Saphenous vein ligation and excision
A specialized surgical procedure used to treat venous insufficiency and related vascular conditions. It involves ligation (closing off) and excision (removal) of the great or small saphenous vein, and may also include ligation of perforating veins and removal of additional vein segments, depending on the case.
Who this treatment is for
It is usually recommended for patients with varicose veins, swollen legs, a feeling of heaviness or skin changes caused by chronic venous disease.
The decision between this technique and less extensive approaches depends on the assessment made during a vascular surgery consultation.
Delaying treatment can allow venous disease to progress into more serious complications, such as ulcers, skin damage or deep vein thrombosis.
Signs you may need this treatment
- ✓Visible varicose veins or enlarged veins in the legs
- ✓Heaviness, tiredness or persistent pain in the legs
- ✓Swelling that does not go down over the course of the day
- ✓Changes in the colour or texture of the skin near the ankles
- ✓Wounds or ulcers that are slow to heal
- ✓Symptoms of more advanced chronic venous disease
There is no need to wait for symptoms to get worse before seeking an assessment.
If you recognise one or more of these signs, a vascular surgery consultation can help clarify the cause and the most suitable treatment.
How ligation and excision is performed
The procedure begins with a thorough pre-operative assessment, including a physical examination and imaging, usually a Doppler ultrasound, to map the affected veins precisely.
During surgery, the saphenous vein is tied off at key points to prevent blood reflux and then removed along the affected sections. Where needed, perforating veins — which connect the superficial and deep venous systems — can also be tied off, and additional vein segments excised.
As a minimally invasive procedure, it is generally performed under local or general anaesthetic, and is always adapted to each patient's specific needs.
The Doppler ultrasound shows how the veins are working and maps where the reflux is. That result determines the extent of the surgery: which segments to remove and whether any perforating veins need treating.
Benefits of treating venous insufficiency
Ligation and excision acts directly on the cause of poor circulation, offering:
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Effective symptom relief — resolves the pain, swelling and heaviness associated with venous insufficiency.
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Better circulation — restores normal blood flow, correcting the venous dysfunction.
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Personalized care — a tailored surgical approach, including optional treatment of perforating veins and additional segments.
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Prevention of complications — lowers the risk of ulcers, skin changes and deep vein thrombosis.
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Better quality of life — improves mobility, the appearance of the legs and overall vascular health.
What is assessed before the procedure
Symptoms and medical history
Review of leg pain, swelling or visible varicose veins, alongside personal and family history.
Physical examination
Focused assessment of the affected veins, to determine the extent of the venous disease.
Diagnostic tests
Doppler ultrasound, to map the venous system and assess blood flow.
Surgical planning
Deciding whether ligation of perforating veins or excision of additional vein segments needs to be included, based on the diagnostic results.
Post-operative guidance
Recommendations for recovery, including compression therapy, adjusting physical activity and maintaining long-term vascular health.
Common questions about this procedure
What is the difference between isolated ligation and ligation with excision?+
Isolated ligation treats only the point of reflux at the vein junction, while ligation and excision also removes the affected vein along the compromised sections. The choice depends on the extent and severity of the venous insufficiency, assessed in consultation.
Is recovery longer than with isolated ligation?+
Because segments of the vein are removed, recovery can be slightly longer, but it remains a minimally invasive procedure, with a gradual return to usual activities following the surgeon's instructions.
Does this procedure hurt?+
It is performed under local or general anaesthetic, so there is no pain during surgery. Some discomfort afterwards is normal, managed with medication and compression therapy.
When is ligation and excision recommended over other treatments?+
It is generally indicated in more advanced venous insufficiency, involving larger segments of the vein or perforating veins, when isolated ligation is not enough to resolve the problem.
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