Varicose or varicose veins, these formulations in phlebology mean a pathology accompanied by a modification, that is, deformation of the veins. The vessels that carry blood to the heart expand, lengthen, thin their walls, and also interrupt the functioning of the venous valves.
If the first stage of varicose veins is treated very effectively with conservative methods, then the progression of the disease to stages 2 and 3 can only be cured by surgery, drugs and other methods can only stop the progressionof pathology. This article will focus on the main surgical methods for the treatment of varicose veins, the features of their implementation, etc.
Indications for surgical intervention
In view of the fact that in the early stage of the development of varicose veins, surgical intervention is extremely rare due to the lack of necessity, a very important factor is the indication of the operation. The decision is based on the data obtained during the detailed diagnosis of the blood vessels and is made by the patient together with the doctor.
A phlebologist is obliged to report on the risks of the proposed operation, the duration and nuances of rehabilitation after surgery, which are subsequently carried out only with the consent of the patient.
As for the indications themselves, surgery for varicose veins is necessary in such cases:
- Pathological dilation and subsequent deformation of purely saphenous veins of second degree of severity and higher.
- Extensive forms of varicose veins, the disease affects not only the saphenous, but mainly the deep veins, or the deformation of the vessels extends to too large an area of the lower extremities.
- There is a serious circulatory disorder, accompanied by aggravated stagnant blood processes.
- Severe forms of edema, high intensity pain syndrome, accompanied by different external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to impaired vascular integrity;
- Progression of the pathological process until the blockage of the venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics in the course of conservative treatment, that is, when medication and other methods of treating varicose veins are impotent.
Limitations and contraindications for the operation
Unfortunately, even with the development of severe forms of varicose veins, accompanied by complications and a severe clinical picture, it is not always possible for a patient to undergo surgery.
There are a number of contraindications that, if they do not completely exclude the possibility of a surgical intervention, are forced to postpone the operation for a certain period of time:
- Ischemic heart disease: In this case, a more complete comprehensive examination is necessary.
- The same applies to grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing an operation to treat varicose veins, you need to cope with the infection or eliminate inflammation.
- Second and Third Trimesters of Pregnancy: For pregnant women, it is best to postpone any surgical procedures until the woman gives birth. The only exceptions are cases where there is serious danger to the life of the mother or child and the operation can help.
- Skin disease in the area of the operation to combat varicose veins. We are talking about eczema, various forms of dermatosis, etc.
- There are also certain age restrictions, of course, for older people. In some cases, old age, as well as concomitant diseases of old age, increase the risk of postoperative complications or endanger the life of a person on the operating table.
Methods of surgical intervention for varicose veins
If, however, the doctor, based on the diagnosis and after examining the patient, is sure of the need for surgical intervention, it remains to choose the most appropriate and effective method, depending on the degree of progression of the veinsvaricose and a number of other factors. To understand what operations are and in which cases they are performed, we will consider the most effective methods of surgical treatment of varicose veins.
A complete operation that is performed under general anesthesia and can take up to 2 hours, depending on the complexity of the task. Phlebectomy can be used to treat the initial forms of varicose veins, but this method is used more often in advanced cases when the disease has progressed seriously.
During the operation, the surgeon makes an incision up to 2 centimeters long for the ankle, or up to 5 centimeters long for a wider area such as the groin. Often these incisions are shallow as mainly the superficial veins are removed.
The principle of the operation consists of tying the anastomosis of the vessel with the subsequent extraction of the part of the vein affected by varicose veins. Also, during surgery, the surgeon can correct the venous valves to restore normal blood flow.
At the end of the operation, cosmetic stitches are applied to the incisions, a dressing is made, and an elastic bandage is applied to the operated area to prevent bleeding.
During this procedure, the affected area of the vein is also removed, however, the scale of the operation is smaller, rather it can be considered purely cosmetic. The conclusion is that the doctor makes a small puncture in the skin, through which he removes a part of the vein that must be cut. This operation is performed mainly on small vessels, and its advantages are painlessness (by local anesthesia) and a minimal recovery period.
A relatively young technique, a minimally invasive method, which is famous for its effectiveness, as well as the absence of painful sensations due to the same local anesthesia and a practically absent rehabilitation period.
The procedure involves the introduction of a special substance into the lumen of the vein: a foamy sclerosant. This substance leads to the collapse of the walls of the vessel with its subsequent sticking. As a result, the vein ceases to participate in the blood circulation process, gradually dissolves and is replaced by connective tissue.
The sclerotherapy method is mainly used to remove small superficial vessels, as well as to get rid of so-called "spider veins".
The most modern and, according to many experts, effective way to treat varicose veins. Its essence lies in the fact that a laser light guide is inserted into the venous lumen through an opening of only 2 millimeters. When the latter is activated, it begins to emit laser waves, the temperature rises inside the vessel, and as the laser is withdrawn, the walls of the veins collapse and stick together. Subsequently, the vessel disappears on its own, it is replaced by connective tissue.
Of course, the main advantage of this procedure is the almost total absence of visible lesions on the skin, as well as the absence of the need for a rehabilitation period.
Even the smoothest operation leaves traces and can have consequences. First of all, this is due to the fact that the anatomical component of the body, a full-fledged vessel, is removed. Of course, with a combined phlebectomy, such consequences can be much more serious than a couple of bruises after laser coagulation.
Consider the most basic consequences that arise periodically after a particular type of surgical treatment:
- When varicose veins are removed by minimally invasive methods, excluding removal of the vessel, there is a risk of relapse. This risk is minimal only during laser coagulation, only 5%.
- Burns: occur after operations during which thermal effects were applied.
- Bleeding: can start after any type of intervention, but is more likely after phlebectomy.
- Cases of nerve damage are also known, but this factor refers only to the level of professionalism of the surgeon.
The rehabilitation process
Rehabilitation, that is, recovery after surgery, is necessary in each of the cases described, but if after coagulation this process takes only a couple of days, after a combined phlebectomy it can take several weeks. For quick and smooth recovery, it is important to follow simple recommendations:
- Follow your doctor's advice carefully.
- Wear compression garments or elastic bandages.
- If incisions have occurred, it is important to wait for them to heal.
- Once the incisions have healed, it is important to restore physical activity, exercise therapy and regular walks will help with this.
- If your doctor has prescribed any medication, take it according to these instructions.
- It is also useful to visit a masseur after surgery and for the prevention of varicose veins.
- Avoid serious physical exertion for at least 2-3 months.
If the surgery went well and the patient followed the doctor's instructions for recovery, the probability of a favorable outcome is very high. In most cases, varicose veins can be cured, but this does not mean that the disease cannot affect other vessels. For this reason, the prevention of varicose veins should always be carried out if there were cases of the development of this pathology.