Varicose vein ligation and stripping: what happens, risks and recovery

Varicose veins are swollen superficial veins whose valves no longer stop blood falling back down the leg. Many people need nothing more than reassurance and, if the legs ache, compression stockings. Treatment of the vein itself is considered when there is pain, swelling, skin changes or ulcers, which is when leaving things alone starts to carry a cost.

The NHS describes endothermal ablation, which uses radiofrequency or laser energy inside the vein, as usually the first choice, with foam sclerotherapy offered if ablation is not suitable. Ligation and stripping is held back for veins that those methods cannot treat, for example very large or tortuous trunks. Trust leaflets also mention that surgery for ulcers can speed healing and help prevent repeat ulcers.

• Compression stockings help symptoms but do not remove the faulty vein.

• Ablation and foam are done under local anaesthetic, with a quicker return to normal activity, per the NHS.

• Surgery is more invasive but is an established option when the others will not work.

You will usually have a pre-assessment visit, and on the day the veins are marked on your skin on the day of admission, according to a Gloucestershire leaflet, so the planned cuts match the veins causing trouble. Fasting instructions for the general anaesthetic will be on your appointment letter and need to be followed exactly.

Bring every medicine you take, including inhalers and creams, and tell the team about blood thinners, hormone treatment and any previous clots. Arrange a lift home and an adult to stay the first night, because one Gloucestershire leaflet makes both a condition of same-day discharge.

Under general anaesthetic, a cut of about 4 to 6 cm is made in the groin crease, according to a Guy's and St Thomas' leaflet, and the top of the main superficial vein is tied off and separated from the deep vein. A flexible wire is threaded down the vein and the vein is drawn out through a second, smaller cut near the knee. The Cambridge leaflet says the vein is stripped to below the knee.

Branch veins are then removed through very small cuts, which a Cambridge leaflet gives as 2 to 5 mm. The groin wound is closed with dissolving stitches; the little wounds may be closed with tape strips, stitches or glue. Bandages or stockings go on at the end. Most people are home later the same day.

Bruising and soreness along the leg are expected and can take weeks to fade; the Guy's and St Thomas' leaflet says bruising lasts three to four weeks. Wound infection, usually treated with antibiotics, is possible, and a Guy's and St Thomas' leaflet says inflammation of a vein (phlebitis) affects about 1 in 10 patients.

Figures differ between hospitals, so they are given here with their source. A Cambridge leaflet says 10 to 20 per cent of patients notice numbness that usually settles within a year, deep vein thrombosis or pulmonary embolism in under 1 per cent, and recurrence in about 10 per cent after five years. A Gloucestershire leaflet instead says numbness may be permanent in 1 in 20 and DVT occurs in fewer than 1 in 100. Ask your surgeon which figures reflect their own results.

Walking starts the day of or after surgery, and trust leaflets ask for regular walks rather than rest. One recommends at least 20 minutes, three times a day. Elevate the leg when sitting. Bandages come off after about 24 to 48 hours in the Cambridge and Guy's leaflets, followed by stockings for a further period.

Stinging or burning in the leg is common and, according to the Guy's and St Thomas' leaflet, eases at around two weeks; scars fade to near-invisible over many months. Standing still for long periods and crossing the legs are discouraged. A GOV.UK page says you must tell the DVLA if you are still unable to drive three months after an operation, though most people are back at the wheel far sooner.

Call 999 for chest pain, sudden breathlessness or coughing up blood, which could signal a clot reaching the lung. A calf that becomes swollen, tight or crampy needs same-day medical review, as does a wound that turns red, hot and painful. Bleeding through a dressing can usually be controlled by lying down with the leg raised and firm pressure while you seek advice from the ward, your GP or NHS 111.

• Why is stripping suggested for me rather than ablation or foam?

• Which veins will be removed, and will both legs be treated at once?

• What are the numbers for numbness and recurrence in your own practice?

• How long should I wear stockings, and who removes the bandages?

• When will my follow-up be, and is a scan planned afterwards?

Access is the main practical difference. NHS commissioners in some areas apply criteria before funding varicose vein treatment, so not everyone with symptoms is offered it, whereas private care depends on what you and your insurer agree. A private surgeon may offer ablation or foam first for the same reasons the NHS does; ask for the reasoning if surgery is proposed instead.