Vein Stripping: Procedure, Risks, and Prospects for Success

Varicose veins, medically known as varices, are permanently dilated and twisted veins that primarily occur in the legs. They develop when the venous valves lose their function and blood can no longer flow freely back to the heart. As a result, blood pools in the vessels, leading to a visible enlargement of the superficial veins. Initially, varicose veins are usually only a cosmetic concern; however, over time, symptoms such as a feeling of heaviness, tightness, swelling, or pain in the legs may develop. If left untreated, varicose veins can develop into chronic venous insufficiency, which increases the risk of skin changes, inflammation, or thrombosis.

How do varicose veins develop?

Varicose veins are caused by a congenital weakness in the connective tissue or vein walls. Previous deep vein thrombosis in the legs can also lead to an overload of the superficial venous system, thereby contributing to the development of varicose veins.

As a result of the natural aging process, the walls of the veins gradually weaken and venous valves can become leaky. Consequently, varicose veins tend to develop gradually over the course of many years.

Women are particularly prone to varicose veins. They are about three times more likely to be affected by this bothersome venous condition than men. Many women develop varicose veins especially during pregnancy.

What are the risk factors?

Typical risk factors include

• advancing age,
• being female,
• multiple pregnancies,
• jobs that require standing (teachers, cashiers),
• being overweight, and
• a congenital weakness of the connective tissue.

What are the different types of varicose veins?

Varicose veins occur particularly frequently on the legs, for example in the great saphenous vein (Vena saphena magna). This vein runs from the inner ankle to the groin and is thus the longest superficial vein in the body.

The small saphenous vein (Vena saphena parva) runs from the outer ankle along the back of the lower leg to the back of the knee.

Veins in the arms or abdomen are affected much less frequently.

Depending on the severity, the following forms are distinguished:

• In trunk varicosities, the main veins beneath the skin’s surface—namely, the small saphenous vein (Vena saphena parva) and the great saphenous vein (Vena saphena magna)—are affected. The vein stripping procedure is the preferred treatment for these forms of varicose veins.
• In collateral varicose veins, the collateral branches of the venous system are affected by blood congestion in the main veins.
• If there is a leak in the connecting veins between the superficial and deep venous systems, this is referred to as perforating vein insufficiency.
• In spider vein varicosity, small, reddish-bluish veins can be observed. These are often the first sign of venous disease.

Stripping is an effective surgical method for treating varicose veins © Solarisys | AdobeStock

Varicose veins do not resolve on their own. If they cause more than just cosmetic concerns—that is, if they also cause symptoms—health insurance plans cover the costs of necessary treatments.

There are three possible forms of treatment:

Conservative therapy

Conservative therapy involves the use of compression stockings. These are designed to apply pressure to the vein walls, thereby supporting them.

Compression stockings are available in various compression levels and should be worn continuously during the day. Also,

• exercises,
• Kneipp treatments, or
• lymphatic drainage

can help alleviate symptoms.

Sclerotherapy and catheter therapy (endoluminal therapy)

If conservative therapy does not yield sufficient results, sclerotherapy using liquid or foam may be indicated.

In addition, there is the option of using catheters to seal the vein from the inside through heat application (laser or radiofrequency therapy). These procedures can usually be performed under local anesthesia; however, the application of heat carries a certain risk of skin burns.

Surgical Treatment (Stripping)

In classic varicose vein stripping, the varicose vein

• at its junction with the deep venous system (groin or popliteal fossa) as well as
• at the lowest point of the dilation

. A thick wire (probe) is then inserted through these incisions, the vein is tied to the wire, and finally pulled out (“stripped”). 

Sclerotherapy, laser therapy, and stripping can all be performed on an outpatient basis. The costs for surgical varicose vein stripping are generally covered if medically indicated.

Only certain health insurance providers cover the costs of sclerotherapy and laser therapy.

Stripping is a minor surgical procedure that can often be performed on an outpatient basis under local anesthesia. However, depending on the severity of the condition, general anesthesia may also be necessary. The treating physician will determine which type of anesthesia is best for your case.

