Recovery after varicose vein surgery: swelling, bruising, walking and follow-up

Varicose vein surgery is not always the same procedure. The surgeon chooses the treatment after an examination and a Doppler scan, so recovery also differs. It is usually one of these procedures, and sometimes a combination of them:

• closing the vein from the inside through a needle puncture, for example with a laser or radiofrequency
• removing smaller varicose veins through a few small incisions
• sclerotherapy, an injection of a substance that closes the vein
• conventional surgery, in which the vein is tied off through an incision in the groin or behind the knee and removed through small incisions

After a procedure through a needle puncture, people usually return to everyday activities sooner. After conventional surgery recovery usually takes longer, and bruising and pain may last for several weeks. Recovery is also affected by the number of veins treated, whether one or both legs are treated, the type of anaesthesia and your general health. Your vascular surgeon will explain at the consultation which procedure is suitable and what exactly to expect afterwards.

After the procedure the leg is usually wrapped in a bandage or fitted with a compression stocking. Mild pain, a feeling of tightness and a stinging sensation along the treated vein are expected. Your doctor decides when you can go home. Do not drive yourself on the day of the procedure, so arrange for someone to accompany you in advance. Before the procedure it helps to have loose clothing, shoes that are easy to put on and a pillow for raising your legs ready at home. In the first days the usual advice is:

• short walks several times a day, from the day of the procedure, unless your doctor says otherwise; after spinal or general anaesthesia, get up for the first time only once the anaesthetic has worn off, with help from staff
• raising your legs above hip level when sitting or lying down
• avoiding standing for long periods and sitting for long periods without moving
• wearing the bandage or stocking exactly as instructed
• taking only the painkiller your doctor recommends, especially if you already take blood thinners
• if your doctor has prescribed a medicine to prevent blood clots, taking it exactly as instructed, without missing doses

After the vein has been closed from the inside, the feeling of tightness or pulling along the vein may increase a few days after the procedure, most often towards the end of the first week, as the closed vein gradually shrinks. This is usually part of the normal course and then eases, but mention it at your follow-up appointment. If the pain is severe or comes with swelling of the calf, contact your doctor before the scheduled follow-up.

Bruising along the treated vein and around the small incisions is common. It is most noticeable in the first days, then changes colour and gradually fades over several weeks. Mild swelling of the lower leg and ankle, especially in the evening, is also common. It usually goes down over several weeks with walking, raising your legs and wearing the compression stocking.

Sometimes a firmer, tender cord or a small lump can be felt along the vein. This is usually the closed vein or a small collection of blood under the skin, which settles over time. If the cord is red, warm and increasingly painful, contact your doctor, as this may be inflammation of the vein that needs to be examined. The skin over the treated vein sometimes stays darker, which usually fades over several months. Some people also notice numbness or tingling of the skin over a small area of the leg, because small nerves next to the vein have been irritated. This usually settles gradually, sometimes only after several months, and rarely remains permanent. Mention it to your doctor at your follow-up appointment.

Expected symptoms gradually ease over the following days and weeks, although tightness after the vein has been closed from the inside may briefly increase towards the end of the first week. Swelling that suddenly gets worse, calf pain that keeps increasing and redness that spreads are not part of normal recovery. These signs are described further below, in the section on when to contact a doctor before your scheduled follow-up.

Walking is part of the treatment. The calf muscles help blood flow faster through the deep veins, which reduces swelling and the risk of a blood clot. Start with short walks several times a day and gradually make them longer. As a rough guide, based on general recommendations:

• lighter work and everyday activities: after the vein has been closed from the inside, often within a few days, and after conventional surgery usually within one to three weeks
• work that involves standing for long periods or physical effort: usually later, as agreed with your doctor
• running, the gym, intensive exercise and lifting heavy objects: after the vein has been closed from the inside, usually after one to two weeks, and after conventional surgery later, once your surgeon allows it
• showering with lukewarm water: usually after 24 to 48 hours, when your doctor allows the first bandage to be removed
• baths, swimming pools, the sea, saunas and strong sun on the leg: usually postponed for several weeks, until the incisions have healed and your doctor allows it
• driving: when you can brake suddenly without pain, are not taking medicines that make you drowsy and your doctor approves; after general anaesthesia or sedation, the next day at the earliest
• a longer flight or coach journey in the first weeks after the procedure: agree this with your doctor, and during the journey wear a compression stocking if your doctor advises it, take breaks, move your feet and drink enough water

These are general guidelines, not rules for everyone. Your surgeon will give you the exact timings for your procedure at discharge and at your follow-up appointment.

