Vein stripping is a surgical procedure used to treat severe venous disease. This technique involves the physical removal of a large, damaged vein segment through incisions. While effective, it is generally considered a more invasive option compared to newer, less surgical approaches available today. The goal is to eliminate the problematic vein, allowing blood flow to be rerouted entirely through the remaining healthy veins.
Why Vein Stripping is Performed
Vein stripping addresses faulty one-way valves within the veins, which are meant to keep blood flowing upward toward the heart. When these valves malfunction, venous insufficiency develops, causing blood to pool and resulting in veins swelling and twisting. The procedure is often considered for severe, symptomatic varicose veins that have not responded to conservative treatments, such as elevation or compression stockings.
This surgical intervention also treats chronic venous insufficiency (CVI), especially when it leads to complications like skin changes, persistent pain, or venous skin ulcers. The high pressure from pooled blood causes aching and heaviness in the legs. By removing the severely damaged vein, the procedure aims to reduce this pressure and prevent further disease progression.
The Vein Stripping Procedure
Vein stripping is typically performed in a hospital setting using general anesthesia or spinal anesthesia, which numbs the lower body. The surgeon identifies the target vein, often the Great Saphenous Vein (GSV), which runs from the ankle up to the groin. The location and extent of the damaged vein are confirmed beforehand using ultrasound mapping.
The procedure begins with a small incision, usually in the groin area, where the affected vein joins the deeper venous system. A second incision is made farther down the leg, typically near the knee or ankle, depending on the vein segment needing removal. The vein is tied off (ligated) at the upper incision to prevent blood from flowing back into it.
A thin, flexible wire, known as a vein stripper, is threaded into the damaged vein. The surgeon secures the vein to the tip of this device and carefully pulls the entire segment out through the lower incision. This action physically “strips” the vein from the leg, and the incisions are then closed with stitches. The procedure generally takes 60 to 90 minutes, after which the leg is immediately wrapped in bandages or compression stockings to manage swelling.
Recovery and Post-Procedure Care
The recovery phase begins immediately, and most patients are able to go home the same day. Patients can expect pain, stiffness, and significant bruising in the treated leg for the first one to two weeks. Over-the-counter or prescription pain medication manages this discomfort, and applying ice and keeping the leg elevated helps reduce swelling and bruising.
Consistent use of compression stockings is a mandatory part of post-operative care for several days to weeks. These stockings provide external pressure to minimize swelling and support the surrounding tissue. Patients are encouraged to walk multiple times a day to promote circulation, but must avoid strenuous activities and prolonged sitting or standing for two to four weeks.
Returning to work depends on the job’s physical demands, with many people returning to light duty within a week or two. Full recovery and the fading of bruising can take six to twelve weeks. Patients should be aware of the potential for minor scarring and temporary numbness along the path of the removed vein.
Modern Alternatives to Vein Stripping
Due to the invasive nature and recovery time associated with traditional vein stripping, minimally invasive alternatives have largely replaced it as the preferred initial treatment. These modern methods aim to close the faulty vein instead of physically removing it, typically involving only a small puncture site. Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) are the most common alternatives.
Both EVLA and RFA use a catheter inserted into the vein to deliver thermal energy. EVLA uses laser light, while RFA uses radiofrequency waves to heat the vein. This heat causes the vein wall to collapse, seal shut, and eventually be absorbed by the body. These procedures are often performed under local anesthesia, resulting in a shorter recovery time, less bruising, and less pain than vein stripping.
Other options, such as ultrasound-guided foam sclerotherapy (injecting a chemical solution to collapse the vein) and medical adhesives, are also used to treat varicose veins. These alternatives offer comparable long-term effectiveness to stripping but with significantly less patient downtime. Vein stripping remains an option for highly severe or complex cases, but the shift is toward these minimally invasive approaches.