Varicose Vein Surgery: What Can I Expect?

If you’ve suffered from the symptoms caused by varicose veins for any amount of time, you’re probably very excited to move forward with treatment. No matter how life-changing a procedure promises to be, it can still be nerve-wracking in the days leading up to it. 

The treatment of varicose veins involves various steps that may take 6 months up to a year and involve six to 12 visits depending on the treatment protocol that Dr. Douglass selects for you. 

That’s why we created this guide. We’ll discuss:

  • How to prepare for varicose vein surgery
  • What to expect during venous surgery
  • What recovery will look like once the procedure is complete

How to prepare for varicose vein surgery

The first step in preparing for varicose vein surgery is simply choosing a time. Fall and winter are the best times of the year to have surgery on varicose veins. There are practical as well as cosmetic reasons for this. On the practical side of things, if you schedule your procedure early in the year, you’ll have time to meet your insurance provider’s requirements sooner than later. 

Most providers will cover your treatment as long as you’ve met your deductible and meet certain medical requirements. For example, most insurers have a 90 day waiting period that requires people to at least attempt to wear compression stockings. That applies whether you’ve worn them before or not. Your doctor will provide you with a prescription, which sets the clock ticking on the 90 days. Work with our team and your insurance providers to find out if there are any other requirements you may have to follow. 

Cosmetically, having your procedure done during the winter allows you to cover up any bruising or signs of surgery without getting too hot. Not everyone experiences bruising, but some patients do, along with swelling or redness. You can also cover up those compressions stockings, which aren’t anyone’s idea of fashion. But who cares? You’re getting the treatment you need to live your best life! 

Tips to prepare for varicose vein surgery:

  • Ask your doctor any questions you may have. Make sure you know all the risks and benefits, and if alternative treatment is available. 
  • Let your doctor know what medications you take, even if it’s over-the-counter or homeopathic. This is so that our team can ensure there are no negative interactions with anesthetic or other medications we may prescribe after treatment. 
  • Stay as active as you can during the weeks or months leading up to surgery. The healthier you are, the better your recovery will be. 
  • If you smoke, stop if you can, or at least cut back. The same goes for alcoholic and junk food. 

What to expect during surgery for varicose veins

Before undergoing any treatment, you’ll have an ultrasound performed. Ultrasound mapping is both the first and most important step in the evaluation of vein disease. Mapping of a leg takes  about thirty minutes and is done by our ultrasound technologist who has extensive experience in the assessment of venous  leg disease. 

Treatment these days is so much better than it was a few decades ago. Our procedures at East Tennessee Vein Clinic are quick and often painless. 

We offer a number of different procedures here. Each one is different and addresses different symptoms. The good news is that for the treatments listed below, there is no need for general anesthesia, scalpels, or stitches! We’ll just use general anesthetic, and sometimes nitrous oxide, known as laughing gas. You’ll be in and out in no time. 

Most patients will have three ultrasound guided treatments. These are typically an initial treatment followed by treatments in one and four months. 

Endovenous thermal ablative therapy

This is for medium to large varicose veins. Dr. Douglass uses heat from a laser fiber or a radiofrequency catheter to close the diseased veins. This process reroutes blood flow to healthy veins. Endovenous laser ablation treats the hidden “root source” of visible varicose veins via a laser catheter placed inside the  saphenous vein. As the laser catheter is withdrawn the vein is sealed shut by the laser energy. The procedure lasts 20 minutes and is performed under local anesthetic. Nitrous oxide (laughing gas) is used to make you comfortable. 

After the EVLT you will be asked to wear compression stockings and begin to take Advil or Aleve for one week. At the  end of the week you may discontinue these. Most of the soreness of the vein treated with EVLT will  be gone after a week or two. If at any time after stopping the anti-inflammatory medication and stocking, the leg begins to  feel sore again you may resume wearing the stocking and restart the anti-inflammatory medication for another three days.  

It is important to remember that most patients will not see a great difference in the appearance of their varicose veins immediately after EVLT. This is normal because there are still many varicose veins that are too narrow or twisted for an  endovenous catheter to pass through. These will be treated later with microphlebectomy and/or ultrasound guided foam sclerotherapy. After your EVLT, you will be scheduled to come back soon after to check the leg with ultrasound and make  certain that the vein treated with laser is closed and to plan how soon to start the next phase of your treatment. 

