Background Information:

What are the other Names for the Procedure?

• Removal of Varicose Vein
• Stripping of Varicose Vein
• Varicose Vein Surgery

What is the Varicose Vein Removal surgical procedure?

• The Varicose Vein Removal procedure, basically involves the removal, or ‘stripping off’ of the varicose veins
• The varicose veins are large, bluish-purple, swollen veins, filled with blood, which are painful. They generally develop in the legs
• Valves present in the veins enable the circulation of the blood; varicose veins develop, when the valves are absent or defective

What part of the Body does the Procedure involve?

• The regions of the diseased veins are usually the greater and lesser saphenous vein of the legs
• Varicose veins are often observed in the lower limbs (legs); however, other parts of the body maybe affected too
• The Varicose Vein Removal procedure is confined to the affected parts of the body

Why is the Varicose Vein Removal surgical procedure Performed?

• Varicose Vein Removal procedures are performed, when the varicose vein becomes huge, rope-like, and cause a lot of pain and discomfort
• They may be also removed for cosmetic purposes, because varicose veins are definitely not visually appealing

What are some Alternative Choices for the Procedure?

There are various other alternative procedures for Varicose Vein Removal. These are opted for, only when lifestyle changes and medications are not helpful. These are as follows:

• Sclerotherapy: A liquid chemical is injected into the vein that causes the vein walls to stick together and seal shut. The blood stops flowing and the vein becomes a scar tissue and fades away
• Surface laser treatments: In this procedure, very strong bursts of light are sent through the skin. This method is used only for small varicose veins
• Endovenous techniques: A very small tube, called a catheter, is inserted into the vein. A small probe is placed through the tube; a device at the tip of the probe heats up the inside of the vein and closes it off. The device can use radiofrequency or laser energy to seal the vein
• However, surgery is the method of choice for very deep veins.

What are the Recent Advances in the Procedure?

More non-invasive procedures are being developed for the treatment of varicose veins, ensuring complete removal of the vein, along with no scar tissue formation.

What is the Cost of performing the Varicose Vein Removal surgical procedure?

The cost of Varicose Vein Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Varicose Vein Removal procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm#A

http://www.nlm.nih.gov/medlineplus/ency/article/002952.htm

http://www.nhlbi.nih.gov/health/health-topics/topics/vv/treatment.html

The following article link will help you understand Varicose Vein Sclerotherapy.

http://www.dovemed.com/common-procedures/procedures-surgical/varicose-vein-sclerotherapy/

Prior to Varicose Vein Removal surgical procedure:

How is the Varicose Vein Removal surgical procedure Performed?

• During a Varicose Vein Removal procedure, the surgeon makes 2-3 small incisions, near the top, middle, and bottom of the large, damaged vein
• The upper and lower ends of the veins are cut and tied
• A thin, flexible, wire-like plastic instrument is passed through the vein, beginning at the ankle and extending upward through the inside of the vein. The wire is used to strip the entire vein out
• Similarly, the smaller damaged veins are cut, tied, and stripped. The skin is then closed with the help of sutures, and the legs are wrapped snugly in elastic bandages

Where is the Procedure Performed?

A Varicose Vein Removal procedure is performed at an out-patient or hospital, surgical facility.

Who Performs the Procedure?

A general surgeon or a vascular surgeon performs the procedure.

How long will the Procedure take?

The Varicose Vein Removal procedure lasts for about 1-1.5 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally, local anesthesia is not used; however, do inform your physician, if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Varicose Vein Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Procedure?

No specific tests are required prior to the procedure; however, routine blood and urine examinations may be performed.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Varicose Vein Removal procedure?
• Why is this procedure necessary?  How will it help?
• What does the procedure involve?
• Will I need adjunct treatments after the surgery? 
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed? 
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Varicose Vein Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

• General anesthesia by injection and inhalation with an airway tube, placed in the windpipe, is generally administered
• However, the procedure may also be performed under local anesthesia or a spinal anesthesia

How much Blood will you lose, during the Procedure?

The amount of blood loss depends on the number of veins being treated, as well as the position/location of the vein (how deeply embedded is it). Generally no blood transfusions are required, unless any complications are seen to arise.

What are the possible Risks and Complications during the Varicose Vein Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Inadvertent injury to the nearby arteries or nerves
• Reactions from anesthesia
• Infection

What Post-Operative Care is needed at the Healthcare Facility after the Varicose Vein Removal surgical procedure?

The stitches or sutures need to be removed after 5-7 days. Apart from that no post-operative care is needed at the healthcare facility, unless any complications arise.

After the Varicose Vein Removal surgical procedure:

What are the possible Risks and Complications after the Varicose Vein Removal surgical procedure?

Post Varicose Vein Removal procedure, the following complications may arise:

• Bleeding, redness, swelling, or intense pain
• Infection
• Any leakage from the suture line
• Deep-vein blood clots (rare)
• Bruising or scarring
• Recurrence of varicose veins

What is the Prognosis after the Surgery?

• Varicose Vein Removal is usually a very successful procedure. It reduces the pain and improves appearance of the leg
• In rare cases, vein stripping may cause scarring
• It is important to wear compression stockings after the procedure

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Leakage from the sutures
• Bleeding
• Swelling
• Fever
• Infection
• Blood clots

What Post-Operative Care is needed at Home after the Varicose Vein Removal surgical procedure?

At home, the following post-operative care is recommended, after a Varicose Vein Removal procedure:

• Move and elevate the legs often, to avoid deep vein clots
• Wear compression stockings for at least 4-6 weeks, after the surgery

How long does it normally take to fully recover, from the Procedure?

It takes about 4-5 weeks to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Varicose Vein Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility
• A general or vascular surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Varicose Vein Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA