Varicose vein stripping at Parkside Hospital

What is varicose vein stripping?

Varicose vein stripping, also known as ligation and stripping, is a surgical treatment for varicose veins. It involves tying off and removing a faulty superficial vein. In modern UK practice, varicose vein stripping is now usually considered when less invasive treatments, such as endovenous laser ablation, radiofrequency ablation or ultrasound-guided foam sclerotherapy, are unsuitable or not appropriate. It is often performed as a day-case procedure, meaning you can often go home the same day, although you may need a longer stay depending on your general health, anaesthetic and the extent of surgery.

What is varicose vein stripping also known as?

You may also hear varicose vein stripping referred to as high ligation and stripping, vein ligation, or ligation and stripping.

What are varicose veins?

Varicose veins are large, often twisted veins. They are often found in the legs. They develop when the valves that control blood flow become weak and don’t close properly, and this causes blood that should be flowing in one direction to flow backwards into them. The blood then pools, causing the veins to enlarge and develop bulges that mean that they can be seen under your skin.

You’re more likely to develop varicose veins if you’re overweight or pregnant. They also run in families and are more likely to affect women than men.

What are the symptoms of varicose veins?

The most common symptoms of varicose veins include:

• Visible purple, bulging, lumpy veins
• Changes in skin colour
• Skin ulcers
• Aching or heaviness in your legs
• Itchy or burning feeling in the skin over your veins
• Restless legs
• Swollen feet and ankles
• Cramps in your legs, usually at night.

Can varicose veins be dangerous if left untreated?

Although many people consider them to be a cosmetic issue because of the way that they look, if they are left untreated, they can lead to issues such as spontaneous bleeding, blood clots and leg ulcers.

Who is suitable for varicose vein stripping?

You may be suitable for varicose vein stripping if you have symptomatic varicose veins caused by superficial venous reflux and your consultant (surgeon) considers that surgery is the most appropriate option. This may be because endovenous ablation or foam sclerotherapy is unsuitable, or because of the pattern of your veins. You may choose treatment for cosmetic reasons alone, but surgery is usually recommended based on symptoms, complications or clinical need.

Who may not be suitable for varicose vein stripping?

Varicose vein stripping may not be suitable, or may need to be delayed, if you:

• Are pregnant or breastfeeding
• Have significant peripheral arterial disease
• Have active deep vein thrombosis, or have a history of thrombosis or a clotting disorder requiring individual assessment
• Have an active skin infection
• Are not fit enough for anaesthetic or surgery, or have vein anatomy that makes stripping unsuitable.

What are the alternatives to varicose vein stripping?

In modern practice, less invasive treatments are often considered before surgical stripping. Your consultant will recommend treatment based on your duplex ultrasound scan, symptoms, vein anatomy and personal circumstances.

Alternative options include:

• Ultrasound-guided foam sclerotherapy: this is where a foam is injected into a faulty vein under ultrasound guidance to make it close, so that blood is diverted to healthy veins instead.
• Radiofrequency ablation (RFA): an endothermal procedure that uses radiofrequency energy to close off the faulty superficial vein.
• Endovenous laser ablation (EVLA): a similar endothermal treatment where laser energy is used to close the faulty vein.

Will I need a duplex ultrasound scan before varicose vein stripping?

Yes, you will usually need a duplex ultrasound scan before varicose vein surgery. This scan shows which veins are faulty, the direction of blood flow, and whether the deep veins are open and functioning. It helps your consultant decide whether surgery, endovenous ablation, foam sclerotherapy or another treatment is most appropriate.

How can I prepare for varicose vein stripping?

Preparing for your surgery can help to ensure that everything goes smoothly, as well as minimising your risk of complications and boosting your recovery. It’s sometimes referred to as prehabilitation and will involve several steps that your consultant will discuss with you ahead of your procedure. These may include:

• Stopping any regular medications if advised to by your consultant
• Following the fasting guidance provided by your medical team (if you’re having treatment under general anaesthetic, you’ll have to stop eating for at least 8 hours before your surgery, and you’ll have to limit your fluid intake too)
• Also following the guidance related to drinking, including how much water to hydrate yourself, when to stop drinking on the day of your procedure and why you need to avoid alcohol before and after your treatment
• Arranging for someone to drive you home after your varicose vein stripping appointment
• Arriving at your appointment in loose-fitting clothes
• Do not shave the area before your procedure unless otherwise advised.

What happens during varicose vein stripping?

Varicose vein stripping is commonly performed under general or regional anaesthetic. In some cases, local anaesthetic with sedation may be suitable. Your anaesthetist and surgeon will advise which option is safest and most appropriate for you. The aim is to keep you comfortable during the procedure, although you may have bruising, swelling and tenderness afterwards.

