Varicose vein surgery in Niš

The veins in the legs carry blood back to the heart. They contain small valves that stop blood from flowing backwards. When the valves in the superficial veins do not close properly, blood pools in them, and the veins widen and become visible and twisted. These are known as varicose veins of the legs, or varicosities.

Varicose vein surgery closes or removes the superficial vein that is not working properly. This is usually the great or small saphenous vein and its branches. Blood then continues to flow through healthy veins, mainly the deep veins of the leg, which carry most of the blood from the legs. At Maja Hospital, the procedure is part of the vascular surgery service.

The decision on surgery is made after a consultation with a vascular surgeon and a Doppler ultrasound scan of the leg veins. Varicose veins are not always a reason for surgery.

The surgeon usually suggests the procedure when the Doppler scan shows that blood is flowing backwards through a superficial vein and there are also symptoms or changes such as:

• a feeling of heaviness and tiredness in the legs, especially after standing for a long time
• swelling around the ankles towards the end of the day
• cramps in the calves at night
• changes in skin colour, eczema or hardening of the skin on the lower leg
• a wound on the lower leg that is slow to heal
• repeated inflammation of a superficial vein, or bleeding from a varicose vein

These symptoms can also have other causes, for example heart, kidney or arterial disease, so they should always be assessed by a doctor.

For some patients, wearing compression stockings, moving about more and attending regular check-ups is enough. The strength of the stockings is decided by the doctor after checking the circulation in the arteries of the legs, because when blood flow through the arteries is reduced, strong compression can cause harm.

The procedure is usually postponed during pregnancy and for some time after giving birth, and also in the case of a recent deep vein thrombosis or inflammation of a superficial vein. If the deep veins have been blocked in the past, or the circulation in the arteries of the legs is reduced, the surgeon assesses particularly carefully whether the procedure is possible. This is always decided by the doctor.

This is an overview of the methods used today. At the consultation, the surgeon explains which of them are offered at Maja Hospital and which one suits your findings. The surgeon chooses the method on the basis of the Doppler findings, the width and course of the vein and your general health.

Closing the vein with a laser (endovenous laser ablation, EVLA). Through a small puncture in the skin, guided by ultrasound, a thin fibre is passed into the vein. Heat from the laser closes the vein from the inside. It is usually done under a local anaesthetic, through a puncture, without a surgical cut.

Closing the vein with radiofrequency energy (radiofrequency ablation, RFA). The principle is the same as with the laser, but the vein is closed by a thin catheter that is heated with radiofrequency energy.

Conventional surgery. The vein is tied off in the groin or behind the knee and removed through small cuts. It is usually done under a spinal or general anaesthetic. It is still used today, for example when the vein is very wide or twisted.

Removal of branch veins through small punctures (phlebectomy). Varicose side branches are removed through punctures a few millimetres long, often together with one of the methods above.

Sclerotherapy. A substance that closes them is injected into a smaller vein or into thread veins. It is done as an outpatient procedure, usually without an anaesthetic.

There are also other methods, for example closing the vein with medical glue.

Arrive for admission at the time agreed with the hospital, bringing your test results and a list of your medicines. Your medical records are checked, the doctor talks to you about the procedure once more, and you sign a consent form for the procedure.

Before the procedure, the surgeon uses ultrasound, usually while you are standing, to mark on your skin the course of the vein and the branches to be treated. The anaesthetic is then given: usually a local anaesthetic when the vein is closed from the inside, and usually a spinal or general anaesthetic for conventional surgery.

After the procedure, an elastic bandage or a compression stocking is put on your leg. After a local anaesthetic, you usually get up and walk about after a short rest. After a spinal or general anaesthetic, you get up only once the anaesthetic has worn off, the first time with help from the staff. Before you are discharged, you receive written instructions, advice on wearing the stocking and an appointment for your first follow-up.

Arrange for someone to accompany you home. Do not drive yourself on the day of the procedure.

The Maja Hospital team includes Dr Nemanja Stepanović, a specialist in vascular surgery. You will find out who will carry out your procedure at the consultation. When a spinal or general anaesthetic is needed, it is managed by a specialist in anaesthesiology and resuscitation.

Every procedure carries certain risks, which the surgeon discusses with you at the consultation. After varicose vein surgery, the most common effects are bruising, tenderness and a feeling of tightness along the treated vein. These usually settle within a few days to a few weeks.

Less common effects include numbness or tingling in a patch of skin (this usually goes away and only rarely becomes permanent), inflammation of a superficial vein, darker discolouration of the skin over the vein, a collection of blood under the skin and inflammation at the site of a puncture or cut. Deep vein thrombosis is rare, and very rarely a blood clot travels to the lungs. The risk is reduced by walking after the procedure, wearing a compression stocking and having a follow-up ultrasound scan, and for some patients the doctor also prescribes a medicine to prevent blood clots.