Post-operative instructions
EndoVenous Radiofrequency Therapy
You are encouraged to walk as soon as possible to
prevent a blood clot. You can return to work within 72
hours post surgery.
EVLT is a, minimally invasive, percutaneous
endovenous technique for ablation of the incompetent
long saphenous vein.
You may have some bruising and soreness for 7-10 days
after the treatment, and you will be given a prescription
for some anti-inflammatory pain medication.
It is a safe, fast, durable and well tolerated procedure for
eliminating LSV reflux allowing patients to be
discharged one hour post-procedure. However not all
patients are suitable for this therapy and the option
should be discussed in more detail with your vascular
surgeon
Day 3: Remove the first (Class II) elastic stockings from
leg, leaving 2nd elastic compression stocking in place for
one week
1.
Day 7: Remove elastic stocking from leg and soak in
warm bath, with Savalon or salt. This will remove the
steristrips. Reapply elastic stocking and continue to wear
for at least two more weeks.
Week 6: You will have a check-up appointment. Options
for treating rare small persistent veins or spider veins,
e.g. photoderm therapy, can be discussed at this point.
Complications:
However, a few complications are associated with vein
stripping.
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Bruising or tender lumps may occur along the
course of the removed vein. These resolve within 68 weeks.
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Swelling of the foot and ankle may occur but
usually disappears within a few weeks. A few
simple measures help alleviate this, such as,
wearing compression stockings, avoiding long
periods of standing, sitting with you feet elevated,
taking short walks and keeping mobile.
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Rarely, the procedure can damage superficial nerves
that lie near the stripped vein, causing a patchy area
of numbness in the leg. The nerves usually recover,
however, and sensation returns within 6 to 12
months.
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8.
Sultan S. Thermal Ablation Is a Primitive Way of Managing Superficial
Vein Reflux. Vascular 2010; 18 (S2):S49-50.
Hoary M, Sultan S. Endovenous Subadventitial Stripping of the Great
Saphenous Vein: The 21st Century Graceful Solution. Vascular 2010;
18 (S2): S78.
Sultan S, Hynes N. Comparison of endovenous upward perforate
Invaginate stripping, downward Invaginate, and high-energy
endovenous LASER ablation for varicose veins. Vascular 2009; 17 (2)
S81-82.
Mwaura B, Hynes N, Connolly CE, Sultan S. The impact of differential
expression of extracellular matrix metalloproteinase inducer, matrix
metalloproteinase-2, tissue inhibitor of matrix metalloproteinase-2
and PDGF-AA on the chronicity of venous leg ulcers. Eur J Vasc
Endovasc Surg. 2006 Mar; 31(3):306-10. PMID: 16169261
Hoary M, Sultan S. Advances in Ablation of the greater saphenous vein
in the 21st Century: Development of an Endovenous Upward Perforate
Invaginate (EUPIN) stripping device and procedure based on best
medical practice. Vascular 2008 16 (2) S103
Hynes N, Sultan S. Comparison of Endovenous Upward Perforate
Invaginate Stripping (EUPIS), Downward Invaginate (DIS) and Highenergy Endovenous LASER ablation (HE-EVLA) for Varicose Veins:
Factors Influencing Complication Rate, Long-term Recurrence, Quality
of Life and Cost-effectiveness. Vascular 2008 16 (2) S154-155:
Tawfick W, Sultan S. Early Results of Topical Wound Oxygen
(TWO2) Therapy in the Management of Refractory Non-Healing
venous Ulcers (RVU); superior Role over Conventional Compression
Dressings (CCD) Vascular 2008 16 (2) S156-157:
Hynes N, Sultan S. The down slope of endovenous laser therapy for
primary varicose veins. Technology is still lacking. J Cardiovasc Surg
(Torino). 2007 Jun;48(3):S1;50
Prof Sherif Sultan, MB BCh MCh MD FRCSI DEVS
FISVS FASA DMD FRCS EBQS-VASC FACS,PhD
Depart of Vascular & Endovascular Surgery
Galway Clinic, Doughiska, Galway
Phone: +353 91 720122
Fax: 353 91 720121
E-mail: [email protected]
www.vascular.ie
Varicose Veins
A Guide for Patients
What are varicose veins?
Varicose veins are abnormal, dilated blood vessels
caused by a weakening in the vessel wall.
Your veins carry blood back to the heart. In your leg, this
means the blood has to flow upward, against gravity.
Consequently, these veins have one-way valves to
prevent the blood from back flowing. Over time these
valves can fail to close tightly allowing blood to pool and
causing the bulging and twisting characteristic of
varicose veins.
What are the symptoms of varicose veins?
Treatment
Some people do not have symptoms but may be
concerned about the appearance of the veins. If
symptoms occur, they may include:
Compression Stockings
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Swollen legs
Muscle cramps, soreness or aching in the legs
Tiredness, burning, throbbing, tingling or
heaviness in the legs
Soreness behind the knee
Itching around the vein
Brown discoloration of the skin, especially
around the ankles
Symptoms often worsen after prolonged standing or
sitting. In women, symptoms may be worse during
menstruation or pregnancy. Sometimes the condition
leads to more serious problems, such as, a painful blood
clot, referred to as superficial phlebitis (inflammation of
a vein), or skin ulcers.
How are varicose veins diagnosed?
What causes varicose veins?
High blood pressure inside your superficial leg
veins causes varicose veins. Factors that can
increase your risk for varicose veins include having
a family history of varicose veins, being
overweight, not exercising enough, smoking,
standing or sitting for long periods of time, and
having a history of Deep Vein Thrombosis (DVT).
Women are more likely than men to develop
varicose veins. Varicose veins usually affect people
between the ages of 30 and 70.
Pregnant women have an increased risk of
developing varicose veins, but the veins often
return to normal within 1 year after childbirth.
Women who have multiple pregnancies may develop
permanent varicose veins.
During a physical exam, the doctor will check your legs
while you are standing. You will also need to attend the
vascular lab for a non-invasive duplex ultrasound scan to
check the blood flow in the superficial veins (near the
skin’s surface) and deep
veins.
Your doctor may prescribe compression stockings, which
are elastic stockings that squeeze your veins and stop
excess blood from flowing backward. Compression
stockings also can help heal skin sores and prevent them
from returning. You may be required to wear compression
stockings daily for the rest of your life.
Skin Camouflage
The purpose of skin camouflage is to alleviate the
psychological, physical and social effects that can have on
people’s lives by the simple application of specialised
products. The specialist products are designed to be long
lasting and contain sun protection.
Venous disease is often associated with spider naevi and
telangiectasia (tiny veins on the surface of the skin). Skin
camouflage is effective in hiding these often unsightly skin
changes.
Key-hole technique: Varicose Vein Endostripping- 6 hour Admission
Vein stripping is the gold standard if intervention is needed
for varicose veins. To perform endovenous stripping, your
surgeon disconnects and ties off all varicose veins
associated with the saphenous vein, the main superficial
vein in your leg. This vein is then removed from your leg.
A procedure, called ‘small incision avulsion’ can be done
alone or together with vein stripping. Needle avulsions
allow your surgeon to remove additional varicose veins
branches from your leg using hooks passed through small
incisions. The skin is closed using steri-strips (sticky paper
strips) and if possible no stitches are used. You are let
home six hours post-surgery.