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From what I see online it seems that minimally-invasive options like endovenous ablation are always being recommended for varicose veins, and I can see why, but is there ever a time where surgery is preferred? Are there benefits to surgery?
Occasionally, a ligation is required surgically to treat veins that arise right at the deep source vein. This however is quite an unlikely event, and most of our vein treatments are done minimally-invasively with ablation, microphlebectomies, and or targeted vein injections (sclerotherapy) in the office.
Most doctors are now primarily doing EVLT or VNUS Closure. However, not everyone is a candidate for EVLT or VNUS Closure; in those cases, minimally invasive surgery is recommended instead. You would need to consult with a vascular surgeon and have a diagnostic ultrasound done in order to determine which treatment or procedure you are a candidate for.
Varicose vein surgery is almost obsolete. Studies show that endovenous ablation has equal if not better results compared to high ligation and stripping (surgery) with lower complication rates and post-procedure recovery times. The only time I would recommend surgery is if the vein to be ablated is greater than 20 mm in size or very tortuous. This is
very unusual. However, you shouldn't have any procedure unless your symptoms are lifestyle limiting.
With the current techniques there is no reason to ever have traditional stripping and ligation. The recovery time for surgery is significant. In my opinion there are no benefits to surgery. If endovenous thermal ablation is not an option there are still better options than surgery such as endovenous chemical ablation (sclerotherapy). Also, microphlebectomy is frequently used as an adjunct to any of the endovenous approaches and is very successful and minimally invasive.
Surgery is a word which means many things. The vein stripping surgery of
years ago is not required any longer since the introduction of endovenous
closure. This is a much more effective treatment for saphenous vein
insufficiency (great, small, accessory) and for connecting veins between the
seep system and superficial system. Surgical removal of large varicose
veins is still appropriate in certain patients where the veins are so large
and painful or near bleeding that endovenous closure alone will not suffice.
All venous procedures can and probably should be performed in the outpatient
setting (usually in the office) by a specially trained physician dedicated to treating
vein disorders. I personally believe that vascular surgeons are the best
suite specialists to offer the full array of treatments.
It is rare now to need varicose vein surgery rather than endovenous ablation. Open surgery has many more associated risks. Indication for surgery rather then ablation could be recurrent veins or very large saphenous veins. However, in experienced hands, there is rarely a need for open surgery.