Veins that are swollen, twisted and can be seen under the skin are varicose veins. Vein stripping is the surgical removal or obliteration of varicose veins. It is performed both for cosmetic and non-cosmetic reasons.
Veins that are swollen, twisted and can be seen under the skin are varicose veins. Generally varicose veins appears in the leg, and are a result of damaged or missing valves in the veins. Varicose veins are blue or red colored visible veins under the skin, especially while standing.
Vein stripping is the surgical removal or obliteration of varicose veins. It is performed both for cosmetic and non-cosmetic reasons. The aim of the surgery is to take pressure off the skin veins in the leg, by tying and dividing (and often removing) the principal skin veins in the leg. The removal of varicose veins does not affect blood flow because other veins and especially the deep veins take over blood flow job.
Surgery is recommended only after alternative home treatments do not work. In following cases, vein stripping surgery is required:
Ulceration, or threat of ulceration resulting from varicose veins.
If the veins have caused bleeding through the skin.
Phlebitis (inflammation in the veins and overlying skin), large varicose veins and aching in the veins.
Pain, fatigability, heaviness and recurrent superficial thrombophlebitis
Venous hypertention after skin or subcutaneous tissue changes, such as lipodermatosclerosis, atrophie blanche, ulceration, or hyperpigmentation.
Patients who cannot remain active enough to reduce the risk of postoperative deep vein thrombosis (DVT) should not undergo surgery. Surgery during pregnancy is contraindicated because many varicose veins of pregnancy spontaneously regress after delivery.
Before varicose vein surgery, there are a number of tests that need to be done.
Vascular surgeon will take a detailed history will be taken with regard to the varicose veins and the nature of symptoms. An examination of the leg is performed to check at the distribution of the varicose veins and for signs of tissue damage secondary to the varicose veins.
It is also particularly important to undergo a detailed ultrasound mapping scan, called a Colour Flow Duplex, to figure out most effective treatment. This is particularly important for redo surgery, history of thrombosis in the veins, valve abnormalities behind the knee or leg ulceration. The scan will provide a map for the surgeon detailing the exact problems in the veins.
Varicose vein surgery is performed under general or spinal anesthetia, and generally takes about 60 to 90 mintues.
During the surgery, the vascular surgeon will
After anesthesia is administered, make an incision at the back of the knee. Normally, a slanting cut about 4 to 6 cm long is made running in the skin crease of the groin.
Through this incision the top end of the faulty skin vein (long saphenous vein) is tied off to stop blood flowing through it - this is known as ligation.
A wire is then inserted into the vein and passed down to knee level. At knee level a second cut is made and the vein (with the wire running through it) is pulled out. The ligation and removal of the long saphenous vein deals with the cause of the varicose veins and should prevent recurrence.
Less frequently, when the principal vein on the back of the knee has a leaking valve, it too needs ligation. This is performed through a horizontal incision about 3 cm long on the back of the knee. The vein is then removed. The short saphenous vein is rarely stripped from the leg because it lies close to a nerve, picking up skin sensation, which may be damaged.
Finally, in most cases, the visible varicose veins are removed from the leg through tiny incisions about 2 - 3mm in length. Incisions are placed about 3 - 5cm apart along the line of the varicose vein. There may be a large number of tiny incisions if the varicose veins are extensive.
Most patients describe the leg as stinging or burning after they wake up from the surgery. It is unusual for the leg to be painful. Following this sort of surgery the patient is very unlikely to feel sick and should be able to eat and drink again within a few hours.
Some of the smaller incisions may bleed a little over the first 48 hours. For this reason, it is best to keep the leg covered with bandages or stockings for the first 48 hours. After this time, the stockings may provide support to the bruising making the leg more comfortable.
The incisions, although initially very visible, will subside to become virtually invisible within 9 to 12 months. There is usually extensive bruising in the leg, particularly down the inside of the thigh. This bruising usually lasts for 3 to 4 weeks.
Risk and Complications
Varicose veins surgery is usually a safe procedure. In some cases, complications might occur. Known complications are
Subcutaneous hematoma, which can be managed with warm compress, anti-inflammatory drugs or aspiration if necessary.
Infection and arterial injury
Bleeding or leakage of clear fluid from the incision
In rare cases, deep vein thrombosis may occur in patients with extensive varicose veins
If you have any additional questions, talk to our in-house doctors. Call 1800-1022-733 (toll free).
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