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Varicose vein stripping

Definition

Vein stripping is surgery to remove varicose veins in the legs.

Alternative Names

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

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 with varicose veins are either damaged or missing. This causes the veins to become filled with blood, especially when you are standing.

Vein stripping for this problem is done to remove a large vein in the leg called the superficial saphenous vein.

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

• General anesthesia and will be unconscious 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 small surgical cuts in your leg.

• The cuts will be near the top 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. Your surgeon will guide the wire through your vein toward the other cut farther down your leg.
• The wire is pulled out through the lower cut, which pulls the vein out with it.
• Your surgeon may also use hooks to pull out veins during this procedure.

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

The doctor will close the incisions with sutures (stitches). 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, often described as heavy or tired
• Ulcers or sores that are caused by excess pressure in the veins (venous ulcers)
• Blood clots or inflammation in the veins (phlebitis)
• Improving the appearance of the leg
• Lipodermatosclerosis - fatty tissue under the skin that hardens over time from high blood pressure in a vein

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.

See also: Varicose Vein - noninvasive treatment

Risks

Vein stripping is generally safe. Ask your doctor about specific problems that might occur.

The risks for any anesthesia include:

• Allergic reactions to medicines
• Breathing problems

The risks for any surgery include:

• Bleeding
• Bruising
• Infection

The risks for vein stripping include:

• Bruising or scarring
• Nerve injury
• Return of the varicose vein 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.

When you are resting, try to keep your legs raised higher than the level of your heart. Place pillows or blankets under your legs to raise them up.

You may also wear compression stockings. These help improve blood flow. It is very important to keep your bandages and compression stockings on until all the surgical cuts have healed. Your doctor will tell you when you no longer need them. To prevent the varicose veins from returning, you may have to wear compression stockings for a long time.

Your doctor may prescribe pain medicine. Take the medication before your pain gets severe. Do NOT drive or use machinery if you are taking narcotic pain medicine. The medicine will make you drowsy, and it will not be safe for you to drive or operate machines.

Take at least 10 to 12 short walks a day, for 5 to 10 minutes each. Do not sit or stand in one place for too long.

You will probably be able to return to your normal routine in 2 weeks. However, you should not do strenuous physical activity for 3 to 6 weeks. You should be able to shower 2 days after surgery.

Outlook (Prognosis)

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

References

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 68.

Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol. 2009;60(1):110-119.