Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Several surgical procedures are available to relieve varicose veins, but not everyone with varicose veins is a candidate for surgery.
the patient is pregnant or recently
pregnant, it is advisable to wait at least 6 weeks after delivery before
considering this option, because many of the varicose veins that occured during
pregnancy will fade.
If the veins bother the pateint for cosmetic
reasons only, and the patient is not bothered by pain or inflammation, then surgery
may not be the best option.
Surgery is usually reserved for people who either do not get relief from the home care techniques or lifestyle changes, or who for cosmetic reasons want to try methods other than sclerotherapy or laser treatment to make
the veins less prominent.
Most of the surgical procedures are performed on an outpatient basis.
The surgery involves either vein ligation (tying) or stripping or avulsion (pulling
away) of the smaller branches.
With any surgery, risks and benefits exist. These
should be discussed with the health care professional and with the
Recurrence of varicose veins does occur and may be due to incompetent perforator veins or failure to ligate the vein more proximally in the groin.
Avulsion requires many tiny incisions and removal of the varicose veins that have been outlined on the skin.
This involves at least
two incisions, one at the groin and one at the knee.
A tunneling device is placed under the skin between
the two points, and the saphenous vein is dragged or pulled out of the
This technique will leave not only scars from the
incisions, but also a significant amount of
bruising and possibly bleeding. The
bleeding is easily controlled by pressure dressings and stops immediately. The
bruising is usually noticeable for a few weeks.
For vein stripping, a recovery period of 5-10 days is
needed before returning to a regular routine. For just vein ligation, a
few days off is more than adequate.
A possibility of persistent numbness from damage to the nerves in the skin exists (for this reason, usually only the vein to the knee is stripped, not the vein below the knee). The numbness is only mild in nature and does not cause any future problems.
Endovascular laser therapy
Endovenous laser therapy is a technique that uses a laser to destroy the vein. The procedure is usually performed in a doctor's office and takes about 30-45 minutes. The small laser is passed into the vein with guidance from the
The laser is then fired up and the entire vein is fibrosed. The laser is fired
at multiple locations and the entire procedure is performed with some local
Recovery is rapid and involves minimal pain. The procedure is relatively new and except for some mild bruising and a numbing sensation, no other effects have been seen in the short term.
Radiofrequency ablation is a similar technique to
endovascular laser, but it uses heat to destroy the vein. The probe
is placed in the vein under ultrasound and once in position, the vein is heated along the entire length. The procedure is performed under local anesthesia and takes about 30 minutes.
Short-term results are excellent using radiofrequency ablation.
This was formerly the surgical treatment for varicose veins before the newer treatment modalities described above became available. It usually involved an incision at the groin and tying off of the saphenous vein where it enters the femoral vein. It is tied just at the entrance. The procedure can be performed under local anesthesia.