Dr. John Happel | Sep 22, 2018 | 0
Why No One Talks About Stripping Varicose Veins Anymore
Varicose Vein Stripping – Stripped Down
Darth Vader’s Guide to Stripping Varicose Veins
People often make faces when I mention the “s” word. Many know its reputation from having relatives that had it done years ago. The word, stripping, sounds painful and has negative connotations.
The old stripping operation has deservedly fallen into disrepute. The traditional vein stripping surgery was started in the United States and modified by Dr. Charles Mayo and Dr. Wayne Babcock.
Stripping veins involved excessive pulling and tearing. Surgeons ripped the saphenous vein out of the leg with a significant force. That resulted in a considerable amount of trauma to the surrounding tissues.
This primitive operation involved an over-sized stripper head with a long wire that was used to yank out the saphenous vein.
Nearby nerves were often damaged. That left painful, tender and sore areas around the ankle either permanently or for years. Saphenous nerve damage was the biggest reason for lawsuits after this type of brutal surgery.
Nowadays, that type of sadistic procedure is classified as cruel and unusual punishment.
13 Facts About Varicose Vein Stripping That’ll Make Your Hair Stand on End
The Problems with Stripping Varicose Veins:
- Long Recovery
- Unacceptable scarring
- General Anesthesia
- Painful Convalescence
- Higher Rate of Complications (DVT or blood clots)
- High Recurrence Rate
- Disliked by the Surgeons Performing the Operation
- Expensive Hospital Stay
- Expensive Anesthesia Bill
- People Fear and Dread Even Hearing the Words “Stripping Veins”
Is There Still a Role for Stripping Varicose Veins?
Unbelievably, vein stripping sometimes has its place.
But only in certain circumstances.
Let me explain.
When straight abnormal veins are located right under the skin, alternative methods such as laser, radiofrequency or sclerotherapy can often leave a brown discoloration where the vein was located. When this type of very superficial vein is closed with heat from the former two methods, the carbonization of the vein is transmitted to the skin.
The result is a brown line on the inner thigh where the vein could be felt. That ugly staining often lasts a year or more. Sometimes its permanent.
Therefore, removing this portion of either the great saphenous vein or a branch tributary can prevent this cosmetic complication. This newer modification is called perforate invaginate or PIN stripping.
When removing the subcutaneous saphenous vein in the thigh, an incision that was traditionally made in the groin is not necessary. Groin incisions can interfere with the lymphatic drainage, result in infection, and cause new vessels to occur.
These new vessels that occur after stripping are called neovascularization. It is a form of neoangiogenesis. Neovascularization is often difficult to treat years after the groin incision is made. Foam sclerotherapy is the preferred method of treatment of this condition.
Don’t Stop Believin’ (and Throw the Baby Out with the Bathwater)
With PIN stripping, a mini incision is made usually in the upper thigh. The vein is divided after it is exteriorized. The proximal segment is ligated or tied off. The perivenous tissue and the target veins are anesthetized with tumescent anesthesia.
It is performed in an office setting. No general anesthesia is required. Tumescent anesthesia is just local anesthesia that is diluted in a liter of sterile saline.
The target vein is then gently teased out through a separate mini incision at or below the level of the knee. It is truly minimally invasive and leads to little to no scarring at all. There is no ripping, yanking, or trauma to the surrounding tissues.
Here is a link to this modern “tamed” version of varicose vein stripping.
The minimally invasive stripping operation was first introduced in Germany, Belgium, and Switzerland. Dr. Andreas Oesch devised a new type of stripping devise with a very tiny head at the end of the instrument. It is no larger than a match head. This minute head minimizes tissue trauma and pain.
Dr. Gabriel Goren MD was one of the pioneers of this refined approach to an operation that has fallen into disrepute with modern techniques.
However, this tamed or refined technique still has its place in the armamentarium of the best vein doctors in the country. That is the most recent declaration of vascular surgeon vein specialists in this country.
Some doctors can’t do it. Since they were not trained in this elegant technique, they don’t get it. He who laughs last, didn’t get it.
Modern Vein Techniques are Bad to the Bone
Modern minimally invasive techniques like laser, radiofrequency, mechanic-chemical ablation and glue have transformed the field of vein care.
Your vein specialist should be proficient in some of these techniques. The common expression that “if all you have is a hammer, the entire world is a nail” is the concept. If your doctor can’t customize your treatment to your particular venous anatomy, you won’t get optimum results.
If you have a superficial subcutaneous great saphenous vein that you can feel when you stand, the treating vein specialist must have the ability to remove this vein with the modified and tamed stripping technique to get optimum cosmetic results. Sometimes phlebectomy of this vein is an alternative.
It will not hurt during or after the procedure if done properly.
Best of all, you won’t see the ugly brown line of hyperpigmentation when this type of vein is treated with other techniques. The cosmetic results are definitely superior!
Furthermore, traditional stripping is still widely done in Europe. European doctors have a different approach to treating varicose veins. They often attack the visible varicose veins and try to spare the saphenous veins unless the saphenous veins are very large.
Stripping vs. Phlebectomy
Phlebectomy (also called ambulatory phlebectomy) is sometimes confused with varicose vein stripping. Stripping involves removal of the saphenous veins that are usually the source of the pressure of the visible bulging varicose veins seen on the surface of the skin.
The varicose veins are actually just branches of the saphenous vein that are usually not visible when you stand. Many patients have presented with scars on their skin and told me that they had their veins stripped.
However, when I look with ultrasound, the saphenous vein is intact. Varicose veins can be the result of failure of the great saphenous vein. Unknown to the patient, the surgeon only removed their branch varicose veins and left the root, saphenous vein, intact. They were doomed to a recurrence since their procedure was incomplete.
Modern phlebectomy is done through needle holes or very tiny mini incisions that are virtually invisible after it is completely healed. Recovery is quick. Some bruising may result.
Pain afterwards is minimal. It can be easily controlled with over-the-counter medication that you take for headaches. There is minimal or no hyperpigmentation as compared to sclerotherapy.
With sclerotherapy of the superficial large veins, blood is trapped in the injected veins. Hemoglobin in these subcutaneous veins is transformed to hemosiderin that gives the overlying skin the brown color. This hyperpigmentation usually subsides but in some cases can take a year or two to resolve.
Don’t confuse phlectomy with stripping. Phlebectomy is surgical removal of the varicose vein branches alone. Stripping is removal of the underlying saphenous vein.
Varicose vein stripping has been largely replaced by more effective and less painful modern minimally invasive techniques.
However, it is widely regarded by many respected vascular surgeons specializing in vein procedures as having its place in specific special circumstances.
This is not heresy.
Vein stripping is still helpful in a minority of patients with a subcutaneous straight vein that would result in cosmetically unappealing brown staining with most of the modern techniques.
Choosing a vein specialist like a vascular surgeon who has all the tools available treat any situation or circumstance will give you the best chance of a great result.
Dr. Happel has the longest personal experience in Pittsburgh specializing in and treating varicose veins.
He has been treating veins for over thirty years.
He is a board certified vascular surgeon who trained at the Mayo Clinic. The Happel Laser and Vein Center is the only vein center in Pittsburgh that has been inspected by a national panel of experts.
It is the only accredited vein center in Pittsburgh.
Call us at 724-969-0600 or click here to learn more.