Surgery Overview

Vein ligation and stripping is a minor surgery. It is used to remove a damaged vein and prevent complications of vein damage. If several valves in a vein and the vein itself are heavily damaged, the vein (or the diseased part of the vein) is removed (stripped). An incision is made below the vein, a flexible instrument is threaded up the vein to the first incision, and the vein is grasped and removed.

During this surgery, one or more incisions are made over the damaged veins, and the vein is tied off (ligated). If the ligation cuts off a faulty valve and the vein and valves below the faulty valve are healthy, the vein may be left in place to continue circulating blood through other veins that still have valves that work well.

What To Expect After Surgery

Vein ligation and stripping typically do not require a hospital stay and are done on an outpatient basis with regional or general anesthesia. Most people go home the same day of their surgery.

Most likely, you will be able to return to work within a few days. After several weeks, you can resume normal leisure and recreational activities.

Why It Is Done

Vein ligation and stripping is generally done on large varicose veins. It also can be done to prevent venous skin ulcers from returning after treatment. This surgery may be used when:

• You want to get rid of varicose veins for cosmetic reasons and you don't have other health problems that would make surgery more risky.
• Your legs ache, swell, or feel heavy, especially after prolonged standing.
• A varicose vein bleeds.
• Open sores (ulcers) develop because of varicose veins or poor blood circulation in a vein.
• The vein is damaged in the section where it joins the superficial and deep veins in the knee or groin.

If you have both small and large varicose veins, you may have more than one type of treatment. Following vein ligation and stripping to treat large varicose veins, you may have sclerotherapy to treat smaller varicose veins.

Who should not have ligation or stripping

Vein ligation and stripping should not be done in:

• Older adults for whom surgery poses a high risk due to other medical conditions.
• People who have poor circulation in the arteries of the legs.
• People who have swelling and fluid buildup due to blockage in the lymph vessels (lymphedema), skin infections, or blood-clotting defects.
• Women who are pregnant.
• People who have an abnormal passageway between an artery and vein (arteriovenous fistula) in the leg.

How Well It Works

Vein ligation and stripping removes varicose veins and keeps them from coming back in 90 out of 100 people. It doesn't work for 10 out of 100 people.¹

Risks

Vein ligation and stripping surgery has some risks, such as scarring and varicose veins recurring. Also, if the deep vein system is damaged, surgery may make problems with blood flow in the veins worse. Varicose vein surgery has the same risks associated with general surgery, including infection, bleeding, and anesthesia risks.

If the largest vein in the leg (great saphenous vein, or GSV) is stripped below the knee, numbness may result due to nerve injury.

What To Think About

For help deciding whether to have a procedure for varicose veins, see:

Varicose Veins: Should I Have a Surgical Procedure?

In the past there was concern about removing the great saphenous vein, because this vein is often used as a replacement or graft for an artery in the heart when a person has bypass surgery. Doctors now believe that there is no reason not to strip the GSV in the leg if needed. If the vein is badly damaged, it will not work as a vein graft anyway. In most cases a blood vessel from the chest (mammary artery) can be used during heart bypass surgery instead of the GSV. If necessary, arm veins can be used.

Vein stripping surgery is seldom done for people who have chronic venous insufficiency (CVI) resulting from deep vein problems and who also have varicose veins. Removing varicose veins close to the surface of the skin (superficial varicose veins) may cause problems if the deep leg veins are also damaged. If you are considering this surgery, get an opinion from a vascular specialist.

If you are thinking of ligation and stripping, consider some questions to ask about varicose vein treatment. These questions include: How much experience does the doctor have with the particular treatment? How much do the exam and treatment cost?

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

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