Note Before Proceeding
A doctor must determine if varicose vein ligation is the right procedure for any person with varicose veins. There are several factors a doctor will use to determine if a patient is eligible for varicose vein ligation and if this treatment option is the best course of action. Stripping is not used as much any more unless the veins are too large to be treated with endovenous laser or radiofrequency ablation. Before ligation and stripping, endovenous laser ablation or radiofrequency ablation of the great saphenous or small saphenous veins, your doctor will determine if the deep veins are open and functioning. The deep veins carry over 90 percent of the blood out of your leg to your heart. There are some cases when the large veins you see are the only veins remaining to drain your leg.
What is ligation and stripping for venous disease?
Vein ligation and vein stripping are two procedures that are occasionally still used in the treatment of varicose veins if the underlying deep vein system is still open. Superficial branches of the great saphenous and small saphenous veins occasionally are too large to be treated by sclerotherapy and these will be removed through very small microphlebectomy incisions. They may be too close to the skin to treat with a laser because it could damage the skin.
Ligation means the surgical tying of veins through a small incision in the skin to prevent pooling of blood. Ligation may be used in conjunction with vein stripping, or removal of the vein. In many instances, the vein is removed using minimally invasive surgery.
Vein ligation and stripping work by tying off or removing damaged surface veins through a simple surgical procedure. This is done in an effort to improve the appearance of the legs, relieve leg pain, cramps, swelling or fatigue, prevent or treat ulceration that can be caused by varicose veins, or to prevent future complications, such as blood clots.
What are the advantages and disadvantages of surgical ligation and stripping over other vein treatments?
The main advantage of vein ligation and stripping is that these procedures can effectively treat varicose veins that cannot be treated or removed by other available treatments. These veins are too large to be treated by laser or radiofrequency ablation and these veins are so tortuous (or crooked) that one cannot pass the laser or radiofrequency catheters through them.
These procedures can also be more cost effective than some newer varicose vein treatment options, but there is less downtime with the newer procedures.
Vein ligation and stripping are considered safe procedures that offer long-term good results but require more recovery time and time off work. There is more disruption of the surrounding tissues with vein ligation and stripping.
These procedures can effectively be used to reduce leg pain, swelling and fatigue quickly, and to reduce the appearance of unsightly varicose veins.
Who is and is not a candidate for vein surgery?
Good candidates for vein ligation and stripping include men and women who have varicose veins and would like to have them removed due to pain, to improve the appearance of their legs, have an ulcer that will not heal with conservative treatment, have an ulcer that has healed and want to prevent recurrence, have veins that have eroded through the skin, bled, have had recurring blood clots in these veins and are unable to perform activities of daily living because of the veins. These procedures are generally used for very large varicose veins where those that are smaller and are of average size are best treated for the same reasons with endovenous laser ablation and radiofrequency ablation.
People who are not good candidates for vein ligation or stripping include pregnant women, men and women who have poor arterial circulation in the legs, patients with swelling related to lymph blockage, patients with abnormalities in the passageways between arteries and veins (arterial-venous fistule) or older patients who have medical conditions that make them poor candidates for any type of surgery.
How are ligation and stripping performed?
Vein ligation is performed by a vascular specialist in a clinical setting usually using local anesthesia. This procedure involves making very small incisions over the problem vein through which the vein is tied off at the faulty valve. Vein ligation is generally used on veins with smaller areas of damage and few faulty veins. When problem areas are tied off and the vein is left intact, the healthy portion of the vein continues to work in circulating blood in the legs. There is a fairly high recurrence rate if this faulty vein is not also removed.
Vein stripping is an outpatient procedure that is performed by a vascular specialist usually using local anesthesia. In this procedure, small incisions are made below the damaged vein through which an instrument is threaded into the vein to grasp the vein and remove it through the incision. This procedure is reserved for veins that have several faulty valves and cannot be partially preserved to maintain circulation through that vein. The upper incision is most usually at the groin. The vein is removed between these two incisions.
The procedure usually takes two to three hours as it is performed in the outpatient setting under local anesthesia. You can anticipate going home soon after the surgery is completed.
What happens after the procedure?
You will be given specific instructions to follow after the surgery until your incision is healed. Typically these instructions are limiting your activity, proper elevation of your leg whenever possible and wearing compression stockings.
In general, patients are able to return to work and their regular activities within a few days after treatment and should be at least somewhat physically active to avoid complications and encourage circulation. Compression stockings will need to be worn for between two and six weeks after surgery, and strenuous activities should be avoided for several weeks. There should be no high-impact workouts or distance running or weightlifting for two to four weeks. Ask your doctor before resuming these activities.
Most patients experience immediate and long-lasting relief from the pain associated with varicose veins as well as improved appearance of their legs.
What are the risks?
As with any surgical procedure there are always risks, which is why a full diagnostic examination and ultrasound mapping is an important step in determining if vein ligation and stripping are right for you. Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you. This is generally a very safe procedure causing relatively little pain and, in most cases, is well tolerated. However, as with any surgical procedure there are risks, including scarring, bleeding, infection at the site of the incisions, the development of a clot in the vein in the leg and irritation of a nerve that runs along with the veins that are typically stripped. There is much lower incidence of injury to the nerve, to the skin, medial side of your ankle or lateral side of your ankle with endovenous laser ablation or radiofrequency ablation.
Special precautions are taken to decrease these risks.
When you meet with your doctor, ask any and all questions to make sure you understand the risks of the procedure and why the procedure is recommended.
Does insurance cover the procedure and how much does it cost?
Vein ligation and stripping may be covered by medical insurance if the procedures are considered medically necessary, such as when patients experience painful symptoms or nonhealing ulcerations, recurrent superficial blood clots and to prevent recurrent ulcerations.
If patients pursue vein surgery solely for cosmetic purposes, it is generally not covered by medical insurance.
A number of factors influence the cost of vein surgery, including the combination of procedures required and the number of veins to be treated. We will discuss this with you and provide the information.
We hope the information on these pages is both informative and helpful, but it is intended for education only. Please do note that no web site, no matter how much information is shared, can replace a consultation with your doctor and a vascular specialist. Medical technology and treatment are continually improving and evolving so before making any decision on treatment, it is always advisable to see your doctor first for a comprehensive evaluation of your vascular disease and other medical conditions.
At the Vascular Center of Wichita Falls, we work closely with your other physicians. If you have concerns about your arteries or veins, contact us. A referral is not necessary to make an appointment.