Surgical treatment for varicose veins

VEIN HIGH LIGATION & STRIPPING

High Ligation and Stripping

Vein High Ligation & Stripping

The refluxing vein is tied off,
and the affected vein is removed directly in
a surgical treatment.

Ligation and removal of the vein

Chosen according to the state of the vein

Ultrasound-based assessment

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What are high ligation and stripping?

High ligation and stripping for varicose veins —
Surgery that removes the refluxing vein directly.

VEIN HIGH LIGATION & STRIPPING

High ligation and stripping tie off the refluxing vein at its origin and use a special instrument (a stripper) to remove the affected vein directly.

Unlike radiofrequency, VenaSeal or ClariVein, which close the vein from within, this surgery removes the diseased vein from the body. It suits certain vein conditions and is not needed for every case of varicose veins.

Learn more about varicose veins →

High ligation and stripping surgery for varicose veins

Ligation and stripping procedure

How it works

The vein is not closed and left in place — it is removed.

Radiofrequency and laser close the vein with thermal energy, and VenaSeal closes it with a medical adhesive. High ligation and stripping differ in that the affected vein is removed surgically.

High ligation of the vein (tying off)

The point where reflux begins is identified and tied off, so blood no longer flows backwards.

Stripping of the vein (removal)

A special instrument called a stripper is passed into the vein and the affected vein is removed directly.

More than the veins you can see,
the direction of flow inside matters

When it may be considered

In these situations, surgical treatment may be worth assessing.

Having these symptoms does not mean surgery is needed. In early stages, or when reflux is not clear, conservative care may come first.

The vein is large and markedly dilated

The vein is very tortuous, making catheter treatment difficult

Symptoms have returned after previous treatment

The reflux extends over a wide area

Thrombus, inflammation or skin changes are also suspected

Heaviness, swelling, numbness or night cramps have continued for a long time

Bulging veins are prominent and daily discomfort keeps returning

What to check before treatment

More than the veins you can see,
We check the flow inside first.

A duplex ultrasound is required before surgery. It shows whether surgery is needed, or whether radiofrequency, VenaSeal, ClariVein, sclerotherapy or conservative care would be more appropriate.

See our treatment criteria →

Whether the venous valves are refluxing

Where the reflux begins

Vein diameter and length

How tortuous the vein is

Any existing thrombus or inflammation

Skin changes or chronic venous insufficiency

Whether another treatment is possible

The stripper instrument used in stripping surgery

Key features

Key features of high ligation and stripping for varicose veins

High ligation and stripping is a long-established surgical treatment and, depending on the state of the vein, can still be an important option.

Direct removal — the refluxing vein is taken out of the body

A long-established surgical treatment

Can be considered for large, tortuous veins

Surgery that requires incisions and anesthesia

Suitability judged on ultrasound findings

Comparing treatments

How high ligation and stripping differ from other treatments

Rather than declaring one treatment better, the right method depends on where and how severe the reflux is, the vein diameter and the shape of the vein.

High ligation and stripping

Ligation of the refluxing vein, then direct removal

Surgery; incisions and anesthesia required

Radiofrequency

Closes the vein with radiofrequency thermal energy

Thermal treatment, catheter-based

Laser

Laser thermal energy through an optical fiber

Thermal treatment, closes the vein from within

VenaSeal

Closes the vein with medical adhesive

Non-thermal, uses no heat

ClariVein

Rotational stimulation plus sclerosant delivery

Non-thermal, combined mechanical and chemical action

Sclerotherapy

Closes the vein by injecting a sclerosant

Mainly for branch and small veins

The treatment process

From examination to recovery guidance, in seven steps.

STEP 01

Duplex ultrasound

Confirm the location and extent of the reflux

STEP 02

Marking the veins

The treatment sites are marked while standing

STEP 03

Anesthesia

The method of anesthesia is decided by the extent of surgery

STEP 04

Ligation

The vein is tied off where the reflux begins

STEP 05

Removal

The affected vein is removed with a special instrument

STEP 06

Checking

Bleeding, swelling and the state of the vein are checked

STEP 07

Recovery guidance

Compression care, walking and daily-life guidance

Before the name of a treatment,
check the flow in your own veins

Cautions and limits

This is surgery that requires incisions and anesthesia, and that must be considered.