A compression stocking or bandage puts pressure on the treated area. This reduces swelling, pain and bruising and helps blood flow through the veins. How long you wear it depends on the procedure and your surgeon's assessment: usually from a few days to a few weeks. Some surgeons ask for it to be worn day and night in the first days, and then only during the day. Do not remove the first bandage or stocking until your surgeon allows it. A few practical tips:

• wear the stocking your doctor has recommended, in the right size and compression strength
• once your doctor allows you to take the stocking off at night, put it on in the morning before you get up, when swelling is at its lowest
• the stocking must not wrinkle, dig into the skin or squeeze like an elastic band
• if your toes turn pale or blue, feel cold or go numb, loosen the bandage or take off the stocking and contact your doctor; if the colour and feeling in your toes do not quickly return, seek urgent assessment
• do not stop wearing it earlier without agreeing this with your doctor

Your surgeon decides the schedule of follow-up appointments, and the first one is usually in the first or second week after the procedure. At the first follow-up the doctor usually examines the leg, incisions and bruising, asks about pain and swelling and checks how you are wearing the stocking. If the incisions were closed with stitches that need to be removed, your doctor will tell you when this will be done.

After many procedures, and especially after the vein has been closed from the inside, your doctor may arrange a follow-up Doppler scan, an ultrasound scan of the veins. The Doppler scan shows whether the treated vein is closed and whether there is a clot in the deep veins. The scan is done with gel, with no needles and no radiation. A Doppler scan of the leg blood vessels can be done at Maja Radiology, at the same address as Maja Hospital, Vizantijski bulevar 39 in Niš. The price of the Doppler scan is in the radiology price list.

Later follow-up appointments are used to check the result and the condition of the other veins. Varicose veins can appear elsewhere over time, so your doctor will advise when to come back. Bring your discharge summary, previous Doppler results and your questions written down to the follow-up appointment.

Contact your surgeon or GP the same day, without waiting for your scheduled follow-up, if you notice:

• swelling of the calf or the whole leg that is getting worse, especially with pain or tightness in the calf
• pain that keeps getting worse and does not settle with rest, raising the leg and the painkiller your doctor recommended
• a hard cord along the vein that is red, warm and increasingly painful
• redness, warmth, pus or an unpleasant smell at the incision site, or an incision that opens and leaks
• a high temperature or shivering
• a stocking or bandage that is so tight your toes change colour or go numb

If the wound bleeds, lie down, raise your leg and press on the area with clean gauze for about ten minutes. If the bleeding does not stop, call an ambulance on 194.

Sudden swelling and pain in the calf or the whole leg need urgent assessment at the nearest emergency department, as they may be a sign of a clot in a deep vein. Sudden breathlessness, chest pain or coughing up blood may be a sign of a clot in the lungs and mean calling an ambulance on 194. These signs are rare, but do not wait for your scheduled follow-up if they occur.

The procedure closes or removes varicose veins, but it does not change the tendency for new ones to develop. That is why habits that take the strain off your veins remain useful after recovery is complete:

• regular activity, such as walking, swimming or cycling, once your doctor allows it
• maintaining a healthy body weight
• taking breaks and moving your feet when standing or sitting for long periods
• raising your legs when you rest
• compression stockings when standing for long periods or travelling, if your doctor advises them

A special diet after varicose vein surgery is usually not needed. If you have dietary instructions because of another condition, they still apply after the procedure.