This information is provided as a resource and is not a replacement for the detailed and individualised patient information personally provided by Mr Ponosh
Veins are blood vessels that drain used blood up the leg back to the heart. There are two types of veins in your legs. The deep veins which do the bulk of the work, and the more superficial draining system.
The deep veins are larger veins deeper in the muscles that drain the majority of your legs blood back to the heart. These veins develop conditions such as deep vein thrombosis, colloquially known as “economy class syndrome”.
The skin draining system consists of 2 veins, the long saphenous vein running from the ankle to the groin on the inside of your leg and the short saphenous vein running up you calf from the Achilles to the back of your knee. These veins drain into the deep system. The malfunctioning of these veins is the common cause of varicose veins and are the focus of treatment in many cases.
These veins have no pump but rely on a system of hydraulics moving blood up the leg against gravity. When compressed, blood moves up these veins with one-way valves stopping the blood flowing back down the leg. Under certain circumstances these valves fail or become “incompetent” with blood now flowing up and down the leg. This reverse flow back down the leg causes abnormally high pressure in the veins. The veins cannot cope with this abnormally high pressure and dilate, thus causing varicose veins.
In addition, veins particularly at the ankle are “watertight” at these high pressures and thus become “leaky”. Fluid and inflammatory cells leak out causing many more sinister, non-cosmetic symptoms such as swelling, pigmentation, itching and even ulcers. This is known as chronic venous hypertension.
A common treatment for varicose veins with a failure of the major draining veins (long or short saphenous vein) is contemporary open varicose vein surgery. This consists of ligating (tying off) the draining veins in the groin and/or behind knee through a 2-3 cm incision and removing the draining vein to the knee. A number of small avulsion incisions (1-2mm) are then made over the varicose veins to “tease them out”. This is usually conducted under a general anaesthetic at St John of God Subiaco or Hollywood Private Hospital with one nights stay.
Anaesthetic Complications: Are extremely low with modern techniques. Your specialist anaesthetist will discuss options and risks with you at length.
Deep Vein Thrombosis (DVT): Is a very rare complication manifested as significant pain and swelling. This risk is reduced by techniques in hospital as well as maintaining mobility and your stockings
Please advise us if you have a personal or family history of DVT.
Bruising: There is usually bruising along the vein that was stripped, this should resolve over 3-6 weeks.
Bleeding: Blood loss during and after varicose vein surgery is usually minimal.
Infection: This is rare and can be treated with a short course of oral antibiotics.
Groin haematoma: This is a clotted bruise in the groin and usually dissolves over time. The wounds can be a little “lumpy and bumpy” for a few weeks but will settle down.
Leg swelling: This is common post surgery due to the interference with the lymph drainage system in the leg. This will settle with leg elevation, wearing your stockings and walking.
Nerve injury: During the surgery small veins that supply the skin surface can be damaged. This can cause numbness and tingling in the skin. If this occurs, this usually resolves over a few weeks
Scarring: The incisions are only small so scarring will be minimal within 3 months.
Recurrence: New varicose veins can develop in the future. In most cases it just requires touch up injections or sclerotherapy. This commonly occurs many years after the surgery.
Cosmetic Issues: Whilst your leg will be dramatically improved by vein intervention, it is impossible to achieve perfection. Some additional sclerotherapy or topical laser may be required in the future.
To relieve pain, take simple analgesics such a regular paracetamol
Compression stockings: A form will have been provided to you by the rooms to obtain these stockings PRIOR to your procedure ONLY from the recommended supplier.
To be worn: Continuously for 5 days
Not to be removed for bathing/showering (Hospital Nursing staff will provide advice for bathing options)
Then during the day for 2 weeks
Contact Mr Ponosh’s Rooms or see your GP if you have:
Remove groin dressing on day 3 after operation.
The steri-strips (paper strip dressings) will slowly fall off 7-10 days after operation. You can shower over them and pat dry.
Monitor for signs of infection including redness, swelling, pus and heat. See your GP if these symptoms develop.
A routine follow-up review in the rooms will be arranged 4-6 weeks following your procedure. If a second leg is being treated, you will usually not see Mr Ponosh until both legs have been treated. You will be notified of this appointment by Mr Ponosh’s staff via writing. A letter will be sent to your GP and/or referring doctor advising them of your management. If any concerns arise or you would like to see Mr Ponosh please contact the rooms on 9386 6200 and we will see you as clinically indicated.
Some small residual varicose or spider veins may persist and these may require some touch up injection or sclerotherapy.