. If your job involves prolonged standing or driving, then you should not consider going back for at least two weeks. It is unusual to need more than about three weeks off work after surgery.
Avoid violent sports while you are still in support stockings or bandages, and thereafter start with some gradual training, rather than in immediate competition. Do not go swimming until you are out of support stockings and all the wounds are dry.
Complications are rare
Serious complications are uncommon after operations for varicose veins. Some bruising is usual, and occasionally the leg becomes very bruised. This bruising may appear during the first few days after the operation: it will all go away over a period of weeks.
1. Aches, twinges, and areas of tenderness may all be felt in the legs for the first few weeks after the operation. These will all settle down, and should not discourage you from becoming fully active as soon as you are able.
2. Lumps under the skin are common and are sometimes tender. They are not dangerous and will gradually be digested by the body, but this can take several weeks. Occasionally they can be quite painful during the first two weeks or more. Topical anti-inflammatory creams and gels are helpful.
3. Infection is an uncommon problem, but can occur. It usually settles with antibiotic treatment.
4. Rarely, a leak of clear lymphatic fluid can occur from a wound, and this may take days or weeks to dry up.
5. All complications in groin wounds are more common in people who are obese, and after operations done following previous surgery in the groin.
6. The scars on your legs are easily noticeable to start with, but will continue to fade for many months after the operation. Very occasionally, some people develop a little brown staining where the veins were removed, or areas of tiny veins appearing in the skin nearby: this is unpredictable and uncommon.
7. Small nerves under the skin can be bruised when removing varicose veins close to them. This is uncommon, but will give an area of numbness on the leg, which settles or gets smaller over some weeks. If varicose veins on the foot are removed, damage to small nerves is a special danger. If a main vein behind the knee needs to be dealt with, then there is a small risk to the nerve which conducts feeling from the skin on the outer part of the lower leg and foot. The risk of nerve damage is increased when surgery is done after previous operations in the area.
8. Deep vein thrombosis causes swelling of the leg and can result in a blood clot passing to the lungs. It is an uncommon complication after varicose vein surgery, but is particularly unlikely if you start moving your legs and walking frequently soon after the operation. Heparin injections are given just before surgery to make the blood clot less than normal: these reduce the risk of thrombosis but increase bruising. If you are taking the contraceptive pill, your risk of thrombosis is increased, and the surgeon will discuss with you the pros and cons of stopping the pill or continuing it and taking special action to reduce your risk of a thrombosis. If you start taking the contraceptive pill while waiting for your operation, let Professor Magee know.
9. Any general anaesthetic carries risks, but considerable precautions are taken to keep these risks as low as possible. The risk of death as a result of varicose vein surgery is less than one in a many thousands.
Will my varicose veins come back?
Some people develop new varicose veins during the years after a varicose vein operation, but this is uncommon after thorough surgery guided by accurate duplex scanning. Rarely, varicose veins simply re-grow in the areas which have been dealt with, or else they develop in a different system of veins which was normal at the time of the original operation. If veins develop again they can be dealt with should they be troublesome or unsightly