How the stripping of varicose veins works
The varicose veins seen on the surface as bulging veins, or swelling or skin damage around the ankles (red stains, brown stains, venous eczema or leg ulcers) are usually caused by the valves failing in either the Great Saphenous Vein (GSV) or Small Saphenous Vein (SSV). There are other causes which need more specialist treatments such as Incompetent Perforating Veins that need the TRLOP procedure, or pelvic veins that need embolisation of the ovarian or internal iliac veins within the pelvis. However, it has only been since 2000 that these other causes have really become well recognised as causes of varicose veins and so traditionally, surgeons have only treated the Great Saphenous Vein (GSV) or Small saphenous vein (SSV) – or both.
When a patient comes to see a specialist in a vein clinic, with varicose veins or the signs of hidden varicose veins (venous incompetence or venous reflux – ankle swelling, aching legs, red stains around the ankles, brown stains around the ankles, venous eczema, lipodermatosclerosis or leg ulceration) a duplex ultrasound scan is used to identify which vein or veins are causing the problem. A hand held Doppler can also be used but is much less accurate.
The affected vein will have valves that are not working and so when blood is being pumped up the deep veins, it will be seen when the muscles relax that blood will fall back down any veins that does not have any valves working within it.
As the blood that is falling down these veins has already been pumped up by the “good” and competent deep veins, it will improve the circulation to prevent blood falling back down the leg. Therefore to tie the vein at the point that the blood starts falling out of the deep system, and to strip the vein away to stop blood falling down it from tributaries feeding into it, is a logical way to treat the vein.
Stripping does work in the very short term, as it does stop reflux provided the right vein is stripped and no other veins are involved. However as stripping causes veins to grow back again, it does not work in the medium to long term and therefore is not performed by true venous experts any more.