Vein stripping (synonym: varicectomy) is the essential component of surgical therapy for varicosis (so-called varicose vein disease). Varicosis is understood as the extensive occurrence of varices. Varicose veins (lat. varix – varicose vein) are irregularly tortuous, superficial veins, which may be dilated in some places in the form of a node. The forms of varicosis are classified as follows:
- Primary varicosis – This varicosis is also called varicothrombosis because of a tendency to thrombosis (venous blood clot). The cause of primary varicosis may be a congenital weakness of the connective tissue, which leads directly to venous valve insufficiency via dilatation of the vessel wall (the venous valves prevent blood from flowing back into the legs; if they are damaged, backflow with varicose vein formation is likely). Risk factors for primary varicosis are pregnancy, obesity (overweight) and standing occupations.
- Secondary varicosis – As a result of another venous disease, for example, after a post-thrombotic syndrome, there is an outflow obstruction in the deep venous system. Venous blood flow is now increased through the vv. perforantes, which are connected to the superficial venous system and divert blood from the deep venous system. A collateral circulation is formed via the Vv. saphenae, which leads to varicose vein formation.
Primary varicosis can again be divided into different forms in the nature of their expression:
- Truncal varicosis – In this form, the two main veins of the superficial system (great saphenous vein and saphenous vein parva) are affected.
- Side branch varicosis – Here side branches are affected by congestion of blood in the main veins.
- Reticular varicosis – This is phlebectasia (uniform diffuse dilatation of veins without tortuosity) in the subcutaneous fat tissue.
- Perforansvarikosis – The connecting veins between the deep and superficial venous system are dilated.
- Spider varicosis – This refers to small reddish-bluish veins, which are usually the first sign of venous disease.
Vein stripping is the surgical extraction (removal) of varicose veins using a vein stripper, a flexible, special probe. Removal of the varicose veins serves to prevent complications such as thrombophlebitis (inflammation of a superficial vein), variceal hemorrhage, or (in cases of long-term progression) chronic venous insufficiency with venous ulcers (ulcers). The procedure is mainly used for truncal varicosis and is performed as vein stripping according to Babcock. Vein stripping is part of the standard therapy of varicosis and has been surgically proven many times. In addition to truncal varicosis, smaller varicoses (e.g., of the side branches) can be treated, thus reducing the risk of secondary diseases (thrombophlebitis, etc.).
Before surgery
Before surgery, an intensive medical history discussion should be conducted that includes the patient’s medical history and motivation for the procedure. The procedure, any side effects, and the consequences of the surgery should be discussed in detail. Note: The requirements of the explanation are stricter than usual, since courts in the field of aesthetic surgery demand a “relentless” explanation. Furthermore, you should not take acetylsalicylic acid (ASA), sleeping pills or alcohol for a period of seven to ten days before the operation. Both acetylsalicylic acid and other painkillers delay blood clotting and can lead to unwanted bleeding.Smokers should severely limit their nicotine consumption as early as four weeks before the procedure so as not to jeopardize wound healing.
The surgical procedure
In the classic Babcock vein stripping procedure (synonym: Babcock operation), the insufficient (damaged) sections of the great saphenous vein are removed. A prerequisite is the patency of the deep venous system, this is checked by phlebography (contrast imaging of the veins) and/or Doppler sonography (ultrasound examination). Babcock surgery begins with an incision in the groin. The surgeon exposes the so-called “crosse”: the place where the great saphenous vein joins the femoral vein. All side branches of the great saphenous vein that open into the crosse are interrupted. Subsequently, the truncal vein itself is interrupted. This procedure is called a crossectomy.The second incision is made below the varicose section of the vein. If the entire vein is varicose, this site is just above the medial malleolus (inner ankle). The lower portion of the great saphenous vein is now dissected bluntly free and tied off. The Babcock probe (vein stripper) is inserted into the vein via the distal (lower) access and advanced to the groin. Here, the surgeon knots the vein to the head of the probe and pulls both together out of the distal incision site. The procedure can also be done in reverse to relieve pressure on nerve fibers around the ankle. Because varicosis can affect other components of the venous system and related procedures must sometimes be performed in combination with classic Babcock vein stripping, they are briefly described here:
- Conventional stripping of the saphenous vein – The saphenous vein is removed in a similar manner to the great saphenous vein: first, a so-called parva crossectomy is performed in an analogous manner, and the vein is interrupted at its junction with the popliteal vein in the popliteal fossa. The distal (lower) incision is located above the malleolus laterales (lateral malleolus). Here, the probe is inserted, advanced into the popliteal fossa, and pulled out along with the knotted vein.
- Invaginating stripping – This procedure is considered particularly gentle. Usually, a so-called pin stripper according to Oesch is used, which is also knotted with the vein. During extraction, the stump of the vein bulges in. This keeps the surgical trauma very low.
- Cryostripping (synonym: cryovariectomy) – This procedure allows a gentle approach and can be used for all forms of varicosis, except spider vein varicosis. The vein stripping probe is made of metal and can be cooled down to -80 °C with the help of flowing gas. The vein adheres to the probe and is pulled out. The cold makes it easier to remove the vein and almost completely prevents bleeding.
- Miniphlebectomy – This method is used to remove side branch varicose veins, which can occur in isolation or together with truncal varicose veins. The veins are previously marked on the standing patient and then pulled out via fine stitches with small hooks.
- Perforator ligation – If, in addition to the insufficiency of the great saphenous vein, some perforating veins are also insufficient, the surgeon seeks them out and interrupts them.
Depending on the severity of varicose veins and the cost of the measures, the operation is performed on an outpatient or inpatient basis. If necessary, the treatment can be done in several sessions.
After the operation
The patient should wear class II compression stockings for at least 3 months after discharge and avoid prolonged sitting or standing. Swelling, tightness, and a feeling of pressure in the legs may occur.
Possible complications
- Blue spots on the skin; swelling, tightness and a feeling of pressure in the legs, possibly also sensory disturbances. These usually disappear after a few days.
- Injury to skin nerves; this then leads to paresthesia (numbness); in rare cases, also permanent pain due to a neuroma, which is a benign nodule that can develop after severing a peripheral nerve (neurectomy) at the site of the defect.
- Strength pain, as a sign of a circulatory disorder (in this case, an immediate control examination is required)
- Wound healing disorders (rare)
- Infections (rare)
- Injuries of the artery in the groin (A. femoralis communis)
- Temporary swelling, tightness and feeling of pressure in the legs may be due to lymphatic congestion or/and hematoma (bruise). This is well treatable by compression therapy (eg compression stockings): should it come to chronic lymphatic congestion is possibly a lymphatic drainage required.
- As after any surgical procedure, thrombosis (formation of a blood clot) may occur, with the possible consequence of embolism (occlusion of a blood vessel) and thus a pulmonary embolism (danger to life). Thrombosis prophylaxis leads to a reduction in risk.
- The use of electrical devices (e.g. electrocoagulation) can cause leakage currents, which can lead to skin and tissue damage.
- Positioning on the operating table can result in positional damage (e.g.B. Pressure damage to soft tissues or even nerves, with the consequence of sensory disturbances come; in rare cases thereby also to paralysis of the affected limb).
- In case of hypersensitivity or allergies (e.g. anesthetics/anesthetics, drugs, etc.), the following symptoms may temporarily occur: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Infections, after which severe life-threatening complications concerning heart, circulation, breathing, etc. occur, are very rare. Similarly, permanent damage (eg, paralysis) and life-threatening complications (eg, sepsis / blood poisoning) after infections are very rare.