Vein Stripping

Vein stripping and ligation is surgery to remove varicose veins in the legs. The veins have valves inside them to help ensure that blood flows in the correct direction toward the heart. Varicose veins can occur if these valves become damaged or weakened and blood pools in the veins.

Varicose veins are the puffy, twisted veins that you can see under the skin. They usually have a red or bluish-purple color. Varicose veins most often appear in the legs, but they may also develop in other parts of the body.

Vein ligation is “tying off” a varicose vein to stop blood from entering it. The vein is then stripped (removed from the body). After varicose vein stripping and ligation, the healthy veins take over to help restore normal blood flow.

Vein stripping treats varicose veins and helps prevent them from coming back. The procedure is also known as vein stripping with ligation, avulsion, or ablation.

Why would I need varicose vein stripping and ligation?

People choose to remove varicose veins for health or cosmetic reasons. Varicose veins affect adults and can cause:

• Feeling of heaviness in the legs

• Itching

• Pain, soreness and muscle cramps

• Skin discoloration and sores

• Swelling

• Twisting, ropelike bulges in the legs that may be blue or purple

Vein stripping and ligation is also perform to treat chronic venous insufficiency (CVI). CVI is another condition that can occur when valves in your leg veins become damaged. The patient might experience symptoms like pain, swelling and skin sores with CVI due to blood pooling in the legs. CVI usually occurs because of a blood clot in your legs known as deep vein thrombosis (DVT).

Risks / Benefits

What are the advantages of varicose vein stripping and ligation?

Varicose vein stripping and ligation is an effective way to treat varicose veins and some cases of chronic vein insufficiency. This surgery generally works well even on severe cases, or very large varicose veins. The affected vein is removed during the surgery, there’s no risk of the varicose vein coming back. Vein stripping and ligation is also an outpatient surgery, so the patient can go home the same day.

What are the risks or complications of varicose vein stripping and ligation?

• Allergic reaction to anesthesia

• Blood clot in the leg

• Infection at the site of incisions.

• Irritation of a nerve near the removed vein, which can cause numbness or pain

• Scarring at incision sites.

Procedure Details

What happens before varicose vein stripping and ligation?

The healthcare provider will give specific instructions to prepare for the procedure. For instance, the patient may need to stop eating or drinking several hours before your surgery. Some may also need to stop taking certain medications.

What happens during varicose vein stripping and ligation?

When it’s time for the procedure, the anesthesiologist gives the anesthesia to keep the patient from feeling pain. For vein stripping and ligation, the patient may receive:

A sedative (medicine to make the patient sleepy) with regional anesthesia (blocks pain in the area of the procedure).

General anesthesia, which makes the patient unconscious.

Once the anesthesia is working, the surgeon makes small incisions in the groin and lower leg. They locate varicose veins using ultrasound imaging. Then, the surgeon ties off the veins and removes them.

In some cases, the surgeon may use endovenous thermal ablation. This newer technique uses 

heat or laser energy to close off varicose veins. Varicose vein stripping and ligation usually takes one to three hours.

For Post-operative home instructions:

• After this initial recovery period, it is important that the patient remains active to help prevent

• venous stasis; however, legs should still be elevated during rest periods

• Medications can be prescribed to alleviate pain

• The compression bandages should be kept in place postoperatively until the surgeon indicates

• that they can be removed and replaced with graduated compression stockings

• Full recovery can take up to four weeks, but the timeframe will ultimately depend on which

• veins and how many veins were treated.

References:

Epstein D, Bootun R, Diop M, et al. Cost-effectiveness analysis of current varicose veins treatments. J

Vasc Surg Venous Lymphat Disord 2022; 10: 504.e7–513.e7. [PubMed] [Google Scholar]

Antani MR, Dattilo JB. Varicose Veins. 2021 Aug 4. In: StatPearls [Internet]. Treasure Island, FL:

StatPearls Publishing; 2022 Jan-. Accessed 10/19/2022.

Raetz J, Wilson M, Collins K. Varicose Veins: Diagnosis and Treatment . Am Fam Physician.

2019;99(11):682-688. Accessed 10/19/2022.

Society for Vascular Surgery. Varicose Veins . Accessed 10/19/2022.

Youn YJ, Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern

Med. 2019;34(2):269-283. Accessed 10/19/2022.

Wieczorek P. Vascular surgery. In: JC Rothrock, ed. Alexander's Care of the Patient in Surgery. 16th ed.

St. Louis, MO: Elsevier Mosby; 2019: 881-912.

Instruments and OR needs

Instruments:

Minor set

Prep set

Light handles

Vein stripper

Weitlaner medium

OR Needs:

Abdominal pack

Operating sponge

Povidone paint and scrub

Sterile shoe cover

Blade 15 and 11

Cautery pad

Cautery cord

Suction catheter

Lidocaine 2% (4 ampoules)

Epinephrine (1 ampoule)

10cc and 1cc syringes

Silk 2-0 strands

Vicryl 3-0SH or any equivalent

Vicryl 4-0PC5 or any equivalent

Tegaderm Medium

Steri strips

Elastic bandage (4” and 6”)