Venous Surgery

Venous and arterial diseases are very different and they tend to affect different types of person. Most diseases of the arterial system do not appear until the last decade of life and tend to be associated with serious life-threatening events. By contrast venous diseases can appear in the 20’s or even late teenage years. They are very rarely life-threatening but they can cause chronic problems over many decades.

• varicose veins
• venous ulcers
• lower limb swelling
• venous thromboembolism
• deep vein thrombosis and pulmonary embolism

Varicose veins

For details about what varicose veins are and the way we treat them please go to the Advice Sheets on varicose veins. These sheets are quite long. There is much you need to consider. Until a few years ago the matter was simple, if your symptoms were bad enough we would advise treatment and that nearly always meant an operation. Now it is more complicated for the following reasons:

• If you are an NHS patient I have to apply through a complicated bureaucratic process for you to be treated. The request may be refused. See my article Lack of availability of varicose vein surgery under the NHS for more information.
• There are now good alternatives to conventional surgery although this may still be the best for most patients.
• We are obliged to inform you about the pros and cons of these different treatments, or, the option of doing nothing.
• You have to decide after doing the homework. If you so wish I can suggest the treatment I think is best for you.

Venous ulceration

This affects up to 1% of the adult population but mainly it occurs in those over 70. It is definitely something to be avoided as it may involve months or years of trouble, repeated dressings, pain, purulent discharge and smell. Even amputation may be required in severe cases that have gone on for years.

Only a small proportion of patients with varicose veins ever develop a venous ulcer but with experience we can spot the patients with severe skin damage who are most at risk and a timely operation can help to avoid later trouble.

The key to successful management of a chronic leg ulcer (defined as a break in the skin that has not healed after one month) is careful examination together with accurate measurement of the blood pressure at the ankles ('Doppler pressures') and duplex ultrasound scanning.

Treatment is based on compression bandaging to heal the ulcer and then firm compression hosiery to prevent recurrence. In some patients the risk of recurrent ulceration can be reduced by varicose vein surgery or foam sclerotherapy (see the Advice sheets for more information). Unfortunately if the deep veins of the leg are seriously damaged by previous thrombosis operation is not an option and compression stockings are the treatment.

Lower limb swelling

This is a common problem which causes great distress particularly to younger women.

There are many causes. Accurate diagnosis is the first step. This is based on the history, the examination and duplex ultrasound. Lymphoscintigraphy is done if lymphoedema is a possibility. This is a radioisotope test.

Varicose veins are only one cause. They generally only cause mild swelling and we cannot always predict that it will reduce after operation. Surgeons often have to warn that operation will not produce the thin shapely legs that patients yearn for!

There are many other causes of swelling such as previous deep vein thrombosis, obesity, cardiac or renal failure and lymphoedema.