Ligation

Some problems, such as large varicose veins, may necessitate the use of ligation, a procedure in which the connections between the damaged veins and the vein systems are interrupted. Ligation is done under local anesthesia in the office. Your initial consultation will give you and the physician an opportunity to discuss which treatment program may be best for you.

During this surgery, one or more incisions are made over the varicose veins, and the vein is tied off (ligated). If the ligation isolates a faulty valve and the vein and valves below the faulty valve are healthy, the vein may be left in place to continue circulating blood through other veins that still have valves that work properly.

If several valves in the vein and the vein itself are heavily damaged, the vein (or the diseased part of the vein) is usually lasered. An incision is made below the varicose vein, a flexible instrument is threaded up the vein to the first incision, and the vein is grasped and removed.

What To Expect After Surgery
Most often, you can return to work within a few days. After several weeks, you can resume normal leisure and recreational activities.

Why It Is Done
Vein ligation and stripping is generally done on large varicose veins.

This treatment is used when:
* You have had a previous stripping.
* You want to get rid of varicose veins for cosmetic reasons and don't have other health problems that would make surgery more risky.
* Your legs ache, swell, or feel heavy, especially after prolonged standing.
* A varicose vein bleeds.
* Open sores (ulcers) develop because of varicose veins.
* The vein is damaged in the section where it joins the superficial and deep veins in the knee or groin.

If you have both small and large varicose veins, you may have more than one type of treatment. Following vein ligation and stripping to treat large varicose veins, you may have sclerotherapy to treat smaller varicose veins.
Who should not have ligation or stripping

Vein ligation and stripping should not be done in:

* Older adults for whom surgery poses a high risk due to other medical conditions.
* People who have poor circulation in the arteries of the legs.
* People who have swelling and fluid buildup due to blockage in the lymph vessels (lymphedema), skin infections, or blood-clotting defects.
* Women who are pregnant.
* People who have an abnormal passageway between an artery and vein (arteriovenous fistula) in the leg.

How Well It Works

With testing to determine the location of varicose vein problems, vein ligation and lasering provides good to excellent long-term results in 95% of all patients.

Risks

Varicose vein surgery has some risks, such as recurrence of varicose veins and scarring. In addition, if the deep vein system is damaged, surgery may make problems with blood flow in the veins worse. Varicose vein surgery has the same risks associated with general surgery, including infection, bleeding, and anesthesia risks.

If the largest vein in the leg (great saphenous vein, or GSV) is stripped below the knee, numbness may result due to nerve injury.

What To Think About

There was once concern about removing the great saphenous vein, because this vein is often used as a replacement or graft for an artery in the heart when a person has bypass surgery. Doctors now believe that there is no reason not to strip the GSV in the leg if needed. If the vein is badly damaged, it will not work as a vein graft anyway. In most cases a blood vessel from the chest (mammary artery) can be used during heart bypass surgery instead of the GSV. If necessary, arm veins can be used.

Surgery is done on a very limited basis on people who have chronic venous insufficiency (CVI) resulting from deep vein problems and who also have varicose veins. Removing varicose veins close to the surface of the skin (superficial varicose veins) may cause problems if the deep leg veins are also damaged. If you are considering this surgery, get an opinion from a vascular specialist.