Varicose vein stripping

Description

Varicose veins are swollen, painful veins that have filled with blood. They usually develop in the legs.

• Normally, valves in your veins keep your blood flowing forward, so the blood does not collect in one place.
• The valves in varicose veins are either damaged or missing. This causes the veins to become filled with blood, especially when you are standing.
• The varicose veins often stick out and are bluish in color.

Vein stripping is usually done when a large vein in the leg called the superficial saphenous vein is thick and rope-like.

Vein stripping usually takes about 1 to 1 1/2 hours. Most people receive either:

• General anesthesia and will be asleep and unable to feel pain.
• Spinal anesthesia, which will make the lower half of your body feel numb. You may also get medicine to help you relax.

Your surgeon will make two or three small surgical cuts in your leg.

• The cuts will be near the top, middle, and bottom of your damaged vein. One will be in your groin. The other will be farther down your leg, either in your calf or ankle.
• Your surgeon will then thread a thin, flexible plastic wire into the vein through your groin and guide the wire through the vein toward the other cut farther down your leg.
• The wire is then tied to the vein and pulled out through the lower cut, which pulls the vein out with it.

If you have other damaged veins, your surgeon may also make small cuts over them to remove them or tie them off.

The doctor will close the cuts with stitches (sutures). You will have bandages and compression stockings on your leg after the procedure.

Why the Procedure is Performed

Vein stripping may be recommended for:

• Varicose veins that cause problems with blood flow (venous insufficiency)
• Leg pain that feels heavy or tired
• Ulcers or sores that are caused by too much pressure in the veins (venous ulcers)
• Blood clots or swelling (inflammation) in the veins (phlebitis)
• Improving the appearance of the leg
• Fatty tissue under the skin that hardens over time from high blood pressure in a vein (lipodermatosclerosis)
• Large, rope-like veins that cannot be treated with other, newer procedures

Today, doctors are doing fewer vein stripping surgeries because there are newer, non-surgical ways to treat varicose veins. These other treatments are less painful and have a much faster recovery time. However, these methods are not useful for people who have veins below the knee.

Risks

Vein stripping is usually safe. Ask your doctor about any problems that might occur.

The risks from any anesthesia include:

• Allergic reactions to medicines
• Breathing problems

The risks from any surgery include:

• Bleeding
• Bruising
• Infection

The risks from vein stripping include:

• Bruising or scarring
• Nerve injury
• Return of varicose veins over time

Before the Procedure

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking; even drugs, supplements, or herbs you bought without a prescription
• If you have been drinking a lot of alcohol (more than 1 or 2 drinks a day)

During the days before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which medications you should still take on the day of your surgery.
• If you smoke, try to stop. Your doctor or nurse can help. Smoking will slow your healing and recovery.

On the day of your surgery:

• You will usually be asked not to drink or eat anything for at least 6 - 8 hours before surgery.
• Take your prescribed medications with a small sip of water.

After the Procedure

Your legs will be wrapped with bandages to control swelling and bleeding for 3 - 5 days after surgery. You may need to keep them wrapped for several weeks.

Outlook (Prognosis)

Surgical vein stripping is usually very successful. It reduces pain and improves the appearance of your leg.

Rarely, vein stripping causes scars. However, mild leg swelling can occur. It is important for you to regularly wear compression stockings.

Alternative Names

Vein stripping with ligation, avulsion, or ablation; Saphenous vein ligation

References

Brar R, Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM. Surgical management of varicose veins: meta-analysis. Vascular. 2010;18(4):205-220.

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 65.

Nesbitt C, Eifell RKG, Coyne P, Badri H, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database of Syst Rev. 2011:10:CD005624.

Update Date: 5/14/2012

Updated by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.