Surgery
The benefit of attending a practice led by a Vascular Surgeon is that in the rare case a serious vein condition occurs, surgery can be recommended. This full service allows for a balanced approach when considering the best treatment pathways, while maintaining continuity of care.
The surgical techniques used by Doctor Cohen are minimally invasive and will only require a small cut in the groin, allowing access to the veins needing to be treated.
The procedure will be performed under general anaesthetic, with a small amount of local anaesthetic also applied to the leg. A small 3cm incision will then be made at the top of the leg, allowing a fine wire to be inserted into the length of the vein. The wire is secured then gently pulled back, drawing the damaged vein along with it.
What are the risks of surgery?
Varicose vein stripping is a safe, low-risk surgical procedure. But there are always risks associated with surgeries. These include:
- Infection at the incision sites
- Blood clots
- Bruising or scarring
- Nerve injury.
What do I need to do before the appointment?
Fasting
If you are scheduled for surgery in the morning, please do not eat or drink anything from midnight the night before your operation. If you are scheduled for surgery in the afternoon, you can have a normal breakfast at 7am the day of your surgery; however, you cannot eat or drink anything after your breakfast.
Medications
If you are taking regular medications (aka – blood pressure, heart disease, contraction pill) please continue to take them with a sip of water even when fasting.
If you are a diabetic, you should halve the dose of your normal medications the night before and do not take any diabetic medication prior to surgery.
If you are taking Aspirin or Plavix, please take it prior to surgery. If you are taking Warfarin or another anticoagulant such as Dabigatran (Pradaxa) or Rivaroxaban (Xarelto) please speak to your doctor for further advice.
Compression stockings
You will be provided with compression stockings on the day of your surgery.
Radiology imaging
If you have a hard copy, please bring any recent imaging you have had done to the surgery. If you have had your imaging done under the care of Doctor Cohen, you will not need to bring anything with you as he will have digital access on the day.
What to do when you arrive at hospital
When you arrive at the hospital please proceed to Surgical Admissions where the team will help direct you to the preoperative area where you will be asked to change out of your clothes and into a theatre gown.
Leg markings
A nurse will shave your leg prior to the surgery. Doctor Cohen will ask you to stand for a while to allow the varicose vein in your leg to become more prominent. He will then draw markings on your leg to outline the veins being targeted in the surgery.
What do I need to do after the appointment?
What to expect immediately after surgery
Your legs will be tightly bandaged from the foot to the upper thigh to help reduce swelling and minimise bruising. Once you have been returned from theatre, you will be encouraged to get out of bed and walk around. The first time you do this, it is likely you will feel lightheaded and dizzy. If this occurs, hang your legs over the edge of the bed until the feeling passes. The nursing staff will be able to help you as well.
The nurse will remove your bandages and glue any spots that may require attention, and will place your compression stockings on before you leave the hospital.
There will likely be bruising down the inner thigh, knee, and lower leg. This will resolve itself in due course. If you do get bleeding, let the nursing team know and they will put waterproof dressing over the site.
If needed for pain, you can take Panadol or Nurofen.
Post-operative scan
You will need to have a post-operative ultrasound to ensure the vein has been closed off and the other veins in your leg are working well.
Compression stockings
The nursing staff will help you put your compression stocking on. It will need to remain on 24-hours a day for three days. If the stocking causes you significant discomfort you can remove it, but please contact Doctor Cohen’s office to let them know.
You can remove the stocking when you shower. Please place it back on afterwards.
After the first three days, you can remove the stocking before going to bed, but you will need to put it back on in the morning. You will need to wear the stocking for two weeks during the day, a total of three days and two weeks.
Exercise
Doctor Cohen will recommend you remain active by walking 30 minutes twice a day. For those who can do so, you can return to the gym, running, yoga, cycling, etc – in 14 days if you are feeling well. You must avoid swimming for the first three weeks. For other activities, you can remove the stocking and wear active wear for compression. You must put the stocking back on once you have finished exercise.
Returning to work
Most patients can return to work in four to five days. If you need a certificate for work, please speak to Doctor Cohen.
Driving
You can return to driving once you are completely pain free. This is usually 24-48 hours post-surgery.
Certificates for follow-up
Following your discharge please speak to Doctor Cohen’s administration team to book a follow up appointment. This will usually be four to six weeks post-surgery.
Troubleshooting
Bleeding – if you get a small bleed simply place a finger on the site, apply pressure, and elevate the leg for 10 minutes. Place a band aid over the site. This may happen from time to time and will not affect your recovery. If you are concerned, call Doctor Cohen’s office.
Lump under the skin – during the first week you will likely notice a lump under the skin along the line of the old vein, and underneath the small incision from the knee to the ankle. This is a result of old blood beneath the skin and will improve over time as the body absorbs it.
Pulling sensation – some people will experience a pulling sensation down the inside of the thigh. This is due to the heating of the vein and will improve over time.
Tenderness – approximately one week after surgery you may experience tenderness along the inside of your thigh. This is due to inflammation of the vein and will improve with time. You can also take a mild anti-inflammatory medication such Nurofen.
Infection – if the area around the wound is red, please contact Doctor Cohen. While rare, all surgery has a risk of infection. Simple measures such as the application of Betadine and other antiseptics can help.
Bruising underneath the compression stocking – if you do have significant bruising and inflammation under the stocking, you can purchase Hirudoid Cream from the pharmacy and apply twice a day.
