Varicose vein stripping and ligation surgery waiting times update

Find out about the latest waiting times for varicose vein stripping and ligation surgery with Dr Foster Health

Varicose vein stripping and ligation summary

Varicose veins are swollen and unsightly veins in the leg which, while not a serious health problem, can become sore, damaged or infected.

Surgery to treat this condition involves stripping out the affected vein and is classified under General Surgery. A cut is made in the groin and an instrument is threaded down the vein. The vein is then stripped out through a small cut lower down the leg.

Key questions

How common are varicose veins?

Varicose veins rarely cause serious illness, but can be disfiguring and make people feel unconfident about their appearance.

The NHS does not routinely offer varicose vein surgery, except under specific circumstances ⁽¹⁾.

The characteristic distorted and enlarged veins appear mainly on the legs, with 30 per cent of women and 15 per cent of men ⁽¹⁾ developing them. Women tend to get varicose veins more often due to the side-effects of pregnancy.

Varicose veins can also develop after long periods of standing and in overweight or obese people ⁽²⁾

When is varicose vein surgery appropriate?

Surgical treatment for varicose veins on the NHS may be considered in the following cases:

1. Aching, throbbing or tenderness of the veins
2. Cosmetic appearance - varicose veins can be unsightly and cause psychological distress
3. Medical complications, such as eczema around the ankle with or without actual skin ulceration, thrombophlebitis (clotting and acute tender inflammation of the varicose veins) and bleeding from a traumatised superficial vein

If none of the above indications apply, your doctor may not consider referring you for varicose vein stripping and ligation surgery.

Why won't my doctor refer me for varicose vein removal?

Both doctor and patient must be clear about the reasons why treatment should go ahead as well as balance the expected benefits of any surgery against the disadvantages of having a surgical operation i.e. inconvenience, post-operative pain, potential risk of having a general anaesthetic and surgical complications (infection, blood clots).

Most NHS consultants won't recommend surgery for relatively minor varicose veins on a preventative basis. A decision not to operate can always be reviewed in the future if the situation changes.

Properly fitted elastic stockings may be a useful short- or long-term method for alleviating the majority of symptoms or avoiding complications if you are not keen on surgery, but they will not cure the condition.

NHS versus Private Hospitals

While varicose vein surgery is not available for all on the NHS (as described above), you can pay for treatment privately. Prices vary, but range from about £1,500 for one leg to about £3,400 for both legs.

Even if you do opt for private medical treatment, your surgeon may not agree to remove your varicose veins if they are not causing you any physical or psychological discomfort. Surgery can sometimes carry more risks to health than leaving the veins as they are.

Waiting times for varicose vein stripping and ligation surgery

Government targets have gone some way to reducing waiting times, especially for high-volume procedures, such as varicose vein stripping and ligation surgery.

Dr Foster Health data show that waiting times for varicose vein stripping and ligation surgery by Strategic Health Authority (SHA) have been falling year-on-year in all regions:

Figure 1

Hospital length of stay for varicose vein stripping and ligation surgery

The following graph shows you the average length of stay in hospital after varicose vein stripping and ligation surgery according to age group. Varicose vein removal surgery is generally a day case, which means you will probably not need to stay overnight in a hospital.

Figure 2

Inpatient spell: a patient's stay in hospital consists of at least one finished consultant episode (period of care under one consultant/team)

Figure 2 above shows that as patients get older they are more likely to stay in hospital for longer after varicose vein stripping and ligation surgery.

New developments in less invasive varicose vein removal techniques

Recent advances in the treatment of varicose veins have improved the safety, comfort and long-term success of varicose vein removal.

The duration of treatment and recovery with these techniques is shorter than conventional varicose vein surgery, while pain is minimised and results are generally as good. These newer procedures can also be done under a local anaesthetic.

If you do decide to go privately, you should make sure that your insurance covers these types of procedures.

Clinical studies assessing long-term outcomes among these less invasive procedures are ongoing and new treatments continue to evolve.

These newer procedures may not be available at all NHS or Private Hospitals:

Ambulatory Phlebectomy - removes varicose veins on the surface of the legs and can be performed under local anaesthesia. The procedure involves making tiny incisions through which the varicose veins are removed. The incisions are so small no stitches are required. Varicose veins can be made to collapse so that they become much smaller and even large veins can be removed through the tiny incisions used in this technique. You will be able to walk following the procedure.

After the procedure is completed, you will wear compression stockings for a period of time stated by your doctor. Doctors recommend that you walk after treatment, as this reduces pressure in the veins, increases blood flow and reduces the risk of clotting.

Foam Sclerotherapy - the most commonly used treatment for smaller veins with a diameter of less than 5mm, which includes spider veins. A liquid is injected into the vein with a very small needle, causing the walls to become inflamed and stick together, which collapses them completely. After the procedure, you will wear a compression stocking which stops the vein from working. The vein will eventually disappear over time.

This procedure cannot prevent new veins from forming if other faulty blood vessels are not treated. Sclerotherapy can also cause the vein to develop a brown discolouration which can take up a year to disappear. Repeat treatments are usually necessary. In rare cases, the procedure can cause skin ulcers, while some patients may be allergic to the injected solution that collapses the veins.

Endovascular Laser Therapy - a thin laser device is fed into a small incision in the vein near the knee and guided along the vein to the groin using an ultrasound scanner. The vein is then filled with a small amount of fluid. The laser is turned on and pulled back through the vein, which destroys the tissue of the varicose vein with heat (thermal ablation). The incision is then covered and in most cases the patient can leave the treatment room almost immediately.

Laser surgery is much less invasive than varicose vein stripping and only takes a few minutes. It is appropriate for patients with large or painful varicose veins, leg wounds that are slow to heal and swollen legs. The number of treatments needed depends on the extent of your varicose veins.

VNUS Closure (radiofrequency ablation with closure) - uses a radio frequency current which is passed through electrodes into the vein wall causing it to heat up to 120°C. The electrode is pulled along the vein in a similar manner to endovascular laser therapy, thus destroying the problem varicose vein.

The procedure cannot be used for small veins or in small segments of vein under 7 cm long, which are common in people with recurrent varicose veins. Therefore the treatment is only appropriate in selected patients.