Varicose vein stripping

Definition

Vein stripping is surgery to remove varicose veins in the legs. These veins are removed because they are large and painful, and they affect the way the leg looks.

Alternative Names

Saphenectomy; Vein stripping with ligation, avulsion, or ablation

Description

Varicose veins are swollen, twisted, painful veins that have filled with blood. They usually develop in the legs. Normally, valves in your veins keep your blood flowing so it does not collect in one place. But the valves in varicose veins are either damaged or missing. This causes the veins to remain filled with blood, especially when you are standing.

Vein stripping for this problem is done in a doctor’s office or clinic. Most people receive general anesthesia before this surgery. Will be unconscious and unable to feel pain. Vein stripping takes about 1 to 1 1/2 hours.

Your surgeon will make two small incisions (cuts) in your leg.

• The incisions 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. The wire has a small head on it. Your surgeon will guide the wire through your vein toward the other cut farther down your leg.
• As the wire is pulled out through the lower cut, the head of the wire pulls the vein down with it, out through the lower cut.
• 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 may also have bandages and compression stockings on your leg.

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 poor blood flow in the veins
• Blood clots or inflammation in the veins (phlebitis)
• Improving the appearance of the leg
• Lipodermatosclerosis - fatty tissue under that skin that hardens over time from high blood pressure in a vein

Today, more doctors are doing fewer vein stripping surgeries because there are newer ways to treat varicose veins without surgery. These other treatments are less painful and easier to recover from.

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 are:

• Allergic reactions to medicines
• Breathing problems

The risks for any surgery are:

• Bleeding
• Infection
• Bruising

The risks of for vein stripping are:

• 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 drugs 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 several hours before surgery.
• Take your drugs your doctor told you to take with a small sip of water.

After the Procedure

Your legs may be wrapped with bandages to control swelling and bleeding for 3 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 be wearing compression stockings. These help with blood flow. It is very important to keep your bandages and compression stockings on until all the open vein ends have healed. Your doctor will tell you when you no longer need them.

Your doctor may prescribe pain medicine. Take it 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. But 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. Vein stripping does leave scars sometimes.

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. Journal of the American Academy of Dermatology. Jan 2009;60(1).