Vein stripping

Alternative names
Varicose vein surgery; Sclerotherapy of veins

Definition
Varicose vein surgery is used to remove or treat enlarged and/or twisted veins (varicose veins).

Description

Varicose veins usually occur in the legs. The valves in the veins become damaged or are absent, causing the veins to remain filled with blood, especially when you are standing. Varicose veins can be treated by removal (vein stripping) or by injection with a substance that causes the veins to scar closed (sclerotherapy). Removing or treating varicose veins does not cause circulation problems because veins can re-route themselves around a blockage. This is called “collateral circulation.”

Vein stripping is done while the patient is under general anesthesia (unconscious and pain-free). Incisions are made at the bottom (ankle end) and at the top (groin end) of the varicose vein. A thin wire-like instrument is inserted into the vein that to strip the vein from the inside. Small incisions can also be made over the veins to remove them.

Vein sclerotherapy is done while the patient is standing. A sclerosing agent is injected into each varicose vein to cause scarring. An elastic bandage is wrapped snugly around the legs after the procedure.

Many times, both procedures are performed; some veins are stripped and others are sclerosed.

Indications
Varicose vein surgery may be recommended for the following:

     
  • Varicose veins that cause circulatory problems (venous insufficiency)  
  • Skin irritation and sores (ulcers)  
  • Blood clots in the veins (phlebitis), which can travel to the heart, lungs, or brain (embolism)  
  • Cosmetic purposes

RISKS
Risks for any anesthesia include the following:

     
  • Reactions to medications  
  • Problems breathing

Risks for any surgery include the following:

     
  • Bleeding  
  • Infection

Additional risks of varicose vein surgery include the following:

     
  • Blood clots (call your doctor if your feet become cold or change color)  
  • Irritation of the vein from the sclerosing solution  
  • Obstruction of blood flow caused by the sclerosing agent  
  • Leakage of the sclerosing solution out of the veins into other tissue (which can damage the surrounding tissue)  
  • Hematomas (bruises)  
  • Nerve injury

Expectations after surgery

The majority of patients (more than 85%) who undergo varicose vein surgery have good results. Losing a few veins has little consequence because the remaining deeper veins can take over by stretching their walls, holding larger volumes, and opening collateral pathways. This adaptation process can sometimes lead to more varicose veins, which may require repeat surgeries in about one-third of cases.

The outcome is good in about two-thirds of the patients who undergo sclerotherapy. In one-third of patients, however, inflammation with rupture of blood flow and skin discoloration are persistent for several months following surgery.

It is important for anyone who is prone to varicose veins to keep the feet raised above the heart whenever possible.

Convalescence
A hospital stay may not be required. After surgery, the legs are wrapped tightly in bandages. Walking is possible the first day after surgery and is recommended to minimize swelling and avoid the risk of deep venous thrombosis. It is important that feet are kept raised above the heart whenever possible.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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