Before / After

Varicose Vein Stripping

For decades, the only option for large varicose veins has been surgical removal. Injecting larger veins frequently fails because the flow rate within is so high that the injected solution is simply diluted too fast. Blood clotting never happens because the solution is carried away too rapidly.

Vein stripping is done under anesthesia, in an operating room. An incision is made in the groin, and the largest part of the vein is dissected free, along with all its side branches. A second incision is made below the knee, and the vein is dissected free. A heavy plastic monofilament is passed inside the vein from the knee to the groin, and out a small incision in the vein, at the groin. A small plastic ball is attached and the plastic monofilament is pulled, beneath the skin, from the groin to the knee. This is an efficient way to get 50 cm of vein out without a 50 cm incision. However, the vein is literally 'ripped' out beneath the skin, tearing all the side branches in the thigh, and leaving them to bleed.

This results in moderate bruising, and subsequent pain, that can last for weeks. If there are other larger veins below the knee, they are frequently dissected out individually, through separate incisions. While effective, the result always involves several permanent scars, bruising, pain, and time off work. The time off work is variable, depending on your job. If you work in a physical job, on your feet for long periods, you may be off work for as long as 4 weeks or more, depending on the bruising and blood loss.

Average recovery from Varicose Vein Stripping (Bilateral procedures may have longer recovery times)

Most strippping procedures are done on a 'same day' basis at a Hospital, meaning you are home the night of surgery. The procedure typically lasts 1-2 hours, depending if one or both legs are done, and the number of extra incisions necessary for additional veins. Most patients go home with a prescription for pain medications that they will need to take for 3-10 days. This will depend on your pain tolerance, and your activity. All patients will have bleeding beneath the skin which can vary from mild discolouration to significant, purple staining involving the entire leg. More significant bruising resolves more slowly. During recovery, as the blood clot resolves, there is pain, tenderness, and swelling. Average time to rbe able to return to work is 2-4 weeks.
Varicose Vein Stripping surgery is covered under OHIP in Ontario. However, it is not covered if the reason is cosmetic (i.e. if your problem is that you don't like the way your veins look). It is covered for those patients who are suffering from symptoms, such as pain, or longterm changes from varicose veins such as venous ulcers. Surgery is only covered for patients who have been prescribed Custom fitted Compression therapy socks or stockings, have used them for 3 months, and have not improved.
Read the OHIP Criteria for getting coverage for Varicose Vein Surgery
Varicose veins involving the long and/or short saphenous vein(s)
Surgical services (ligation/stripping) for the treatment of varicose veins involving the long
saphenous and/or short saphenous vein(s) are only insured when all of the following
conditions are met
1. There is incompetence (i.e. reflux) at the saphenofemoral junction or saphenopopliteal
junction that is documented by Doppler or duplex ultrasound scanning;
2. The patient has failed a trial of conservative management of at least three months
duration; and
3. The patient has at least one of the conditions described in either a. or b. below:
a. One or more of the following signs of chronic venous insufficiency:
i. Eczema;
ii. Pigmentation;
iii. Lipodermatosclerosis;
iv. Ulceration
b. Varicosities that result in one or more of the following:
i. Ulceration secondary to venous stasis;
ii. One or more significant hemorrhages from a ruptured superficial varicosity;
iii. Two or more episodes of minor hemorrhage from a ruptured superficial
iv. Recurrent superficial thrombophlebitis;
v. Stasis dermatitis;
vi. Varicose eczema;
vii. Lipodermosclerosis;
viii. Unremitting edema or intractable pain interfering with activities of daily living
and requiring chronic analgesic medication.
1. Conservative management includes analgesics and prescription gradient support
compression stockings.
2. Significant hemorrhage refers to a hemorrhage related to varicose veins that requires iron
therapy or transfusion.]
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