High ligation and stripping is surgery that requires incisions and anesthesia. It can be difficult to perform under local anesthesia alone, and spinal or general anesthesia may be considered when needed.

Bruising, pain, tightness, swelling, scarring or altered sensation can occur after treatment, and the treatment plan can differ with the patient's condition.

Bruising, pain, tightness, swelling, scarring, infection, bleeding or altered sensation are possible

The extent of surgery can differ with the state of the vein

The plan may change with a history of thrombosis, current medication, cardiovascular disease or diabetes

New problems can develop in other veins after treatment, so regular check-ups are needed

If symptoms persist or worsen, they should be checked with the medical team

Health insurance coverage

Depending on symptoms, ultrasound findings and the treatment criteria, national health insurance may apply. Because it differs according to whether the veins are merely bulging or reflux from valve failure is confirmed, it is best checked at a consultation.

Bandaging for recovery care after stripping surgery

Compression care and daily-life guidance after treatment

Our approach at Bluesky Phlebology

We look closely at small symptoms and subtle changes in the veins.

High ligation and stripping is a long-established operation that is still performed today. It applies to extensive varicose veins and to moderate or severe disease beyond the scope of laser or ClariVein. Results are good, but because the surgery covers a wide area, the method of anesthesia must be considered carefully.

3,000⁺

Vascular surgery experience

30^years

University hospital professor

1^doctor

Dedicated, focused care

High-resolution duplex ultrasound to locate and grade the reflux

A clear explanation of which veins need treatment and which can be watched

Choosing appropriately between ligation and stripping, radiofrequency, VenaSeal and conservative care

Guidance on recovery and daily care after treatment

Attention to small symptoms and subtle changes

Dr. Bang Jeong-hee

Vascular surgery specialist · MD, PhD · Former university hospital professor

Frequently asked questions

High ligation and stripping — frequently asked questions

When is stripping surgery needed for varicose veins?

It can be considered when reflux is severe, the veins are markedly dilated, or the vein is so tortuous that other endovenous treatments do not suit. Suitability is determined after a duplex ultrasound.

Stripping is an old operation — is it still done?

High ligation and stripping is a long-established method that is still performed today. For extensive varicose veins, or moderate to severe disease beyond the range of laser or ClariVein, it remains an important option.

Does stripping leave scars?

Because incisions are required, scars can remain. How noticeable they are depends on the incision sites, the skin and the course of healing.

Can there be pain or bruising after stripping?

Bruising, tightness, pain and swelling can occur after surgery. Most settle with time and care, but if symptoms are severe or persist, they should be checked with the medical team.

Can I walk right after stripping?

Walking after surgery can help circulation and recovery, but how much you walk and how active you are depend on your condition and the extent of surgery. It is best to follow the guidance you are given.

Do I have to wear compression stockings after stripping?

In many cases medical compression stockings are advised to manage swelling and support recovery. How long they are worn depends on the extent of surgery and the patient's condition.

Which is better, stripping or radiofrequency?

It is hard to say one is better for everyone. Stripping removes the vein directly, while radiofrequency closes it with thermal energy. The right method is chosen from the location, diameter, shape of the vein, the extent of reflux and the patient's condition.

Does health insurance cover stripping for varicose veins?

It can apply depending on symptoms, ultrasound findings and the treatment criteria. Because it varies with the patient's condition and whether the criteria are met, it is best confirmed at a consultation.

Visit information

If your leg symptoms keep returning,
before choosing a treatment by name
check the flow in your veins.

Treating varicose veins does not start by choosing a name — ligation and stripping, radiofrequency, VenaSeal or ClariVein. It starts by finding where and how much the veins in your legs are refluxing, and then deciding the direction that fits.

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What are varicose veins? → Radiofrequency ablation → ClariVein →