Varicose veins of the lower limbs – minimally invasive endovenous ablation surgery

Introduction
The lower limb venous system is composed of deep veins, superficial veins, and perforating veins. It is responsible for returning deoxygenated blood from the lower limbs to the heart, thus maintaining good blood circulation. Incompetence of the unidirectional valves within the veins leads to blood reflux, causing blood stasis and increased venous pressure. This results in venous dilation and tortuosity, known as varicose veins of the lower limbs. Patients may experience lower limb oedema, fatigue, and pain, and in severe cases, this can lead to complications such as skin pigmentation of the feet, thrombophlebitis, ulcers, and bleeding. Surgical treatment can alleviate uncomfortable symptoms, reduce the occurrence of complications, or promote the healing of existing complications.

Surgical procedure
This procedure can be performed under general, regional, or local anaesthesia. The doctor will use laser energy to ablate and close the problematic great saphenous vein. The doctor will first inject a local anaesthetic into the thigh and make a puncture under the skin in the thigh, before inserting a fibre optic catheter into the great saphenous vein. The fibre optic catheter will then release laser energy, burning and causing the vein to shrink and close. Any remaining varicose veins below the knee will need to be removed through several small incisions (approximately 0.5 to 1 cm). In general, you will be able to resume your normal activities on the day of the surgery and return home to rest.

Surgical risks or complications

1. Systemic complications
2. Cardiovascular system complications: Myocardial infarction
3. Respiratory complications: pneumonia, respiratory failure
4. Other: Stroke
5. Localised complications
6. The wound has formed a haematoma or is showing a dark bruise colour.
7. Wound infection or poor healing
8. Deep vein thrombosis of the lower limb
9. Laser energy burns skin
10. Damage to skin nerves in the surgical area, causing numbness or pain in the inner calf and foot.
11. Varicose veins recurrence

Pre-operative preparation

1. For elective surgery, admission is usually arranged for the morning of the operation. If necessary, you will undergo pre-operative checks, including blood tests, X-rays, or an ECG.
2. The doctor will explain the procedure to you and your family in detail, and you will need to sign a consent form.
3. Before your operation, a healthcare professional/vascular diagnostic technician will mark the site of your affected limb where the surgery will take place. Nurses may also apply a local anaesthetic to your affected limb.
4. The night before your operation, you will need to shave hair from your groin, pubic area, and the affected limb.
5. You will need to stop eating and drinking approximately 6 hours before your surgery. The nursing staff will inform you of the time you need to stop eating and drinking.
6. Before going into the operating theatre, you must change into a surgical gown, put on a surgical cap, and wear surgical socks (remove your own clothing, including underwear, dentures and accessories).
7. You may need to have an intravenous drip (saline drip), and to take or receive injections of pre-operative medication.

Post-operative instructions
Post-operative general condition / activities

1. After general anaesthesia, you might feel tired, weak, or dizzy. This is a common post-anaesthetic symptom and will gradually disappear. You can resume your normal activities as guided by the medical staff. You may experience throat discomfort or phlegm, and you should follow instructions to perform deep breathing and coughing exercises to help reduce the risk of lung infection.
2. After surgery under local anaesthetic, you only need a short rest before you can resume your normal activities.
3. A compression bandage will need to be used/medical compression stockings will need to be worn after surgery.
4. When resting in bed, you must elevate the affected limb on pillows so that the lower limb is above heart level and perform foot exercises to promote blood return.
5. Avoid strenuous exercise for 2 weeks after surgery.

Wound dressing

1. After your operation, your wound has been covered with a sterile dressing and plaster. Please remember to keep the wound clean and dry and attend the outpatient clinic for dressing changes as instructed.
2. Bruising may occur in the thigh area and will usually fade gradually.
3. Take painkillers as prescribed by your doctor when needed at home.
4. The stitches on the wound will be removed approximately 7-10 days after surgery.

Food and drink

1. The doctor will assess your condition after surgery, and you will gradually return to a normal diet.
2. Except for patients with kidney disease, diabetes, and the like who need to diet, general patients can eat a normal diet.

Post-discharge instructions

After recovery, you must continue to take the following preventive measures for varicose veins to reduce the recurrence rate:

1. Avoid standing or sitting for long periods.
2. Perform appropriate lower limb exercises regularly.
3. When resting in bed, elevate the lower limbs above heart level to promote venous return.
4. Avoid being overweight.
5. Continued use of therapeutic medical compression garments, such as graduated medical compression stockings (below-knee compression stockings, compression 20-30 mmHg).

Notes

This leaflet provides only basic information about the surgery, and not all possible risks or complications can be listed. The risk level also varies for different types of patients. Please contact your doctor if you have any questions.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/vascularsurg_endovenouslasertherapyforvaricoseveins_0176_chi.pdf