Before your procedure, your surgeon will identify which veins are being treated, usually using the findings from your duplex ultrasound scan, and may draw the outlines of these on your leg with a marker pen. Once you are suitably anaesthetised, an incision is usually made near the groin for great saphenous vein surgery, or behind the knee for small saphenous vein surgery. A second incision may be made lower down the leg. The top of the faulty vein is tied off to prevent reflux through it.

A thin, flexible wire or stripper is then passed through the vein. The vein is attached to the stripper and removed. Visible bulging surface veins may also be removed through very small cuts, called phlebectomies, during the same operation. Your surgeon will close the incisions, and your leg will be bandaged and usually placed in a compression stocking to help control swelling and bruising.

Will I need a general anaesthetic for varicose vein stripping?

Varicose vein stripping has traditionally often been carried out under a general anaesthetic, although regional anaesthetic or local anaesthetic with sedation may be suitable in selected cases. Speak to your surgeon and anaesthetist about your anaesthetic options.

How long does varicose vein stripping take?

The exact time varies, but in many cases varicose vein stripping takes around an hour per leg. It may take longer if both legs are treated or if additional phlebectomies are performed.

How long does it take to recover from varicose vein stripping?

It can take several weeks or more to recover from varicose vein stripping, although your exact recovery time may vary. Recovery after stripping is usually longer than after endovenous treatments such as EVLA or RFA, because stripping involves surgical incisions and removal of a vein. You’ll usually be recommended to start walking the same day, although you’ll need to limit your exercise initially.

Swelling is normal, and you’ll usually be advised to wear compression stockings after surgery. The exact duration varies depending on the extent of surgery and your consultant’s practice, but it is often for 1 to 4 weeks. Beneath the bandages and stocking, your legs may be bruised and tender. Again, this is normal and will gradually improve with time.

You may need to take at least a week off work while you recover, but if you have a more physically demanding job, you may need to wait at least 2 weeks before you return to work. You won’t be able to drive until you feel that you can safely perform an emergency stop, and you have the permission of your surgeon.

By around 4 weeks after your procedure, you should be able to return to most of your usual activities, including high-impact exercise. However, you may notice bruising on your legs for several months after varicose vein stripping.

When can I fly after varicose vein stripping?

Flying naturally increases your risk of developing a deep vein thrombosis (DVT). Flying after varicose vein surgery should be discussed with your consultant, particularly if you are planning a long-haul flight or have risk factors for DVT, such as previous DVT, thrombophilia, cancer, obesity, reduced mobility or hormone therapy. Your consultant (surgeon) will advise you based on your individual risk.

What are the benefits of varicose vein stripping?

Potential benefits of varicose vein stripping include:

• Improvement in symptoms such as aching, heaviness, swelling and discomfort in your legs.
• Reduction in superficial venous reflux, which may reduce the risk of varicose vein-related complications such as bleeding, skin damage or ulceration if this applies to you.
• Improved appearance of your legs by removing unsightly, raised veins.
• Improved comfort when standing or walking if your varicose veins were previously making these activities painful.

How successful is varicose vein stripping?

Varicose vein stripping can be effective at improving symptoms and removing the treated vein.

Can varicose veins come back after stripping?

Varicose veins can come back, even after a stripping procedure. This can happen because of new reflux, new varicose veins developing, or small new veins forming near the previous operation site. It is not usually a failure of the original operation alone.

What are the risks and possible complications of varicose vein stripping?

As with any procedure, there are always some side effects and risks of complications that you should be aware of. They include, but aren’t limited to:

• Bruising and swelling
• Pain or tenderness at the incision sites
• Infection of the wound
• Bleeding or a haematoma
• Scarring, sometimes more noticeable than expected
• Nerve injury, which can cause numbness, tingling, or altered sensation in your leg or foot
• Blood clots, including deep vein thrombosis
• Damage to surrounding structures, including nearby blood vessels
• Anaesthetic complications, such as nausea, breathing problems, allergic reactions, or other general surgery risks
• Skin discolouration or pigmentation changes
• Recurrence of varicose veins over time
• Residual varicose veins that remain after surgery
• Rarely, more serious complications such as significant bleeding or persistent nerve pain.

Rarely, lymph fluid can leak from the groin wound or collect under the skin, which may require dressings or further treatment. Your consultant will explain the potential risks to you in more detail.

How much does varicose vein stripping cost at Nuffield Health?

Select your local Nuffield Health hospital to find contact details and guide prices for varicose vein stripping. Please note that the guide price stated is an approximate cost of treatment only. You will be given a fixed all-inclusive price for treatment following your initial consultation with a consultant.