The surgeons that used to strip veins (and unfortunately the few who still do!) usually performed this procedure under general anaesthetic. A surgical incision is made through the skin in the groin for the Great Saphenous Vein (GSV)
, or through the back of the knee for the Small Saphenous Vein (SSV)
. The vein was then identified by direct vision and was dissected upwards to the junction with the deep system.
At the point of junction with the deep vein, the Great Saphenous Vein (GSV)
or Small Saphenous Vein (SSV)
was tied off using surgical ligation material (this being called the "high tie" or "high saphenous tie").
The Great or Small Saphenous Vein then had a "stripper" passed down it. A stripper is usually a metal or plastic wire or rod that could be steered down inside the vein. When the stripper had got to a point either below the knee or at the ankle, depending on the vein and the surgeon preference, a cut was made in the skin to pass a stripper out of. The end of the stripper either had a large head like an "umbrella" which would catch the vein as it was pulled down, or the vein was tied to a hole in the end of the stripper, to invert the vein as it was stripped out.
Either way, the stripper was then pulled out of the leg, "stripping" the vein out at the same time. This barbaric procedure ripped all of the side branches (more accurately the tributaries) off of the vein causing intense bruising and pain. Many people think that general anaesthetic stops this pain, but of course as soon as the patient wakes up, they then feel the pain which normally lasts for approximately 2 weeks after stripping.
In the short term, stripping of the vein is very successful provided a venous duplex ultrasound scan
has shown that the vein that was stripped was indeed refluxing, and that it was the only cause of the problem. If this is the case, then tying it off and stripping it away will stop the venous reflux and solve most of the problem in the short term.
Unfortunately as the vein grows back again, as the bruising and pain is so intense, and as the risk of damaging the nerve during the stripping process is so comparatively high, the medium to long-term benefits of stripping are very poor compared to some of the new endovenous techniques
. As such, stripping is not performed by true venous experts and has not been for many years now.