Varicose vein stripping and ligation surgery 

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

Surgery to treat the condition involves stripping out the affected vein. 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.

How do varicose veins happen?
Blood is pumped out of the leg via veins through one-way valves toward the heart when you move. If the valves of the superficial veins are weak, they don't close properly and blood falls back to the leg under gravity, making the vein swell.

There are two types of vein: superficial veins just under the skin; and deep veins in the muscle layers. Superficial veins are the ones that become varicose veins.

What do varicose veins look and feel like?

• A swollen varicose vein will look blue, convoluted and raised
• Varicose veins can cause varying degrees of discomfort, from throbbing or pulsing aches to cramping, itchiness, thinning of the skin over the vein area and even leg ulcers
• Varicose veins cannot be cured and can only be removed

Diagnosis and detection
Your GP will probably refer you to a specialist, if they believe your varicose veins need treatment.

The specialist will perform a number of tests, including checking the blood flow of your veins and pinpointing which veins are affected:

• An ultrasound hand-held Doppler uses sound waves to measure the direction of blood flow in the veins
• A special ultrasound duplex scan enables the doctor to see and hear the blood flowing through superficial and deep veins to detect leaking valves and any evidence of previous deep vein thrombosis (DVT)

Before surgery
You will normally attend a health assessment appointment one week before your operation.

If you take any medication (prescribed by a doctor or bought over-the-counter), you must bring them with you, so the doctor can identify them.

Your doctor will also ask you about your medical history, including allergies, dental history and previous operations. Your doctor will also ask you not to eat anything for six hours before the operation.

The varicose vein operation can be done as a day case, where you will be able to go home on the same day. If your surgeon or doctor would like to keep you in hospital for observation you may remain for one or two nights.

You may have to undergo the following tests:

• Blood test
• Heart tracing (ECG)
• Chest X-ray

What happens during surgery?
You will be booked in for a general anaesthetic, which means that you'll be unconscious during the procedure and won't be able to feel or remember anything.

The length of time you're in surgery depends on how many veins need removing. Your surgeon will inform you of the estimated length of time before the procedure begins.

The surgeon will make small incisions, around five centimetres in diameter, at the source of the diagnosed, weakened spots on the vein. This is usually in the groin or behind the knee, depending on the position of the varicose vein.

If the varicose vein is large, or extremely knotty, it will be grasped with a special surgical tool and removed (1). The wounds are then closed by dissolvable sutures.
When the operation is over, you will be taken to the recovery area.

Reference:
1) Campbell
Clinical review: varicose veins and their management
British Medical Journal Aug 2006; 333: pp 287-292
DOI: 10.1136/bmj.333.7562.287