Day case varicose vein treatment

These days most varicose vein surgery is done via the endovenous ablation technique. This is a keyhole procedure, it's done without general anesthesia by and large and it's done in about 25 to 35 minutes. Literally you can walk into the procedure room, have your treatment and walk out again. Now the procedure is split into two sections. The origin or cause of the problem is in the truncal veins quite often. These are the saphenous veins, the great saphenous and the short saphenous veins. These veins are treated using an ablation technique. The most common ablation technique is a thermal ablation technique. This thermal ablation technique can be done using a laser fibre providing the heat energy or a radio frequency fibre providing the heat energy. The second part of the procedure is potentially optional, depending on your venous anatomy. The second part of the procedure I'm referring to is treatment of the varicoses. These are the visible varicose veins you see in your leg. These visible varicose veins can be treated with either avulsions, which involves making small incisions and removing the veins directly using forceps, or potentially we can treat these varicocities, these visible varicose veins using foam injections. Now is it necessary to do the treatment of the visible varicocities at the same time as the origin, truncal varicose veins? The answer is probably no, you don't have to have them done at the same time. And studies have been done to show that perhaps up to 75% of people are very happy with the results after treatment of the truncal veins themselves. On the day of your surgery, you'll come into a treatment or procedure room, or potentially an operating theatre, after having been consented for the procedure. A consent process needs to involve good understanding of what the reasons are you're having the procedure and the risks associated with the procedure, so you have a balanced decision that you make in conjunction with your surgeon. But once you've been appropriately consented for the procedure and you've entered the procedure room, you'll be wearing a gown at the top half of your body and obviously the lower half will be accessible for the procedure. You'll lie down on a couch and we will prepare your skin by sterilizing it with an antiseptic solution. Once that's done, we'll apply the appropriate sterile drapes to make sure that the operative field where we are performing the procedure isn't subject to any infection, infectious sort of bugs and whatnot. Now we use ultrasound to find the vein that we want to remove from the circulation, the truncal varicose vein. Using ultrasound guidance we insert a needle into that vein and then exchange that needle for a wire and then a catheter, a catheter, or a sheath, sorry, is a flexible plastic tube. Now the purpose of that flexible plastic tube is to allow the passage of radio frequency or laser fibre into the vein to do the job that we want it to do. This process of puncturing the vein with a needle and eventually having a sheath inserted, the flexible plastic tube takes between one and five minutes generally, and the puncture itself can be numbed by local anaesthetic. So you will feel pushing and pulling but you shouldn't feel any sharp pain. Once the access to the vein has been established, we then pass the catheter which will deliver the energy up the vein to the junction with the deep vein, being very careful not to compromise a deep vein at all. Once the catheter is in the appropriate position, we then need to numb the vein before we deliver the energy to treat the vein. And that numbing process is done by what we technically term cumescent anaesthesia. It's essentially a solution of local anaesthetic which we inject around the vein with a series of needle injections down the leg. Now that does feel like a heaviness in your leg while that injection is happening, well while those injections are happening, but the purpose of it is to act as a heat sink when we when we treat the vein with the energy delivering catheters. Also it prevents pain and discomfort largely. As the procedure is done awake and under local anesthesia you will be aware of what's happening and again it's important to understand that you will feel pushing and pulling but the vast majority of patients tolerate this part of the procedure without too much difficulty at all. Once your truncal varicose vein has been treated using the endothermal ablation technique the next bit is to apply some compression to the leg to support the leg during the healing face. Now personally I quite often apply a compression bandaging to the treated leg and I ask the patient to keep that compression bandaging on for 24 to 48 hours. At the end of that 24 to 48 hour period I ask the patient to put on some compression stockings. Now they're all the way up the thigh down to the down to the toes and I do ask the patients to wear them 24 hours day and night for at least a week and two if possible and that just allows a little bit of support to the leg while it's healing. Return to work can be as soon as your body tells you you're able and within a day or so I would expect that the vast majority of patients will be will be ready to go back to their normal activities.