Surgical Vein Treatment

There have been several different treatments for varicose veins over the years.  Most of us know someone who has had “vein stripping.”  This procedure had been the mainstay of varicose vein treatment for many years.  There have been refinements and some changes over the years.  More recently there have been other methods developed using more modern technology.  The following are brief descriptions of various surgical treatments for varicose veins.  The only surgical treatment used at bod:evolve veins is Ambulatory Phlebectomy.  The others are briefly discussed for your information.  If you want more information we suggest using an internet search on the terms below.

Ligation and Stripping

This is the classical vein stripping surgery.  There are some variations on this procedure, but generally it consists of pulling the diseased vein or veins out of the leg.  It is not quite as crude as this makes it sound.  But, it usually requires general anesthesia or spinal anesthesia, and a hospital admission.  There is more bleeding, bruising and soreness than with newer procedures.  It usually takes several weeks to get back to normal activities. 

The surgery is effective in some people, but many people begin to develop new varicose veins within a few years of their surgery.  These new veins, called neovascularization, are more challenging to treat. Some people have had very good results from ligation and stripping, but there is a much higher rate of recurrence of varicose vein disease, and there has been a higher rate of complications, than with newer techniques. Some of these complications can be quite dangerous.

High Ligation

When a vessel is ligated a suture is tied around it so blood cannot flow through it.  Sometimes surgeons perform a ligation of the diseased vein without doing a stripping, or removal of the vein.  The ligation is usually done at the groin.  This is why it is called a high ligation.  In generally, but not always, a high ligation is also done in the operating room of a hospital under general anesthesia.  With modern anesthesia techniques general anesthesia is safe. But there are still risks associated with general anesthersia.  High ligation has not been a very successful procedure for treating varicose veins.  There is a high recurrence rate.  It is not used frequently any more. 

Phlebectomy

Phlebectomy simply means to remove a vein.  There are several other methods for removing varicose veins veins.  If the vein is not pulled out from the groin to the knee as in a vein stripping, it may be removed in several pieces.  It has been common for some surgeons to remove sections of veins in the thigh and calf through several individual incisions.  These incisions are usually about 1 to 2 inches in length.  Frequently there will be ten or more of these 1 to 2 inch scars left after a phlebectomy surgery.  These surgeries are usually done in a hospital operating room under general anesthesia.  The cost and risk of these surgeries is similar to that of Ligation and Stripping.

Transilluminated powered phlebectomy (TIPPS)

If you search the internet for various treatments for varicose veins you may come across this procedure.  “Transilluminated” refers to the passing of light through the skin, which illuminates the veins during this procedure. The surgeon views the vein with a transilluminating light and removes it using a small powered surgical device.  TIPPS is also done in a hospital operating room, usually under general anesthesia.  It has not been shown to have significant benefits over office based procedures.

Subfascial Endoscopic Perforator Surgery (SEPS)

When a patient has chronic venous insufficiency severe enough to cause leg ulcers there are almost always refluxing connecting or “perforating” veins between the deep and superficial vein systems.  It can be difficult to treat these perforating veins.  Subfascial Endoscopic Perforator Surgery (SEPS) is a surgical procedure to treat these perforating veins.  During the SEPS procedure abnormal perforating veins are disconnected.  This allows blood flow to be directed into normal veins, and allows healing of the ulcer. 

SEPS requires an hospital operating room, or an outpatient surgery center.  It requires general or spinal anesthesia, and carries the expense and risks of surgery.  At bod:evolve veins perforating veins are effectively treated with Ultrasound Guided Foamed Sclerotherapy, or Endovenous Laser Ablation. These methods are very effective, and do not require an operating room, or general anesthesia with the associated risks and complications. An internet search will give additional information on SEPS.  http://www.njsurgery.com/html/Brochures/seps.shtml is a site with more information and a diagram of how the surgery is done.  It is much more invasive than sclerotherapy and endovenous laser treatment.

Ambulatory Phlebectomy

Ambulatory Phlebectomy (AP), sometimes called microphlebectomy, or even Minimally Invasive Venous Ablation (MIVA), is a minor procedure performed in the office to remove veins that cannot be treated with endovenous laser ablation.  Ambulatory literally means being able to walk.  Phlebectomy means to remove a vein.  The combination of the two words means to remove a vein in such a way that you are able to walk immediately.

Ambulatory Phebectomies are sometimes done on the same day as the EVLA.  Just before the procedure while you are standing we will mark the veins to be treated with a skin marker.  Next, with you resting on the procedure table your leg by carefully washed with antiseptic soap, and draped with sterile surgical drapes.  The areas around the veins will be injected with the same local anesthetic used for the EVLA.  Tiny incisions, about 2mm in length are made near or over the vein.  A small instrument called a phlebectomy hook is used to tease out a length of vein which is then removed.  Several more incisions will be made until all the veins needing treatment in this way are removed.

Your leg will be wrapped with a bandage and compression stockings applied.  After remaining on the bed at bod:evolve for about 30 minutes with your legs elevated you will be allowed to go home.  There is often some bleeding with ambulatory phlebectomies, but this is rarely if ever a severe problem. 

Recovery is about the same for ambulatory phlebectomy, and EVLA.  Results are very pleasing.  The incisions are so small they leave essentially no scar.  There is usually very little soreness after AP.

At bod:evolve veins we use the least invasive techniques possible to achieve the desired results.  Usually this involves EVLA, and some form of sclerotherapy.  Sometimes the doctor will advise you to allow him to perform an Ambulatory Phlebectomy.  He will always discuss all treatment plans in detail with you.  Your consent is an essential part of this process.

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