In the classic vein stripping procedure (Babcock procedure), the surgeon removes the damaged segments of the great saphenous vein. However, this procedure requires that the deep venous system remains patent. This can be verified through a contrast-enhanced imaging study or an ultrasound.

First, as part of the Babcock procedure, the surgeon makes an incision in the groin. This exposes the so-called “crosse,” which is the junction where the femoral vein joins the great saphenous vein. The doctor then ligates all the lateral branches that drain into the femoral vein. In the next step, the doctor ligates the main vein.

Another incision is made below the varicose section of the vein. If the vein is completely affected by varicose veins, this incision is made just above the inner ankle. The lower portion of the trunk vein is then ligated. Finally, the vein stripper (Babcock probe) is inserted and advanced up to the groin. The probe’s head is then screwed on at the groin. The doctor can now pull the vein out of the incision site from top to bottom.

If the goal is to reduce pressure on the nerve fibers in the ankle area, the procedure can also be performed in the opposite direction.

In some cases, related procedures are used in conjunction with classic vein stripping:

• Conventional stripping of the small saphenous vein (Vena saphena parva) follows a similar procedure. In this case, only the small saphenous vein in the lower leg is treated.
• Invaginating stripping is considered a particularly gentle procedure because the surgical trauma is minimal. A Pin-Stripper according to Oesch is used here, which causes the vein stump to invaginate during extraction.
• Cryptostripping is also a particularly gentle procedure. It can be used for nearly all types of varicose veins. In this procedure, a metal probe is used that can be cooled to as low as minus 80 degrees. This almost completely prevents bleeding, allowing the vein to be easily removed.
• Lateral varicose veins are best treated with miniphlebectomy. In this procedure, the affected veins are pulled out of the body using small hooks.
• The perforator ligation procedure is used when other blood vessels are affected in addition to the great saphenous vein.

Whether the stripping procedure is performed on an outpatient or inpatient basis depends on the complexity of the procedure and the extent of the varicose veins. If necessary, the procedure can also be carried out over several sessions.

Prior to the stripping surgery, the doctor must conduct a thorough medical history review. During this consultation, the doctor will also explain exactly how the stripping procedure works and what risks are associated with it.

Avoid taking blood-thinning medications for two weeks before the procedure. This includes pain relievers containing acetylsalicylic acid (ASA). Otherwise, there is an increased risk of bleeding during the procedure. You should also avoid alcohol during this time.

Smokers should begin significantly reducing their nicotine intake one month before the procedure. This helps prevent complications with wound healing.

Stripping is considered the standard procedure for treating varicose veins, in part because it has a significantly higher success rate than other methods: Laser treatment has a recurrence rate of 18 percent. After stripping, varicose veins recur in only 1.3 percent of patients.

The surgery itself requires only small incisions, so no large scars form. However, despite every precaution, tissue is always damaged—for example,

• lymph vessels,
• nerve fibers, or
• tiny side branches of the vein.

Significant bruising and swelling in the surgical area are common. However, these usually subside on their own. Compression stockings aid in healing.

Typically, the patient is on sick leave for one to three weeks after the stripping procedure. You should then wear compression stockings for several weeks or even months. Also, avoid sitting for long periods and make sure to move around frequently.

To prevent new varicose veins from developing in other areas (since the underlying predisposition remains),

• preventive measures and
• regular follow-up visits with a vein specialist 

are recommended.

In general, varicose vein stripping is a routine procedure in which serious side effects occur only extremely rarely.

Possible complications include

• bruising,
• a feeling of pressure,
• swelling,
• a feeling of tightness in the legs,
• numbness caused by damage to the skin’s nerves,
• more severe pain indicating a circulatory disorder—a follow-up examination is required in this case,
• in rare cases, impaired wound healing and infections may occur,
• injuries to the artery in the groin area,

Blood clots may form after the procedure. Therefore, thrombosis prophylaxis should be administered: otherwise, in the worst-case scenario, a life-threatening pulmonary embolism may occur.

