Open surgery removes the faulty vein rather than sealing it shut. The trunk is tied off where it joins the deep system, drawn out through a small cut lower down, and the bulging surface veins are hooked out through punctures a few millimetres long.
Laser has replaced open surgery for most straightforward veins, and for good reason: less bruising, no groin cut, and a faster return to work. Surgery keeps its place for the veins laser handles badly. A very large trunk, a very twisted one, or one lying immediately under the skin where heat could burn is safer and more reliably treated by removing it.
What decides it is the duplex scan, not preference. Both are done here, so the recommendation is not shaped by what is available.
These are usually combined rather than chosen between. A trunk is almost never stripped without also disconnecting its junction.
Duplex ultrasound of both legs, standing, shows which trunk is refluxing and where. Treating veins without it means treating the wrong thing in a proportion of legs.
Veins collapse when you lie down. Marking them standing, immediately before surgery, is what makes the cosmetic result predictable.
Compression limits bruising, reduces swelling and lowers the risk of clot. It is worn for two to four weeks by day in most cases.
The vein removed cannot come back, but new veins can become varicose over the years. A minority of patients need further treatment, usually foam rather than another operation.
Most recovery is uneventful. These few changes should be reported rather than waited out.
What patients ask when an operation rather than a laser has been recommended.
Ask your question →Usually because the vein is too large, too twisted or too close to the skin for heat to be used safely or effectively. Occasionally because a previous laser treatment on the same vein has failed. The duplex scan is what shows this.
Most people are back at desk work within one to two weeks. Bruising along the inner thigh looks dramatic for a fortnight and then fades. Work involving long standing, heavy lifting or a lot of driving usually needs two to four weeks.
No. The deep veins carry the great majority of the blood out of the leg and are untouched. The vein removed had already failed and was adding to the congestion.
Yes, and it is often sensible: one anaesthetic and one recovery. The first fortnight is harder because neither leg is comfortable, so if your circumstances make that difficult the legs can be staged.
Surgery for symptomatic varicose veins, and particularly where there are skin changes or an ulcer, is commonly covered by health insurance and by government schemes. Treatment of thread veins for appearance is not.
