Varicose vein stripping
Vein stripping with ligation; Vein stripping with avulsion; Vein stripping with ablation; Vein ligation and stripping; Vein surgery; Venous insufficiency - vein stripping; Venous reflux - vein stripping; Venous ulcer - veins
Vein stripping is surgery to remove varicose veins in the legs.
Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue in color. They usually appear in the legs but can occur in other parts of the body.
Normally, valves in your veins keep your blood flowing up toward the heart, 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, particularly when you are standing.
Vein stripping is used to remove or tie off a large vein in the leg called the superficial saphenous vein. This helps treat varicose veins.
Vein stripping usually takes about 1 to 1 1/2 hours. You may receive either:
- General anesthesia, in which you 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 2 or 3 small cuts in your leg.
- The cuts are near the top, middle, and bottom of your damaged vein. One is 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 near the surface of your skin, your surgeon may also make small cuts over them to remove them or tie them off. This is called ambulatory phlebectomy.
- The surgeon will close the cuts with stitches.
- You will wear bandages and compression stockings on your leg after the procedure.
From the outside, your veins look like nothing more than a few faint blue lines under your skin. But inside your body, they work hard to transport blood from your organs to your heart. Sometimes, blood can get stuck in your veins and make them swell up so they really stick out. These swollen veins are called varicose veins. And if you have them, you may be putting a lot of effort into covering them up. Veins have valves in them that prevent blood from flowing the wrong way. They're kind of like the valves in your bathroom plumbing that prevent hot water in the water heater from backing up into the cold water supply. The valves inside your veins make sure that your blood keeps flowing in the right direction, toward your heart. But if those valves aren't working correctly, blood can back up and get stuck inside a vein. As the blood collects, the vein swells. So, what causes the valves in the veins to malfunction? Well, you may have been born with defective valves. Or, you might be putting on extra pressure on the veins in your legs if you stand for long periods of time, or you're pregnant. When you have varicose veins, you, and your doctor, should be able to tell just by looking at them. They look like raised, thick blue or purple veins. Varicose veins can also make your legs ache and your ankles swell. So, how are varicose veins treated? Well, first, your doctor will recommend rest and support for your varicose veins. Avoid standing for long periods of time, and prop up your feet on a pillow or box whenever you sit. Wearing elastic support hose can also help. If you're in a lot of pain from your varicose veins, or their appearance really bothers you, your doctor may recommend a treatment such as lasers to minimize the veins. Or, you may have a type of surgery called vein stripping. During this procedure, the surgeon threads a thin, plastic wire into each varicose vein and then pulls the vein out. At first, varicose veins are more of a cosmetic problem than a health issue. But over time, they can get worse. Some people develop sores, inflammation from phlebitis, clots, or their varicose vein breaks. Talk to your doctor if you have varicose veins, especially if they hurt or they don't improve from wearing support hose or staying off your feet. Call your doctor right away if you have intense pain, swelling, fever, or a sore on your leg.
Why the Procedure Is Performed
The provider may recommend vein stripping for:
- Varicose veins that cause problems with blood flow
- Leg pain and heaviness
- Skin changes or sores that are caused by too much pressure in the veins
- Blood clots or swelling in the veins
- Improving the appearance of your leg
- Varicose veins that can't be treated with newer procedures
Today, doctors are rarely performing vein stripping surgeries because there are newer, non-surgical ways to treat varicose veins that don't require general anesthesia and are done without an overnight hospital stay. These treatments are less painful, have better results, and have a much faster recovery time.
Vein stripping is generally safe. Ask your provider about any problems that might occur.
Risks of anesthesia and surgery in general are:
The risks from vein stripping include:
- Bruising or scarring
- Nerve injury
- Return of varicose veins over time
Before the Procedure
Always tell your provider:
- If you are or could be pregnant
- What medicines you are taking, including drugs, supplements, or herbs you bought without a prescription
- If you have been drinking more than 1 or 2 alcoholic drinks a day
During the days before your surgery:
- You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), blood thinners such as warfarin (Coumadin), and other drugs.
- Ask your provider which medicines you should still take on the day of your surgery.
On the day of your surgery:
- You will likely be asked not to drink or eat anything for at least 6 to 8 hours before surgery.
- Take your prescribed medicines with a small sip of water.
After the Procedure
Your legs will be wrapped with bandages to control swelling and bleeding for 3 to 5 days after surgery. You may need to keep them wrapped for several weeks.
Surgical vein stripping reduces pain and improves the appearance of your leg. Rarely, vein stripping causes scars. Mild leg swelling can occur. Be sure you regularly wear compression stockings.
Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 64.
Iafrati MD, O'Donnell TF. Varicose veins: surgical treatment. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 154.
Maleti O, Lugli M, Perrin MR. Role of surgery in the treatment of varicose veins. In: Goldman MP, Weiss RA, eds. Sclerotherapy. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 10.
Last reviewed on: 6/16/2020
Reviewed by: Deepak Sudheendra, MD, RPVI, FSIR, Director of DVT & Complex Venous Disease Program, Assistant Professor of Interventional Radiology & Surgery at the University of Pennsylvania Perelman School of Medicine, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.