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Traditional Stripping
How do strippers work?

At the Whiteley Clinic we use modern pin strippers rather than the normal strippers with a head. The traditional stripper, which the majority of surgeons use, removes the vein by concertinaing the vein, the head acting as a stop. Whilst effective, the head being wider than the vein causes collateral bruising and damage to the surrounding tissues. (as shown in Fig A) The pin stripper on the other hand is narrower than the vein (Fig B) and works by turning the vein inside out on itself thereby avoiding such injury. (Fig C)

Phlebectomies

The unsightly veins on the surface are removed when the main veins are dealt with. A blade, which is no bigger than the nib of a fountain pen, is used to make tiny pinholes at intervals. The wiggly veins are then removed using a fine blunt hook that is like a miniature crochet hook. We have developed a number of refinements to this technique such as carrying out this part of the procedure under tourniquet to reduce blood loss to virtually nil and the instillation of local anaesthetic into all the tiny wounds so that when you wake up you are as pain free and comfortable as it is possible to be.

A cautionary tale

When I made the comment earlier about the hopeful surgeon putting the stripper down ‘blind’ I didn’t mean that he is literally blind in that a properly trained skilled surgeon will insert the stripper into the correct vein at the groin.

However, even in the most skilled hands it can still end up in the wrong place as demonstrated by yours truly recently. I passed a stripper into one of two large long saphenous veins at the groin that I wanted to remove individually (yes you can have two – yet another pitfall!). The stripper sailed down easily and I asked my Senior Vascular Technologist to check the position.

The stripper had passed down the correct vessel for about 2 inches then veered off down a posterior tributary in the thigh thereby missing BOTH of the veins I was after. Fortunately, a potentially embarrassing error was easily corrected, the two long saphenous veins were removed and even the large extra tributary dealt with so that the patient was left with no refluxing vessels in her groin and an excellent outcome.

A surgeon with no ultrasound facility within the operating theatre would have achieved a poor result in such a case and recurrence would have been virtually guaranteed for the patient.