Reasons why veins should not be stripped anymore
Mark Whiteley talks about why varicose veins come back after they've been removed
In July 2007, research by The Whiteley Clinic was published in The British Journal of Surgery that showed veins were growing back again after having been stripped. This work has been presented several times before at specialist conferences and has won a regional research prize at one of them.
When a surgeon removes an organ like a gall bladder or womb, it has 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, veins are not organs, but are part of the connective tissue. Therefore when a vein is removed, it grows back as part of the healing process.
The open end of the vein allows blood to accumulate - the haematoma. This clots, stopping the bleeding but causing a 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. Figures from The Whiteley Clinic over the last decade show that the 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 out of more than 4,000 treated in over 10 years. This compares extremely well to the 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 using pinhole 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 may 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). This 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.
Because of the incisions and stripping, most surgeons perform this old operation under general anaesthetic. With the new pinhole procedures, they are 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 recover from 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 are driving, the day after the procedure.
Endovenous Laser - EVLA
Radiofrequency Ablation - RFA
Foam Sclerotherapy - but only in small veins