Varicose Vein Surgery

Varicose vein stripping is the surgical procedure to treat varicose veins condition. It has been around for a long time and was described by Celsus a Roman born around 25 BC.* Varicose veins are the abnormal veins that appear swollen, twisted, prominent and dark purple or blue through the skin. They can form anywhere in the body, but they are usually seen in the back of the calf or on the inside of the leg. They occur when the valves in the veins do not function properly and the blood leaks down and collects in the veins. This causes the veins to enlarge. Women are more likely to get varicose veins than men.

Vein stripping surgery has typically been employed for:

• Aching legs
• Varicose veins that cause poor circulation of blood (venous insufficiency)
• Ulcers or sores caused by elevated pressure in the veins
• Thrombophlebitis – Inflammation or blood clots in the veins
• Lipodermatosclerosis – Hardening of fatty tissue under the skin caused by increased blood pressure in the veins
• Cosmetic reasons

Dr Stirling would now only recommend vein stripping in a very small proportion of patients. The procedure is usually performed under general or spinal anaesthesia. The surgeon makes two small incisions, one in the groin at the top of the affected vein and the other either in your calf or ankle. The surgeon then advances a thin, flexible plastic wire through the vein from the groin incision to the incision in ankle or calf.  This flexible wire is tied to the saphenous vein and pulled out, theoretically bringing the entire vein with it.

Most people are able to return to work within two weeks of the surgery. Following surgery, your surgeon may ask you to keep your legs wrapped with bandages for several weeks.  Keep your leg elevated above your heart level by placing pillows or blankets under your legs. Compression stockings may be worn to improve blood flow. You may also be prescribed pain medications to reduce pain. Take several short walks, for 5 to 10 minutes each and avoid standing or sitting for prolonged periods of time.

Possible complications of vein stripping include bruising or scarring at the incision sites, nerve damage, and recurrence of varicose veins.

Surgical stripping is the last resort of treatment. The advent of Endovenous treatments like RF or Laser as well as Foam Sclerotherapy mean that the risks and inconvenience of this procedure are rarely warranted.

* For those interested a hand written COPY of Celcus’ Treatise can be seen at www.wdl.org or the english translation of the vein surgery description at www.perseus.tufts.edu

It is amazing to think that this was written two thousand years ago and that antibiotics, antisepsis and modern anaesthetics were many centuries away. Note that OPIUM use was recorded 6000 years ago – long before the Romans, and that at the height of the Roman Empire, Opium use was rampant throughout the world, thus it is highly unlikely that surgery was performed without some form of pain dulling intoxication.