There are several methods for treating varicose veins, such as injections (sclerosing), surgery under general or local anesthesia, or laser treatment. You have been diagnosed with varicose veins of a size that is best treated using the Muller method. This technique, named after the dermatologist Muller who developed it, involves removing the varicose veins through very small incisions under local anesthesia. The Muller method is particularly suitable for large varicose veins. It is a time-consuming procedure, but it does offer greater certainty that the veins will not recur. If any small varicose veins remain, they can be removed with injections at a later date.DESCRIPTION OF THE PROCEDUREDuring the Muller procedure, several small (a few millimeters) incisions are made in the skin next to the varicose vein. The varicose vein is then hooked through this incision with a small hook and pulled out. This procedure is performed under local anesthesia. You will receive injections of the anesthetic lidocaine at the sites where the varicose veins will be removed. These injections are naturally painful, but the rest of the procedure is not.
We recommend that you bring a companion, but this is not mandatory. You can generally walk normally after the procedure, but driving home yourself is not recommended. You can resume your normal activities the next day. If you are allergic to anesthetic fluid, disinfectants, or bandages, please inform your doctor beforehand. It is also important to inform us if you are taking blood thinners. There is no need to stop taking them before the procedure.
On the day of the procedure, do not use any lotions, creams, or ointments to lubricate the skin, as this will make it impossible to draw on the skin with a marker.PROCEDURE DURING THE PROCEDUREAfter reporting to the outpatient clinic reception desk, you will be collected by the doctor or nurse. In the treatment room, you will be asked to sit on a step stool, where the doctor will mark the varicose veins to be removed with a special pen.
You will then lie down on the treatment table. The skin of your leg will be disinfected. The doctor(s) and nurse will then put on a gown, a face mask, and sterile gloves. The leg will then be covered with sterile drapes. An anesthetic will then be injected next to the varicose vein. The vein will then be pulled out through small incisions. The entire procedure takes 45 to 60 minutes. After the procedure, the wounds will be closed with sterile suture strips (dovetails) and adhesive bandages. Suturing is not necessary for these small wounds. Sometimes dissolvable sutures are placed around veins to minimize bruising.AFTER THE PROCEDUREAfter the procedure, a white liner and a brown elastic stocking will be placed over the treated area. You will also be asked to remain in the waiting room for another half hour to monitor any post-operative bleeding. The white liner and elastic stocking must remain in place day and night for three days. You will therefore not be able to shower during these three days. Afterward—if the treatment was performed on a Tuesday, on Friday evening—you may remove everything and remove all bandages. From that point on, only the brown elastic stocking needs to be worn, and only during the day. You must continue wearing it for a full week. After that, you do not need to wear anything else.
When the stockings are removed, your leg will usually be black and blue with bruising. This is normal and will disappear on its own. A follow-up appointment will be scheduled with you after approximately two months to assess the final result.
In principle, you can do anything after the procedure; however, we advise against strenuous exercise.
If you experience any problems with your leg (e.g. congestion, pain or bleeding) or if the stockings are too tight, please contact the department.ARE THERE ANY RISKS INVOLVED?The Muller procedure has few risks or complications. The following problems may occur:
- Bruising (hematoma) often occurs. This is normal; the leg may look black and blue a week after the procedure. This will disappear on its own within 3-6 weeks.
- With a procedure in the back of the knee, temporary numbness in the leg may occur due to bruising. This rarely occurs and will subside within 1-2 days.
- Sometimes pain or cramping in the leg or foot occurs because the elastic stocking is too tight. In that case, please contact the department, and a wider stocking will be fitted or a bandage applied.
- Very rarely, a small nerve branch is damaged when a varicose vein is removed. This can reduce or eliminate sensation (pain and touch) in the area below. This also usually recovers completely, but it takes longer, several months. Large and important nerves that control muscles are never damaged during a Muller procedure, because these nerves are all safely located deep within the vein. |
