Varicose veins are abnormally enlarged, swollen veins which most commonly appear as blue or dark purple lines on the legs. Spider veins are virtually the same as varicose veins, but they do not bulge, are more visible and are closer to the skin surface. Both are very common, affecting about 20% of the adult population and usually follow a benign course.

Surgery performed to treat this condition is called ligation and stripping, commonly known as varicose veins surgery. 

Varicose veins are very common and can usually be managed without any invasive treatment. However, if the condition causes significant symptoms such as severe pain, ulceration, bleeding into the skin, swelling and/or numbness, surgery may be considered to treat the condition.

However, in most cases, conservative measures such as using compression stockings or sclerotherapy must be tried first and surgery is indicated only when all other treatment methods fail.  

Varicose vein surgery has a low risk of complications. However, the following complications may occur in some individuals:

• Allergic reaction to the anesthesia used during surgery
• Wound complications including cellulitis and hematoma
• Numbness or tingling in the affected leg
• Pain and soreness near the incision site
• Infection near the wound
• Leakage of lymph from the groin
• Nerve damage in the affected limb
• Changes in skin color over the treated vein
• Abnormal bleeding from the incision
• In case these complications occur, call your GP right away for further advice.

Surgery to treat varicose veins or spider veins is extremely effective, with low risk of complications and a good chance of full recovery.

Around 80% of all patients who underwent surgery to treat their varicose veins reported having almost no pain after the procedure and significant decrease of other symptoms. The cosmetic appearance of the affected leg is also better after surgery. 

Being an invasive procedure performed by skilled surgeons, surgery to treat varicose veins can cost anywhere from INR 90,000 and INR 1,50,000, depending on the condition of the patient and the hospital where the surgery is performed.

Despite being an invasive procedure, recovery from varicose vein surgery is usually quick and eventless. However, some steps need to be taken to ensure prompt recovery and lower the risk of complications. These include:

• Driving should only be resumed a week after surgery, depending on your doctor’s advice
• Do not engage in strenuous exercise until at least a week after the surgery
• Avoid lifting anything over 20 pounds until the wound heals
• Do not soak the treated leg until a week after surgery
• You can resume your daily work around two weeks after the surgery, or when your doctor gives you the all-clear.

Since the surgery is performed under general anaesthesia, you will feel no pain during the procedure. After the surgery, some burning or stinging sensation in the affected limb may occur; however, pain after surgery is rare.

Even if post-operative pain does occur, it will soon subside and usually vanish in a few weeks. Non-narcotic pain medication is usually enough to control post-operative pain if any.

Sclerotherapy is a procedure performed to treat spider veins. It involves injecting a solution containing an irritant directly into the vein. This solution causes inflammation, scarring and eventually coagulation, forcing blood to flow through healthier veins.

Sclerotherapy is usually the treatment of choice for smaller and less severe cases of spider veins as it is minimally invasive and has high rates of success. However, it is not suitable for larger veins and also not performed in cases where the patient has problems with blood clotting. 

Despite being an invasive procedure, surgery to treat varicose veins has high rates of success. The chances of major post-operative complications occurring is very less (<1%), and hence the surgery should be considered in cases where the condition is significantly affecting the patient’s daily life. 

Most varicose veins are benign and harmless, though they may cause some degree of pain and discomfort. However, there are instances where severe cases of spider veins, if left untreated, cause a condition called Deep Vein Thrombosis.

Deep Vein Thrombosis is a clot forming in the deep vein of the leg which may later break free and travel to the lungs through the bloodstream, causing a life-threatening Pulmonary Embolism. The fact that it causes no symptoms makes this condition all the more serious.

However, one must note that such complications are very rare and patients are advised to follow the directions of their doctor, who can decide if treatment is required depending on the patient’s age, present condition, symptoms and risk of further complications.

In sclerotherapy, your doctor will inject affected veins with a foam or some other similar solution through a fine needle. This solution blocks blood flow through the affected veins and channels the blood flow through different veins. Thus, the vein is practically sealed off. The entire procedure takes around 15 to 30 minutes and can be done on an outpatient basis.

This procedure is usually risk-free and effective in most cases, though repeat procedures may be required to completely close the vein.

There are several conservative measures which are implemented in the treatment of varicose veins before surgery is considered.

In case of no symptoms or discomfort, varicose veins may be left untreated. However, when symptoms do occur, the following treatment measures may be tried:

• Using compression stockings
• Self-care such as exercise, weight loss, and elevating legs
• Sclerotherapy (for small veins) and foam sclerotherapy (for large veins)
• Laser Treatment
• High ligation and vein stripping

These treatments are often effective and may prevent or delay the need for surgery.

Varicose veins are enlarged, twisted, and swollen veins that are seen under the skin. They usually appear blue or red in color and are usually on the legs, but can also be present in other parts of the body.

The exact cause of varicose veins is not known.
However, varicose veins usually occur when the walls of the veins weaken.
As the blood pressure in the vein increases, the weakened walls allow the vein to get bigger.
As the vein stretches, the valves that usually move blood in one direction cannot work as they should.
The sluggish blood backs up or pools in the vein, leading the vein to bulge, swell, and twist.

Some factors increase the possibility of developing varicose veins and may include the following:

• More common in women
• Age above 50 years
• Menopausal women
• Obesity
• Family history of varicose veins
• Jobs that require standing for long hours
• Pregnancy

The symptoms of varicose veins include:

• Twisted, swollen, rope-like blue or purple vein just under the surface of the skin.
• Legs that feel tired, sluggish, or heavy
• Itching around the varicose veins
• Swelling of the legs, ankles, and feet
• Legs that may be painful or sore
• Discoloration of the skin
• Sores (ulcers) on the skin

A varicose vein surgery may be performed by a vascular surgeon, phlebologist, or dermatologist.

