Historically, this was the "gold standard". With the advent of Endovenous procedures (see below), it is seldom necessary.
An incision is made in the groin, or behind the knee (depending which superficial vein is abnormal) and the Saphenous vein is tied off at its origin. Other incisions are made further down the leg to allow for the removal of the entire vein. At the completion of the procedure a compressive bandage is used to wrap the leg, which stays in place for a few days.
The procedure is performed using general anesthesia in a hospital operating room as an outpatient surgery. Patients are encouraged to ambulate as much as possible that same day. Airplane travel is not allowed for two weeks after the procedure.
Endovenous laser ablation of the Saphenous vein is a minimally invasive, in office treatment alternative to the surgical stripping and ligation (see above). In this procedure the vein is sealed with thermal energy, instead of removing it. The outcomes are the same, but it does not require general anesthesia, or any skin incisions.
To ease the anxiety of the patient, intravenous sedation is used. The vein is mapped using ultrasound, and the skin at the decided entry point is anesthetized with local anesthesia. Under ultrasound guidance the vein is entered with a small needle. Then a small laser fiber, less than ½ mm, is inserted into the vein and guided to the top of the vein. The vein is then compressed with fluid to allow the laser fiber to engage the vein wall. Laser light is then continuously fired, causing the vein to collapse and seal shut. Many note an immediate relief of symptoms, with little or no pain.
A compression stocking is placed over the leg, and it remains in place constantly for the next three days. When showering, the compression hose is protected with use of a long plastic bag. After this initial phase, the compression hose is worn during daily activities for three weeks, allowing the patient to remove it at night before going to sleep.
The patient is encouraged to walk immediately, and is able to return to work the next day. Exercise routines may be resumed in a few days. For safety purposes, patients are asked not to fly for at least two weeks after the procedure.
Complications are rare, but may include thermal skin burns or transient numbness.
The success rate of the Endovenous laser procedure is equal to that of the ligation and stripping procedure, and is quickly becoming the new "gold standard" for the treatment of varicose veins.
This procedure is used to remove superficial varicose veins. Small 2-3mm skin stab incisions are made over these veins, and the vein is "teased out" with fine forceps. Since the incisions are so small, they leave an imperceptible scar. The skin incisions are closed with a butterfly (steri stripe) bandage. To obtain the best cosmetic result, the incisions are limited to the larger veins, and perhaps sclerotherapy (see next page) will be necessary as a follow up after the wounds have healed. At the completion of the procedure a compressive bandage is used to wrap the leg, which stays in place for a few days.
The procedure is performed, using intravenous sedation and local anesthesia, in a hospital operating room as an outpatient surgery. Patients are encouraged to ambulate as much as possible that same day. Airplane travel is not allowed for two weeks after the procedure.