Introduction
Whilst the majority of patients are better served with endovenous ablation treatment for varicose veins, in some situations, that treatment is not suitable and Varicose vein stripping is the better option.
Vein striping involves the surgical removal of the main vain causing the varicose veins. Vein stripping is an effective way of removing the abnormal veins, but does cause more bruising and a longer recovery time when compared with the endovenous ablation techniques.
Indications
There are a number of indications for varicose vein stripping:
- Very large or very superficial veins making ablation therapy unsuitable.
- Recurrent varicose veins after previous surgery.
- Patient preference.
Preoperative Instructions
For varicose vein stripping procedures, you will be admitted on the same day as the procedure and generally stay in hospital overnight being discharged the following morning. Please bring your usual medications with you to hospital. You will require fasting prior to the procedure and specific instructions will be provided depending on the day and time of your procedure.
Your leg or legs will need to be shaved for the surgery and you should bring your prescribed compression stockings with you as they will be needed prior to discharge.
The use of blood thinning and diabetic medications will need to be discussed prior to your surgery to have an appropriate plan of management.
Procedure
The procedure of varicose vein stripping will require a general anaesthetic. Surgery generally takes 1-1.5hours depending on the number and size of the varicose veins.
The procedure involves making a small incision in the groin or behind the knee (depending on whether the Long Saphenous vein or Short Saphenous vein is affected). The abnormal vein is then divided from where it attaches to the deep veins. The stripping component is achieved by passing a small plastic tune down through vein into the lower leg region. Another small incision is made over this and then the vein is pulled (stripped) out of the leg. Compression is used to minimize bruising. Following the stripping, a series of phlebectomies is performed over the prominent veins to remove as many of the visible veins as possible. This is done through a series of 2-3 mm incisions. The groin or behind knee incision are sutured closed with a dissolving stitch. The other small incisions are closed with Steri-Strip (tapes) as they are very small and do not require suturing. The leg is then dressed firmly with a compression bandage that will remain in place for 24 hours. The compression stocking is then used thereafter.
Postoperative Instructions
NB: These are general guidelines and may not apply to your specific case.
Post-operative
Bandaging is removed the day after your surgery. You will find that your leg has 2 bandages: a padded absorbent layer or combine and a layer of Vaseline gauze. These layers can all be removed. Over the small incisions, you will find either brown or white tapes or Steristrips. These should be left on for as long as possible (usually 7 days) and then gently peeled off in the shower. Once the dressings have been removed, then you may have a shower and wash the leg. After your shower, you need to apply your thigh length compression stocking. You should wear the stocking for the next 2 weeks. The first week should be 24 hours per day, and then just during the day for the second week. The stocking can be removed each day for you to shower and can be left off for an hour or so to wash and dry the stocking as required.
Wound Care
It is normal to have some bruising around the incisions and occasionally some areas of hardness will develop under the skin. This is a normal part of the post-operative process and is not a concern. Leave the Steri-strips over the wounds until they start to come off themselves then gently peel off in the shower.
Medications
Simple Panadol or Nurofen is generally all that is required following the vein surgery. If pain is not controlled with these medications then please contact Dr Boyne.
Activity
It is important to return to normal mobility as soon as possible. Ideally, you should walk for 30 minutes per day. When not walking, it is best to elevate the legs to prevent swelling. This is most important in the first week after your surgery. A gradual return to all of your usual activities should occur by 2 weeks following your surgery. It is best to avoid prolonged standing or vigorous exercise (such as running) until after 2 weeks. Driving your car should be avoided for the first few days following your surgery but can be resumed once you are comfortable that you can press on the pedals safely.
Follow-up
If you have pain that is not controlled by simple analgesics or you have marked leg swelling it is important to contact Dr Boyne. Otherwise, a review appointment will be scheduled for 2 weeks after your surgery. It is best to avoid plane travel for at least one month after surgery if possible.
Risks
Varicose vein surgery is very safe. As with all procedures there is a small risk of complications. These include:
- Anaesthetic complications.
- Bruising.
- Wound infection.
- Nerve irritation or damage.
- Deep Vein thrombosis.
- Recurrent varicose veins.
All of these complications are rare and will be discussed prior to booking surgery.
Treatment Alternatives
Varicose vein surgery is generally recommended for large or symptomatic varicose veins. Usually, an ablation procedure is recommended however in certain circumstances Vein stripping is the safer or preferred option. An alternative to surgery is the use of compression stockings long term. This can often be a knee-high stocking. Compression therapy can be an effective way of controlling varicose veins however they can be difficult and hot to wear on a regular daily basis. It is an option to avoid surgery.
Sclerotherapy is another method of treating varicose veins. It can be very useful for treating isolated or visible veins but is not ideally used to treat the main cause of varicose veins, the large abnormal major veins. Sclerotherapy may temporise some varicose veins, however more definitive treatment is generally recommended. Sclerotherapy is a very useful adjunct to ablation treatment or vein stripping.
Related Information
Endovenous Ablation of Varicose Veins
Sclerotherapy
Varicose Veins
Superficial Thrombosis
Venous Ulcers