Surgery: Most varicose vein surgery can be done as day surgery or short stay surgery. It can be done under general, regional or local anesthetic. I prefer the former two methods.
Following surgery I prefer to keep a compression bandage on for 48 hours. This can be replaced by a stocking until the first clinic visit one week later, and then dispensed with. In case the perforators are ligated, then there may be incisions in the leg, in which case stockings are given after stitches are removed.
Following surgery patients can walk, carry on with their social activities, go shopping etc. Driving can be undertaken once there is no groin tenderness. Surgery is associated with very little pain or tenderness. Most patients can commence work 4-5 days after surgery or less.
For patients with long saphenous vein incompetence the standard procedure involves a small groin incision. The long saphenous vein is tied off and divided from the femoral vein (together with surrounding branches ). It may then be stripped down to just below the knee (under the skin) or not. The varicose branches (which are premarked before surgery) are avulsed through a series of stab incisions about 2-5mm in length. The lesser saphenous vein is similarly dealt with except that the incision is behind the knee where this vein drains into the popliteal vein.
EVLT : Laser Treatment for Varicose Veins: Endovenous laser ablation is now available. This involves passing a laser catheter up the long saphenous vein. The laser catheter is then activated and slowly withdrawn down the vein. This heats up the inside of the vein wall causing it to stick together thus obliterating the inside of the vein. This procedure avoids a groin incision. Stab incisions are however still necessary. Patients can be back at work after 36 hours.
VNUS : This is the use of Radiofrequency to also heat up the vein and thereby close it. It also entails use of a catheter inserted in the vein.
Both EVLT & VNUS procedures are very similar except for the technology used, in one it is LASER energy and in the other Radio Frequency Waves are used.
With advances in technology both the procedures are being used and have similar results. Preference is basically surgeon dependent. However long term results in various series with recurrence rates of anywhere from 10 – 20{013d8e26d07b1afe015c72520babcb8884609227f71e52264d03663af3c2f983}.
Recurrence in the same vein can happen with any treatment of varicose veins, however the rate of recurrence with surgery is currently lower. Veins are known to grow back even after they are cut.
The drawback of EVLT or VNUS is that they do not treat the perforator veins which are mostly treated with sclerotherapy – after having done laser/RFA treatment to the main vein in the thigh -which as you already know has a 100{013d8e26d07b1afe015c72520babcb8884609227f71e52264d03663af3c2f983} recurrence rate at 4-5 years.
In my opinion the best and long lasting results for varicose vein treatment are by surgery which has to be carried out after a thorough color Doppler examination & any other required investigations, of the venous system of the leg.