The following diagnostic tests are performed before a varicose vein surgery:

1. Physical examination: The doctor examines the physical health status of the patient. The legs are checked for swelling while standing. The doctor will inquire about the pain and aching in the legs, and any other symptoms that the patient may be having.
2. Venous Doppler ultrasound: This is a non-invasive test in which sound waves are used to view the flow of blood through the valves in the veins. A leg ultrasound can help in the detection of a blood clot. 
3. Blood tests: These tests help to check for the presence of underlying medical diseases like diabetes and thyroid disorders.
4. Urine tests: These tests help to check for any urinary infections that may be present.
5. Chest x-ray: A chest x-ray helps in checking the condition of the heart and lungs before surgery.
6. Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart and checking for underlying heart problems.

The following preparation may be required for a varicose vein surgery:

• The doctor should be told about any medical illnesses that you may be having.
• If you are allergic or sensitive to any medications, anesthetic agents, latex, iodine, or tape, inform your doctor about the same.
• If you are taking currently on any supplements, herbs, or medications, inform the doctor.
• Stop smoking at least two weeks before the surgery.
• You will be told to stop taking blood-thinning medications, like aspirin and warfarin, at least a few days before the procedure.
• Avoid shaving the skin on the body part that is going to be operated on, a few days before the surgery.
• You will be told to not eat and drink anything eight hours before the surgery.

The following are the conservative approaches for treating mild forms of varicose veins at home:

1. Self-care: This form of treatment includes self-care, like exercise, raising the legs while sitting or lying down, maintaining a healthy weight, exercising, and wearing compression stockings.
2. Compression stockings: They help in squeezing the legs and the leg muscles and veins in moving the blood more efficiently.

The different methods to close the varicose veins are:
1. Sclerotherapy:

• A solution is injected by the doctor into the vein which causes scarring.
• This leads to a change in the route of the blood and the blood flows through healthier veins instead of damaged veins.
• The collapsed vein then gets reabsorbed into the surrounding tissue.
• Many such treatment sessions are needed, usually 4 to 6 weeks apart, to close off a vein completely.
• The procedure is normally done without anesthesia, and the patient can only feel a small needle prick sensation from the injections given.
• The patient has to wear compression stockings for some weeks following each treatment procedure.

2. Microsclerotherapy:
This procedure is similar to sclerotherapy, but the doctor uses a smaller needle to treat smaller varicose veins.

3. Laser therapy:

• The doctor uses this therapy to close off the vein with bursts of high-intensity light.
• No needles or cuts are used during this procedure.
• This procedure is normally done in cases of small varicose veins.

4. Endovenous ablation therapy:

• Laser or radio waves are used by the doctor to close the varicose vein.
• Local anesthesia is first used to numb the area of treatment.
• A small incision or cut is then made on the skin.
• A thin tube is then inserted through this incision. The tube has a device that uses laser or radio waves for creating heat to close the vein.
• The patient’s leg is then wrapped in a compression bandage.

5. Endoscopic vein surgery:

• An endoscope (a tiny tube with a small camera on one end) is used in this procedure.
• The doctor threads the endoscope tube into the vein through an incision in the skin.
• A surgical device is then used at the end of the tube to close the vein.
• This procedure is generally performed only when the varicose veins lead to severe skin ulcers.

The different methods for the removal of varicose veins are:

1. Ambulatory phlebectomy:
Varicose veins close to the skin surface are removed using this method.
The doctor first numbs the area using local anesthesia and then removes the veins through small incisions.

2. Vein stripping and ligation:
This type of surgery is generally performed under general anesthesia (the patient is put to sleep during the procedure).
This procedure is normally performed for severe varicose vein cases.
The doctor makes at least two incisions in the skin, ties off the damaged veins, and then removes them.

The following post-procedure steps are performed after a varicose vein surgery:

• Depending on the type of procedure being performed, the patient may be discharged on the same day of the procedure or the following day after the surgery.
• Recovery may take approximately one to five weeks, depending on the type of procedure performed, the size of the vein operated upon, the after-care procedures followed, and the overproduction health of the patient.
• It is normal to have some pain and discomfort after the surgery. The doctor may suggest pain-relieving medications for the same.
• It is normal to have some bruising and a change in skin color after the procedure.
• The patient can resume his/her daily activities a few days after the procedure.
• It is important to check for signs of infection or blood clot formation after the procedure, and visit the doctor immediately if such symptoms are seen.
• It is necessary to quit smoking and limit the consumption of alcohol after the procedure.
• The patient is asked to wear compression socks to keep the varicose veins under control and help in quick recovery after the surgery.
• Physiotherapy and mild exercises are recommended after the procedure to improve circulation to the legs.
• Yoga, stretching, and walking are recommended following a varicose vein surgery.

The complications of a varicose vein surgery are:

• Infection
• Bleeding or bruising
• Allergic reaction to the anesthesia used
• Pain
• Blood clot formation
• Development of a lump under the wound
• Nerve damage
• Tingling sensation or numbness near the affected veins
• Continued varicose veins
• Leg swelling
• Development of thread veins
• Damage to deeper veins
• Change of the skin color near the vein removal site

Varicose veins can be prevented by making the following lifestyle changes:

• Maintaining a healthy weight
• Exercise regularly
• Raise your legs when sitting or lying down 
• Eat a high-fiber and low-salt diet
• Avoid sitting or standing in one position for long hours
• Avoid tight hosiery 
• Avoid wearing high heels