Vein stripping is a traditional surgical procedure that treats advanced venous disease by physically removing a long, damaged vein from the leg. For over a century, this technique has been a primary method for managing large, faulty superficial veins. When diseased, these veins cause abnormal blood flow, leading to uncomfortable symptoms. While modern, less invasive methods are now common, vein stripping remains a definitive option for specific complex cases of venous insufficiency.
Conditions Treated by Vein Stripping
Vein stripping primarily addresses severe varicose veins and chronic venous insufficiency (CVI). These conditions occur when the one-way valves inside the leg veins weaken or fail, causing venous reflux. This valve failure allows blood to flow backward and pool, increasing pressure and enlarging the vein.
The procedure often targets the great saphenous vein (GSV), running from the ankle to the groin, or the small saphenous vein (SSV) in the calf, as these are frequent sources of reflux. When these veins become significantly dilated, they cannot be treated effectively with non-surgical methods. The resulting high pressure causes the characteristic swollen, twisted appearance of varicose veins visible beneath the skin.
Vein stripping is medically indicated when venous reflux causes debilitating physical symptoms. These symptoms include persistent leg pain, a heavy or aching sensation, and chronic swelling known as edema. Over time, the sustained high pressure can lead to severe skin changes, such as hyperpigmentation, inflammation, and hardening of the tissue.
In advanced CVI, poor circulation can result in the formation of venous ulcers, which are open sores that are difficult to heal. Removing the diseased vein eliminates the source of high pressure for patients with large, symptomatic varicose veins or non-healing ulcers. The body then reroutes circulation through the deep, healthy veins, which efficiently return blood to the heart.
Step-by-Step Guide to the Surgery
The vein stripping procedure begins with pre-operative planning to identify the exact segment of the vein requiring removal. A vascular surgeon uses Duplex or Doppler ultrasound to map the damaged vein, marking its trajectory and connection points on the skin. This imaging ensures the diseased section is accurately targeted while preserving healthy vessels.
The surgery uses either general or regional anesthesia, such as a spinal block, which numbs the lower body. Once the anesthesia is effective, the surgeon makes two primary incisions to access the vein. The first, usually larger, incision is made at the upper end of the diseased vein, typically in the groin for the great saphenous vein.
Through this upper incision, the surgeon performs a ligation, isolating and tying off the damaged vein where it connects to the deeper venous system. This step is crucial because it halts the backward flow of blood, or reflux, into the superficial system. A second, smaller incision is then made further down the leg, often near the calf or ankle, to access the lower end of the targeted vein segment.
The actual “stripping” involves inserting a thin, flexible surgical tool, known as a vein stripper, into the vein through the lower incision. The surgeon guides it up the vessel toward the groin. Once the tool reaches the upper incision, the vein is secured to the stripper, and the surgeon carefully pulls the stripper back down and out through the lower incision, effectively removing the long segment of the diseased vein.
The surgeon closes the incisions with sutures or surgical staples. The procedure generally takes 60 to 90 minutes, though the duration varies based on the length and complexity of the segment stripped. The leg is immediately wrapped with compressive dressings to control bleeding and minimize post-operative swelling and bruising.
Immediate Post-Operative Care and Recovery
Following surgery, patients are observed in a recovery area as they wake from anesthesia. Vein stripping is often an outpatient procedure, allowing many patients to return home the same day, though some may require an overnight stay depending on the surgery’s extent. A responsible adult must be available to drive the patient home and assist with initial recovery.
A compression bandage or stocking is applied immediately after surgery. This external pressure is the single most important component of post-operative care, helping to reduce swelling, limit bruising, and support the remaining vasculature as blood flow is redirected to the deep veins. Patients are instructed to wear these garments continuously for the first few days, and then during waking hours for several weeks.
Managing post-operative discomfort is a primary focus. Patients may experience bruising, swelling, and mild to moderate pain, which is controlled with prescription medication initially, followed by over-the-counter relievers as symptoms subside. Temporary numbness or tingling along the leg is a common short-term side effect resulting from minor nerve irritation during vein removal.
Physical activity is encouraged shortly after the procedure; patients should begin walking as soon as possible to promote healthy circulation and prevent blood clots. Short, frequent walks are recommended, and prolonged periods of sitting or standing should be strongly discouraged. Strenuous activities, such as heavy lifting or intense aerobic exercise, must be avoided for two to four weeks to protect incision sites.
Patients should keep the leg elevated above the level of the heart whenever sitting or lying down, especially during the first few days. Incisions must be kept clean and dry, avoiding submerging the leg in baths or pools until wounds are fully healed, typically about one week. Full recovery and a return to normal activities usually occur within two to four weeks.