Ambulatory phlebectomy/microphlebectomy

Sometimes large, bulging veins get twisted, and we perform microphlebectomy. This requires the vein specialist to make a small needle puncture over the vein and then remove the bulging portion. You will not feel pain with this once the anesthetic is administered.  Even though this seems a little more intimidating, you’ll be happy to know that we still don’t use a scalpel and there are no stitches.

Patients with very prominent bulging veins will undergo microphlebectomy after the “root source” of the veins has first been treated with endovenous laser ablation. The procedure lasts about 20 minutes. After giving nitrous oxide to make you comfortable and local anesthetic directly over the bulging veins a needle puncture is made next to the bulging veins through  which a small “knitting hook” device extracts the vein. 

  • Steri strips are placed and a bandage over the leg is worn continuously for 2 days.
  • You will need to sponge bathe until the bandage is removed in two days to avoid getting the bandage wet.
  • You will continue to wear the stocking during the day  for five more days. Most, if not all, of the bulging veins will be gone then. There are no stitches.
  • Mederma cream is applied to the puncture sites where the vein was removed. There is usually no visible scar. 

Ultrasound Guided Foam Sclerotherapy

This is a highly effective, unique procedure that involves a foamed sclerosant being injected into the diseased veins. The sclerosant is an irritant, and over time, the veins narrow and become invisible.

Ultrasound guided sclerotherapy addresses refluxing varicose veins that cannot be seen without ultrasound. Treatment of  these veins is important for symptom relief and to prevent recurrence of other visible varicose veins. 

After the ultrasound guided foam sclerotherapy, you will be asked to walk for 15 minutes on our treadmill and later at home. You can resume your normal activities. Stockings will be worn for two weeks after each  treatment.  

After ultrasound guided foam sclerotherapy the varicose veins may sometimes feel as lumps and cords beneath the skin, but these lumps will gradually disappear altogether. Some patients will develop a temporary brownish discoloration over where treated veins once were. Patients with a dark complexion or who tan easily are more likely to hyperpigment in this way. This hyperpigmentation will gradually fade in most patients, though in a small minority of patients it may persist. 

What to expect during recovery from a varicose vein procedure

Recovery time is minimal with any of the procedures we outlined above. You’ll drive yourself to and from your appointment, and can take Tylenol as needed. Dr. Douglass says that this is one of the tremendous advantages of these newer procedures. You resume life and activities. 

Make sure to get plenty of rest and take it easy to heal as quickly as possible. Patients can expect to return to their usual activities almost immediately. You’ll be able to resume all your normal activities, and we encourage you to take daily 20 minute walks. 

We recommend the following precautions be taken:

  • We ask that following laser or microwave ablations, or after microphlebectomy, you avoid strenuous activity — such as lifting anything over 40 lbs. or anything that puts prolonged stress on core abdominal muscles — for 7 days. 
  • Avoid strength training for 7 days and replace it with aerobic activity like walking, running or jogging. 
  • We ask that patients not fly for 48 hours after any venous procedure. 
  • We ask that patients who do fly anytime within 30 days after a venous procedure wear their stockings in flight. The same is true for prolonged car rides over 3-4 hours for 30 days after a venous procedure. 

Our team will provide you with a comprehensive list of other post-care instructions. 

At East Tennessee Vein Clinic, you’ll find the help you need so that you don’t have to suffer from symptoms such as swelling, aching, throbbing, heaviness, or restless legs. Varicose veins are caused by genetics, and surgery is the only way to find relief. When our patients learn that today’s advanced treatments are quick and require little to no down time—plus are typically covered by insurance—they’re glad they didn’t delay treatment any longer.

If you’re ready for relief, schedule an appointment online today! Make sure to ask about our free vein screenings, too.

“Every visit was a pleasant time because of the staff. Dr. Douglass is an excellent doctor. I highly recommend East Tennessee Vein Clinic."

- A.S., Knoxville, TN