If electrical devices are used, leakage currents may occur, which can lead to tissue and skin damage.

Lying on the operating table can cause pressure sores on soft tissues and nerves. This can lead to sensory disturbances—and, in the worst-case scenario, paralysis.

In the event of an allergy or hypersensitivity to the agents used,

• skin rashes,
• itching,
• swelling,
• vomiting,
• dizziness, or
• watery eyes

may occur.

Infections affecting the respiratory system, heart, or circulatory system occur extremely rarely.

Of course, a doctor must determine on a case-by-case basis whether stripping is an appropriate method for treating your varicose veins. In general, however:

• Stripping is an option when the trunk veins are affected, as these tend to be less tortuous. If a varicose vein is too twisted, it is difficult to guide the wire through it with the probe.
• In most cases, other treatment methods are tried first, such as compression therapy combined with exercise and other complementary therapies. Stripping is performed only if these therapies are no longer effective.
• For patients with an increased risk associated with surgery or anesthesia, other minimally invasive methods are attempted to achieve the desired outcome. These may include, for example, laser treatments and sclerotherapy.

How is the vein stripping procedure performed?
During vein stripping, the diseased vein is removed through two small incisions in the skin. The first incision is usually made in the groin; the second is made below the affected section, often in the back of the knee or near the inner ankle. A fine probe, known as a Babcock probe, is inserted through these incisions. This probe is used to surgically remove the affected vein. This procedure is also known as the Babcock procedure and was developed by the surgeon William Wayne Babcock. The treatment is considered a proven surgical therapy for varicose veins.

How long does the procedure take, and is it performed on an outpatient basis?
Stripping the trunk vein usually takes between 30 and 60 minutes. The procedure is usually performed on an outpatient basis under local or regional anesthesia. In some cases, it is performed on an inpatient basis, such as when multiple sections of the vein are affected. After the procedure, a compression bandage is applied to prevent bruising and promote blood clotting.

What risks or complications can occur?
Vein stripping is a safe treatment method; however, complications can occur in rare cases. These include postoperative bleeding, infections, or nerve injuries, which can cause temporary sensory disturbances. Insufficient compression can also lead to delayed wound healing or bruising. To prevent the formation of blood clots, targeted thrombosis prophylaxis is administered after the procedure.

What should you keep in mind after the surgery?
After the surgery, you should consistently wear the Class II or III compression stockings prescribed by your doctor. They promote blood flow, reduce swelling, and prevent the veins from dilating again. Regular exercise also helps stabilize blood circulation in the venous system. In the first few weeks after the procedure, it is important to elevate your legs and avoid standing for long periods. Mild pain or a feeling of pressure in the legs is normal and will subside after a few days.

When can I return to work or exercise?
Depending on the level of physical exertion, sick leave is usually prescribed for one to three weeks. Light activities are generally possible after a few days. After about two to three weeks, you can begin light exercise, provided no complications have arisen. Full recovery is usually achieved after four to six weeks.

What are the advantages of vein stripping compared to other procedures?
Vein stripping is a proven surgical treatment for venous diseases and is particularly suitable for removing superficial trunk veins whose venous valves no longer close completely. The procedure is considered reliable and allows for the permanent removal of the affected sections of vein. Modern variants such as endo- or cryostripping are particularly gentle and are usually performed on an outpatient basis. The advantages and disadvantages include rapid relief of symptoms, a low risk of recurrence, but also a slightly longer healing time compared to minimally invasive procedures.

Can new symptoms develop despite surgery?
After a successful procedure, venous blood flow improves significantly; however, if venous insufficiency is present, other veins may dilate again. Consistent compression therapy and regular exercise are crucial for preventing the development of chronic venous insufficiency. In rare cases, mild swelling or a feeling of tightness may occur weeks after the procedure, which can be effectively managed with compression stockings.