Stripping removes the length of saphenous vein that has stopped working, so blood can no longer fall back down it. It is the older of the two main options and is still the right one in particular legs, though many patients today are better served by laser closure.
Varicose vein stripping removes the great or small saphenous vein through a cut in the groin or behind the knee and a second small cut lower down. It is done for a vein that ultrasound shows is incompetent, and it is usually combined with removal of the bulging surface veins. Most people go home the same day or the next, walk immediately, and return to office work within one to two weeks.
Two long veins run just under the skin of the leg: the great saphenous vein on the inner side, and the small saphenous vein at the back of the calf. Both carry blood upward against gravity, and both rely on small one way valves to stop it falling back. When those valves fail, blood runs the wrong way down the vein and loads the surface veins, which stretch, bulge and become the visible varicose veins.
Stripping deals with the failed trunk itself. The vein is tied off where it joins the deep system, a thin instrument is passed down inside it, and the vein is drawn out through a small cut further down the leg. The bulging surface veins are then removed separately through tiny stab incisions that usually need no stitches.
Removing a superficial vein does not harm the circulation. The deep veins carry the great majority of the blood out of the leg and continue to do so afterwards. What is taken out is a vein that had already stopped doing its job and was making the problem worse.
Stripping is a good answer for some legs and the wrong answer for others. Duplex ultrasound of both legs decides it, not the appearance of the veins alone.
The veins are marked on the skin while you stand, because they collapse once you lie down. This map guides every cut that follows.
Most vein surgery is done under spinal anaesthesia, which numbs the legs while you stay awake, or under a general anaesthetic if you prefer.
A short cut in the groin crease, or behind the knee for the small saphenous vein, exposes the junction with the deep vein. The saphenous trunk and its side branches are tied off there.
A fine flexible stripper is passed down inside the vein to a second small cut below the knee, and the vein is drawn out along it.
The bulging veins marked earlier are hooked out through stab incisions a few millimetres long. These are so small they are closed with tape rather than stitches.
The leg is bandaged firmly from toes to thigh before you wake, and you are helped to walk within a few hours.
You walk within a few hours. The leg feels tight from the bandage rather than sharply painful. Most people go home the same evening.
The bandage is changed for a compression stocking, usually at 48 hours. Bruising appears along the inner thigh and looks worse before it looks better. Simple painkillers are normally enough. Walk regularly and keep the leg up when sitting.
Stab wounds have healed. Bruising fades through yellow and green. Most people are back at desk work by the end of week two. The stocking is usually worn by day for two to four weeks.
Tenderness along the stripped track settles. Scars soften and fade. Aching and heaviness should be clearly better by now; if they are not, the leg is re-scanned.
Aching and heaviness usually improve markedly, and that is the change most patients notice first. The cosmetic result is good but not perfect. There are small scars in the groin or behind the knee and a scatter of tiny marks where the surface veins were removed, and these stay visible for months before fading. Bruising down the inner thigh is normal and can be dramatic in the first fortnight. Stripping treats the veins you have today; it does not stop new veins becoming varicose later, and a minority of patients need further treatment years on.
No operation of this size is risk free. These are the ones worth understanding before you agree to it, and they are discussed again when you consent.
What you do in the first fortnight affects both the comfort of the leg and the chance of a clot, so these points matter more than they sound.
The deep veins carry most of the blood out of the leg and are untouched. The vein removed had already failed and was adding to the congestion, not relieving it.
Laser closure is less bruising and suits most patients, but a very large, very twisted or very superficial vein can be unsafe or ineffective to treat that way. The ultrasound decides.
Many are. But untreated reflux can lead to skin damage, eczema, bleeding and ulceration at the ankle, and those are much harder to reverse than to prevent.
Surgery deals with the veins present now. New veins can become varicose later, and a minority of patients need further treatment years on.
Vein work is decided by the ultrasound, not by how the leg looks across a consulting room. Every leg is mapped before anything is offered, and the map decides whether stripping, laser or simply compression is the honest recommendation.
Cost depends on whether one or both legs are treated, whether the great or small saphenous system is involved, how many surface veins need removing, and whether the admission is day case or overnight. Varicose vein surgery for symptomatic disease, and particularly where there are skin changes or an ulcer, is commonly covered by health insurance and by government schemes. Purely cosmetic treatment of thread veins is not.
You are given a written estimate after the ultrasound, because only then is the extent of the work known.
These come up in almost every vein consultation.
Ask your question →Most patients describe tightness from the bandage rather than sharp pain, and manage on simple painkillers. The inner thigh is tender for a couple of weeks where the vein was removed. Pain that is severe, or a calf that becomes swollen and hot, is not expected and should be reported the same day.
Desk work is usually possible within one to two weeks. Work that involves long standing, heavy lifting or a lot of driving generally needs two to four weeks. Tell us what your job involves and you will get a realistic date rather than a generic one.
Both legs can be treated in one sitting, and often are. It means one anaesthetic and one recovery, but the first fortnight is harder because neither leg is comfortable. If your work or home situation makes that difficult, the legs can be staged.
It depends on the vein, not on preference. Laser closure causes less bruising and a faster return to work, and suits most straight, reasonably sized trunks. A very large, very twisted or very superficial vein is often better stripped. The duplex scan answers this.
The vein that is removed cannot come back. New veins can become varicose over the following years, particularly if there is a strong family history, and a minority of patients need further treatment. Wearing compression when standing for long periods and keeping weight steady both help.
Treatment for symptomatic varicose veins, and especially where there are skin changes or an ulcer, is commonly covered by health insurance and by government schemes. Treatment of thread veins for appearance alone is not. We give you a written estimate and the documentation your insurer needs.
Many people live with varicose veins for years without difficulty. The reason to treat is symptoms or skin change. If the skin at the ankle is already darkening or hardening, leaving it carries a real risk of ulceration, which is slow and difficult to heal once it starts.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
