Stripping of Long Saphenous Vein (and high ligation)

Introduction

What is venous stripping?

Varicose vein stripping is a technique used in the treatment of varicose veins. It is an open surgical technique that involves making small cuts along the effected vein and stripping the vein out from the leg. Unlike, endovenous techniques (see RFA, EVLA, MOCA) stripping involves removal of the target vein from the leg. Stripping has traditionally and successfully been used in the treatment of varicose veins for many years, but as techniques change some centres may not routinely offer this as an option.

Will I need to do any preparation?

Vein stripping can be performed under general anaesthetic or spinal anaesthetic, and you should confirm this with your surgeon before arriving for the procedure. You will have to fast before the procedure. This means not taking food for 6 hours, and clear liquids only for up to 2 hours prior to the procedure, however you should confirm the details with the surgeon. Always inform your doctor is you are diabetic and have been asked to fast.

If you are taking any medications (such as anticoagulation or blood thinners) you may need to stop them beforehand and should consult with the doctor. Many centres ask that you have not had a long-haul (over 4 hours) flight in the 2 weeks before the procedure.

Before the procedure, you will likely be asked to stand up so that the veins in the leg stick out. Marking with a pen can be done when the veins are most prominent. This is because veins often become difficult to see when you are lying down for surgery.

Technique

What does it involve?

For this procedure the surgeon will ask you to lie in the best position to access the vein - on your back. You will be asleep so not aware of what is going on and should have no recollection later.

Your leg will be cleaned with antiseptic solution and sterile drapes are used to cover the areas not being operated on. This to to reduce the risk of infection of the wounds.

The operation can be divided into two main steps: 1) Sapheno-femoral disconnection and 2) Stripping of the Long Saphenous Vein.

1. Sapheno-femoral disconnection

First, a small horizontal cut is made in the groin area where the long saphenous vein dives deep into the leg to join with the deep vein (Common Femoral vein) - far left of the figure below.

Next the junction of the Long Saphenous vein with the Femoral vein is freed up from the surrounding tissues.

There are multiple feeding veins (called tributary veins) which join into the Long saphenous vein before it joins the femoral veins. These are all individually tied off and cut. This process allows for the top of the Long Saphenous vein to be disconnected from the femoral vein - sapheno-femoral disconnection. This sometimes called a 'high tie' or sapheno-femoral ligation.

2. Stripping of the Long Saphenous vein

Once the top of the Long saphenous vein has been separated from the femoral vein, the Long saphenous vein then needs to be removed from the leg. This is done by the use of a 'stripper' device.

A plastic or wire device called a 'stripper' is passed from the top free end of the Long saphenous vein downwards. A small cut is made around the knee area over the stripping device - which has passed down the leg in the vein. The lower end of the vein and stripper in side it are pulled out of the cut around the knee. The top of the stripping device is tied to the free top end of the Long Saphenous vein. 

The stripper is then pulled out from the lower cut along with the vein. This process strips the Long Saphenous vein from the leg from the groin and thigh area and out of the lower cut around the knee.

Sometimes, a further procedure is performed at the same time. This is to deal with the small feeding veins below the knee. This procedure is called 'multiple phlebectomies' or sometimes 'multiple stab avulsions'. This removed feeding varicose veins to the Long Saphenous vein or ones which drain directly to the deep veins though perforating veins.

The skin cuts are then sewn up and clean the leg at the end of the procedure. It is common to have compression bandaging on the leg for a day or two to reduce bleeding and bruising from the veins after the operation.

An injection of blood thinning medicine is often given at the end of the procedure to reduce the risk of deep vein thrombosis after surgery.

Post procedure course (follow-up)

The full length compression bandaging can be removed in 24-48 hours after surgery, earlier if it becomes loose. Once this is removed, you may be asked to wear a full length compression stocking for a week or two to support the leg while it heals and reduce the risk of deep vein thrombosis.

You may be given antibiotic tablets, or an injection of an anticoagulant to reduce the risk of deep vein thrombosis (DVT). In some circumstances, for example if you have a high risk of DVT, you may be asked to take an anticoagulant tablet or injection following the procedure for a week or 10 days. Always check the discharge paperwork for detailed post procedure instructions.

In the days after the procedure you should aim to regularly mobilise, this will further significantly reduce the risk of DVT. .

If the stitches the surgeon has used are not absorbable (or dissolvable) then you will need to make an appointment with your practice nurse, GP, walk-in centre or surgeon to have them removed often after 10 days. You should keep these wounds clean, dry for five days to avoid infection.

How long will I stay in hospital?

In most circumstances you will be able to go home the same day. If you have had a general anaesthetic you will need someone to pick you up, and will not be able to drive that day.