What is vein ligation and stripping?

Vein ligation and stripping is a minor surgery. It is used to remove one or more varicose veins. These are twisted, swollen veins near the surface of the skin. They are most common in the legs and ankles. The surgery can also be done to prevent venous skin ulcers from coming back after treatment.

You may be asleep during the surgery, but it also can be done while you are awake. If you are awake, you will get medicine to numb your leg and prevent pain. The doctor will make small cuts in the area and then tie off (ligation) and remove the vein (stripping).

You will probably go home the same day as the surgery. You will need to take it easy at home for at least a few days after the surgery. How long it takes for you to recover depends on how many veins are removed.

After surgery, other veins in the legs will take over the work of the veins that are removed.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Follow your doctor's instructions about activity. Your doctor may recommend that you rest in bed or limit your activity for at least a few days after surgery. This can help reduce bruising.
• Resume activity as your doctor tells you. Take short walks several times a day.
• Do not sit or stand for long periods.
• Do not cross your legs at the knees for long periods.
• When seated, do not dangle your legs.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, until your doctor says it is okay. This may be for at least several days. If you do strenuous activities too soon after the surgery, you may have some bleeding from your incisions. If this happens, lie down with your leg propped up on pillows and apply pressure. If the bleeding does not stop, call your doctor.
• Ask your doctor when you can drive again.
• You may need to take at least a few days off from work. It depends on the type of work you do and how you feel.
• You may shower after your doctor says it is okay to take off the compression dressings. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Your doctor may prescribe a blood thinner when you go home. This helps prevent blood clots. Be sure you get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.

Incision care

• If you are wearing a compression bandage or stocking on your leg, follow your doctor's instructions about when to take it off.
• If you have strips of tape on the incisions, leave the tape on for a week or until it falls off.
• After your doctor says it is okay to take off the compression dressings, wash the area daily with warm, soapy water and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Ice and elevation

• To reduce pain, put ice or a cold pack on your leg for 10 to 20 minutes at a time. Do this every few hours. Put a thin cloth between the ice and your skin.
• Prop up your leg on a pillow when you ice it or anytime you sit or lie down during the 2 to 3 days after surgery. Try to keep it above the level of your heart. This will help reduce bruising.

Vein ligation and stripping removes varicose veins successfully in about 90 out of 100 people. That means it does not work for about 10 out of 100 people.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• For several days before surgery, do not shave the skin on the leg that will be operated on. The skin could get irritated, which could lead to infection.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

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. If a nerve is injured, you may feel numbness for several months. Varicose vein surgery has the same risks associated with general surgery, including infection, bleeding, and anesthesia risks.

Vein ligation and stripping typically don't require a hospital stay. They are most often 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. Your doctor can let you know when you can get back to your normal activities. This may be in at least a few weeks.

You will have some pain from the cuts (incisions) the doctor made. Your leg may feel stiff or sore for the first 1 to 2 weeks. Your doctor may give you pain medicine for this. You can expect your leg to be very bruised at first. This is a normal part of recovery and may last 2 to 3 weeks. You may wear compression bandages or stockings on your leg for at least the first few days after surgery. This can help reduce bruising. Your doctor can tell you how long to wear them.

If you have stitches, they may dissolve on their own. Or your doctor may take them out 7 to 14 days after your surgery.

You will need to take it easy at home for at least a few days after the surgery. How long it takes for you to recover depends on how many veins were removed.

After surgery, problems caused by the varicose veins may go away. Removing varicose veins usually doesn't cause circulation problems. That's because other veins in the legs will take over the work of the veins that were removed.

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 or another procedure to treat smaller varicose veins.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.

The doctor will make a small cut (incision) at the top of the varicose vein near the groin and another small cut lower in the leg. These cuts are called incisions. The doctor will tie off (ligation) the vein to stop blood flow through it. Then the doctor will gently pull out the tied-off section of the vein through the incisions (vein stripping). If needed, the doctor also may make other small cuts along the leg to take out smaller varicose veins. The doctor will close the incisions in your leg with stitches or strips of tape.

If the ligation cuts off a faulty valve, and if the vein and valves below the faulty valve are healthy, the vein may be left in place. It will circulate blood through other veins that still have valves that work well.