In July 2007, research from The Whiteley Clinic was published in The
British Journal of Surgery that showed veins growing back again after
having been stripped. This work had been presented several time before to
specialist conferences and had won a regional research prize at one of
them.
When a surgeon removes an organ like a gall bladder or womb, it is gone
for good and the body's connective tissue heals up around the space where
the organ was. Therefore, simple thinking surgeons remove a vein that
isn't working, expecting the same result.
Unfortunately vein are not organs, but are part of the connective tissue.
Therefore when a vein is removed, it grows back as part of its healing
process.
The open end of the vein allows blood to accumulate - the haematoma. This
clots, stopping the bleeding but causing the bruise to form. The open end
of the vein then sends out little buds of tissue (endothelial buds) which
grow into the haematoma, looking for other endothelial buds. When they
find them, they join, grow and open up to form a new vein.
This is why we heal - if you are stabbed in the arm, a year later you
expect to have healed the area. However, if you have a burn on the arm,
the burn never heals fully and you are left with a permanent scar. This is
the same reason that the new pinhole techniques do not remove the vein by
stripping, but burn them with Laser or Radiofrequency electric current.
Figure from The Whiteley Clinic over the last decade show that veins we
close with heat (Laser - EVLA, or Radiofrequency Ablation - VNUS) shrivel
away and do not re-open. We have only ever found one not completely closed
in over 4,000 treated over 10 years. This compares very well to 23%
starting to grow back within one year after stripping!!!!
To tie the vein and then to strip it, a surgeon needs to cut into the body
to find the junction and to tie it off. This incision is in the groin for
the GSV and behind the knee for the SSV. This scar can be anything from 2
- 6 cm. It is painful, has to heal and can get infected. There is also a
second incision further down the leg where the stripper is brought to the
surface. This one is usually 0.5 - 1.5 cm long. However, these incisions
are totally unnecessary as veins can now be treated by pin-hole
techniques!!
Pain after stripping comes mainly from the stripping of the vein, followed
by the pain of the unnecessary incisions. The vein that is stripped is
like a river, taking blood from the lower leg and returning it to the
heart via the deeper veins. Therefore although a surgeon my tie off the
top of the vein and remove the main trunk of the vein, all of the little
veins feeding into it now have their ends ripped off - and so they empty
their blood into the cavity caused by the stripping. Not surprisingly,
this causes a long and painful haematoma (or severe bruise) which makes it
painful to walk for 2 - 3 weeks in many people.
With the new pinhole techniques the vein is sealed closed and is not
physically removed, meaning that the ends of the little feeding veins are
sealed - preventing formation of this haematoma.
With the incisions and stripping, most surgeons perform this old operation
under general anaesthetic. With the new pinhole procedures, they have been
designed to be performed under local anaesthetic as "walk in, walk out"
treatments.
With the old tying and stripping operation, people usually have to take 2
- 3 weeks off of work. This is to get over the operation - general
anaesthesia, surgical incision with stitches and pain and bruising from
the strip. With the new walk in, walk out local anaesthetic procedures,
most people are able to get back to work and driving the day after the
procedure.
