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Why is vein stripping no longer a recommended treatment option?

My mom had her varicose veins treated with vein stripping when she was younger, but I have heard that is no longer at treatment option. Why is vein stripping no longer a recommended treatment option?


Doctors Answers (5)

Vein stripping had a number of variations, but all involved the surgical removal of the vein, often with a long skin incision and significant trauma. I would now describe these older techniques as obsolete due to better technology in treating varicose veins. These include improvements in duplex ultrasound to evaluate and treat vein disorders, and the use of laser fiber-optic and RF catheters that allow the permanent closure of the varicose vein trunk without surgery as a minimally invasive office procedure and with an immediate return to normal activities (unlike vein stripping). If the varicose veins are large and highly visible near the skin surface, they are often still removed by a more modern technique called micro-phlebectomy in which the vein is anesthetized and removed in segments through several one mm long incisions spaced out along the edge of the vein. This is also a minimally invasive office procedure that does not require use of sutures and has an excellent cosmetic as well as functional improvement in the treated vein. These micro-incisions are typically not visible after just a few weeks following the procedure.

Vein stripping works when it is done for the right reason and performed well. However, endovenous thermal ablation has become the standard of care in the United States. EVTA is safer, much less traumatic to the patient, results in much less pain and fewer complications, and it costs far less than vein stripping. Many of us believe that it is more effective than vein stripping. In a few cases when there is a long, straight vein very superficially located under the skin, a type of vein stripping called PIN (perforate-invaginate) stripping is an excellent technique which can be performed very easily in the office with the same local anesthesia used for EVTA.

High percentage recurrence rate. New techniques have fewer complications and much better outcomes.

It is not that vein stripping is not available. Vein stripping has fallen out of favor because of newer techniques using thermal ablation devices (laser or radio-frequency). Today, treatment is done on an out-patient basis, is less invasive, has a short recovery period (most people go back to work the next day), and most important is the success rate (in experienced hands these reach 98 percent). GREAT QUESTION.

Vein stripping was the only option 12-15+ years ago. It was a blind procedure with variable results. Recurrence rates of veins was typically high (new veins developing) as the removal of the saphenous vein was incomplete. Additionally it was a hospital procedure with general anesthetic and all the risks involved with this. Recovery time was and still is lengthy with considerable pain. With the advent of laser and ultrasound technology, improved forms of local anesthetic has reduced the risks and the procedures are not office based. Post procedure recovery is minimal with little or no pain and normal activity the next day. Vein stripping is still performed by some surgeons who chose not to go into laser technology.

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