This is an abbreviated version of the complete article.*
Vein stripping is the removal of large varicose veins in the leg and the closing of smaller vein tributaries.
A technique called small incision avulsion, or phlebectomy, often accompanies vein stripping to remove small veins in the leg.
Vein stripping relieves symptoms associated with painful varicose veins and improves the appearance of the legs.
The body has veins located close to the surface of the skin that help return oxygen-depleted blood to the heart. As superficial vein walls stretch and weaken because of age or heredity, blood can begin to flow backward and collect inside the veins. This in turn may cause increased pressure that can permanently damage the elastic vein walls.
When the walls of veins in the leg stretch and bloat out of shape, the valves that normally prevent blood from flowing backward also become distorted and the veins can begin to malfunction. Varicose veins or spider veins may result.
Varicose veins appear as blue, bulging and twisted veins, visible through the skin on a person's legs. Left untreated, varicose veins can cause tiredness or heaviness in the legs. Affected areas of the leg may also ache or burn. In severe cases, varicose veins can lead to swollen ankles and scaly, dry skin.
The goals of vein stripping are to relieve pain, to improve circulation through the venous system by removing pathways of blood reflux and to improve the appearance of a person's leg. Vein stripping involves the removal of the saphenous vein in the leg and any varicose tributary veins.
WHEN IS IT INDICATED?
Physicians decide to perform vein stripping after a complete duplex ultrasound evaluation of the veins shows that the veins are diseased and malfunctioning.
Vein stripping is typically an outpatient procedure, but it is commonly performed in the operating room using general or occasionally, spinal anesthesia.
WHAT TO EXPECT
After shaving a small site on the upper leg to help minimize the risk of infection, the physician makes a small incision near the groin to access the upper end of the great saphenous vein.
Once the physician can see the vein, he or she disconnects and ties off the main vein tributaries associated with it and disconnects the saphenous vein from the femoral vein. A stiff but flexible wire is inserted into the free end of the saphenous vein and advanced down its length and out through a second incision made at the upper calf, just below the knee.
The end of the vein nearest the groin is tied tightly, and then the knot is tied to the end of the wire, or a metal head is attached to the end of wire at the groin. Smaller veins connected to the saphenous vein along the leg may be cut away with tiny incisions, and then the physician pulls the wire downward. As the wire travels through the length of the vein it pulls the vein with it, turning the vein inside out and pulling it away from the smaller tributary veins.
The vein is removed through the incision in the upper calf, although some doctors may strip the vein all the way to the ankle. The incisions are closed with stitches and compression bandages are applied along the length of the leg.
The risks of vein stripping are typically small, because the procedure is usually performed in people who are in generally good health. As in any vein surgery, blood clots are a special concern.
Certain complications can occur with any surgery requiring general anesthesia. They include:
Other complications are specific to vein stripping, including bruises, recurrence of varicose veins, and nerve injury.
To control swelling and bleeding and promote healing of the surgical wounds, the treated areas may be firmly wrapped with elastic bandages. Compression stockings may also be used. Typically, a person's legs will be firmly bandaged for 36 hours after vein stripping, and the legs are usually rewrapped and compression continued for days and even weeks after the procedure.
People who have had vein removal surgery may be prescribed a mild analgesic. The most important precaution in the postoperative period is taking 10 to 12 short walks per day, each lasting 5 to 10 minutes. Most patients are able to return to their usual daily activities within two weeks.
Medical Review Date: August 1, 2003
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