1. Dilated, elongated and twisted veins along the legs.
2. It is able to cause pain and tenderness along the veins, heaviness, tiredness, leg swelling, skin hardening and color change, infected chronic ulcer or even bleeding from the ruptured varicose veins.
3. Sometime the varicose vein appears to have inflammation (phlebitis), which causes pain and hardening lump from containing clotted blood in the vein called thrombophlebitis.
4. Clotted blood in the varicose vein nearby the deep vein can progress and move into the deep vein and fatally go further up to the lungs.

It is a surgical procedure that removes varicose veins from the legs or thighs
 

1. A venous duplex scan will be performed to determine how the blood is flowing through the veins.
2. Stop drinking or smoking at least two weeks or one month before surgery to prevent anesthesia-related complications.
3. Do not eat or drink anything at least 6-8 hours prior to surgery or as ordered by physician.

The present standard procedure is vein stripping of the leaky axial superficial veins including ligation of the leaky connecting veins between the superficial and deep vein and removal of the varicose vein branches by doing 1 millimeter to 2 millimeters stab wounds and hook them out. The stab wounds heal very nicely without scarring.
 

1. Averagely the hospital stay in the postoperative period is around 2 nights. The graduated compression elastic stockings are used and keep the legs elevated 10-15 degrees above the head.
2. Move ankles up and down to make a better flow of the circulation to prevent deep vein clot.
3. When the patient is fully recovered from anesthesia he is able to walk to the bathroom.
4. Schedule a follow-up appointment. If the wounds are well healed, continue using of compression elastic stockings during the daytime for another 6-8 weeks.

The result of varicose vein surgery is usually excellent and the side effects from operation might happen as followings:

1. Hard tender lumps along the sites of treated veins, which are caused by a collection of blood, will temporary stay.
2. Skin bruising will fade out in 3-4 weeks.
3. Rarely damaging to the vein or arteries might occur.
4. Nerve damage rarely happens, if it does so will lead to numbness of the foot.
5. Increasing risk of heart, lung complications and deep vein thrombosis among the cigarette smokers.
6. Infection of the incision wounds are rarely happened because prevention is well prepared with skin cleaning with antiseptic soap 3-4 days and a preventive antibiotic is given in the operating room before operative schedule.

• Travelers to Thailand should plan to stay in the country for at least seven days or through the duration of treatment.
• If you plan to travel after the procedure, please discuss this with your doctor before making travel arrangements.
• There are no air travel restrictions with this procedure.
• When traveling by air, please wear compression stockings to prevent thrombosis.
• At your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation regarding your treatment history and a “fit to fly” certificate (if needed).

About a third of patients presenting with varicose veins will require only explanation that their symptoms are not related to their varicose veins. If it is uncertain whether varicose veins cause the patient’s symptoms, a trial of compression elastic stockings may help. Anyway, they should have a physical examination before considering for further treatment.
 
What if the procedure is not performed?
Please discuss specific risks of not having the procedure done with your doctor.
 

1. Injection sclerotherapy: Using a kind of chemical solution injecting into the lumen of the bad veins to freeze them and graduated compression elastic stockings are used to compress the injection points in the daytime for 3-4 weeks. Anesthesia is not needed in the procedure and it is done as an outpatient basis.
2. Ambulatory phlebectomy: Marking of the varicose veins with indelible ink and then do surgery under a large volume of diluted local anesthesia or regional anesthesia. Ambulatory phlebectomy is not intended to be complete with surgery, but rather to provide relief to those patients whose venous insufficiency does not justify a hospital operation. The tiny stab incisions of 1-2 mm long are made and a surgical hook is used to pull the varicose vein branches out.
3. Other modern alternatives

• Closure of vein with radio frequency energy: Use intravenous radio frequency fiber to close the leaky truncal vein. The residual varicose veins have to be treated with injection sclerotherapy. The after effects that might happen are skin burn, nerve injury or rarely deep vein thrombosis.
• Intraluminal venous laser treatment: The technique is similar to Radio Frequency treatment but the energy used is laser.