Choosing the optimal way to treat varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of the development of pathology, predominantly conservative treatment methods are used, which make it possible to preserve varicose veins. However, if such a technique is ineffective, the only suitable option that can improve the situation is surgery to remove the veins in the legs. Surgical intervention is the most radical method of treating varicose veins, as remote areas of damaged vessels simply cannot change varicose veins back.
In this article, we will consider the types of operations to remove veins for varicose veins that modern vascular surgery can offer: their characteristics, pros and cons, characteristics of preparation and implementation, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Surgical intervention for varicose veins aims to solve the following problems:
- Reflux Elimination - A pathological reflux caused by venous valve failure.
- Elimination of varicose veins. Recommended if the vein has undergone a serious transformation and there is no hope of restoring normal blood flow to it. In this case, the section of the vessel that affected the varicose veins is removed and the blood is redistributed through the healthy veins.
- Fight against cosmetic defects. Since CVI (chronic venous insufficiency) and the varicose veins caused by it do not modify the appearance of the lower extremities in the best way, the operation must be aimed, among other things, at eliminating aesthetic defects.
Types of vein surgery
The types of surgical interventions that modern angio surgery can offer to combat varicose veins fall into two groups:
- Operations aimed at the mechanical resection of varicose veins affected by varicose veins with their subsequent ligation.
- Operations associated with thermal or chemical exposure to varicose veins.
The choice of the most appropriate leg vein surgery depends on the stage of development of the pathology, the age and general health of the patient, as well as the objectives pursued during the procedure.
Phlebectomy of the veins of the lower extremities: the course of the operation.
Combined phlebectomy (venectomy) is the "gold standard" in the surgical practice of treating varicose veins.
This method aims to remove dilated varicose veins.
The operation has several varieties, each of which bears the name of its inventor: phlebectomy according to Bebkokk, according to Narat, according to Mueller, which are performed under local anesthesia (with extensive vascular lesions, under general).
Despite the differences, all these operations to remove the veins in the legs have one thing in common: they consist of making cuts or punctures in the skin of 1 mm to 5-6 cm in length, through which the angio-surgeon pulls of the affected vein to the surface using hands. The veins are removed, tied off, and pulled out, after which stitches or a special cast are applied to the skin. This operation to eliminate varicose veins in the legs is very effective and allows to achieve positive results in the treatment of venous pathology.
Laser vein surgery
With the development of medicine in the arsenal of vascular surgeons, more modern and less traumatic methods began to appear for performing an operation to remove veins compared to classical surgical intervention. With its help, it is possible to reduce the time of the procedure, minimize postoperative scars, and also reduce the likelihood of complications and side effects. One such method is laser surgery on the veins of the lower extremities (endovenous, endovascular, or endovascular laser coagulation).
A special laser light guide is inserted into the cavity of the affected vessel, heating the blood and the walls of the veins. Under the influence of high temperatures of up to 120 degrees, the walls of the vessel stick together, as a result of which the blood stops flowing into this part of the circulatory system.
Expert opinion
Depending on the area of the injury and the number of veins to be removed, treating varicose veins in this way generally requires several procedures lasting between 30 and 60 minutes.
The operation to remove the veins with a laser is little traumatic, gives a good cosmetic effect (after this there are no visible scars or scars on the skin), does not require long-term hospitalization. However, it must be taken into account that this technique is not suitable for the treatment in the late stages of varicose veins, when the diameter of the veins is significantly increased and there are varicose veins; to eliminate them a traditional surgical intervention will be required. .
Sclerotherapy
This is another modern vein removal operation that allows you to achieve remarkable results with minimal trauma. A sclerosant is injected into the lumen of the dilated vessel, a special liquid or foamy substance that sticks together the walls of the affected area of the vein. Performing a sclerotherapy course allows to achieve a quick cosmetic effect without leaving scars, which makes it very popular. However, this procedure is suitable only for the initial stage of varicose veins, as well as for telangiectasias.
Radiofrequency vein surgery
RFA (radiofrequency obliteration) is the effect on the affected areas of the blood vessels with radio signals of a certain frequency, which causes the heating of the walls of the veins, the destruction of the endothelium and the subsequent sealing of the vascular lumen . The procedure is minimally invasive and does not require hospitalization.
Preparation for vein surgery
Before surgery, it is necessary to carry out preparatory measures: ultrasound of the veins of the lower extremities, a clinical blood test and a coagulogram. On the eve of the procedure, you need to shave your leg without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, you should refrain from eating 8 hours before the procedure (although in some cases the doctor may allow a light snack). Also, a cleansing enema may be required prior to general anesthesia.
Contraindications for leg vein surgery.
These surgical interventions are not recommended during pregnancy, with severe endocrine and cardiovascular pathologies, at the time of exacerbation of chronic diseases, in the presence of infectious and inflammatory processes in the legs.
Recovery after vein surgery.
The length of the recovery period depends on the number of veins removed, the general health of the patient and his compliance with the recommendations of the phlebologist.
Typically, the recovery period lasts from 2 to 6 months.
Depending on the type of surgery, limited activity may be recommended to the patient during the recovery period. For example, after laser coagulation and sclerotherapy, you can get up and move immediately, after sclerotherapy, you have to walk for about an hour, while combined phlebectomy requires a certain period of mobility restriction.
Recommendations for rehabilitation after leg vein surgery.
To reduce the risk of recurrence and complications after surgery, there are some restrictions and recommendations that must be followed:
- You should wear knitwear with an adequate level of compression. Stockings or stockings after vein surgery are a prerequisite for normal restoration of blood flow in the lower extremities.
- Correct the load on the legs. It is important to choose the "golden mean" here: not allowing complete immobility so much as standing, sitting or running for a long time.
- Do not lift weights (during the recovery period, the maximum weight allowed is up to 5 kg).
- Do not take a hot bath, do not take a steam bath or a sauna, avoid contact with the skin in the remote vein area of direct sunlight for some time.
- Wear baggy pants or skirts, forgo tight and uncomfortable shoes (especially with heels).
- Take the medications prescribed by your doctor. Most often, the intake of venotonics, anticoagulants, antioxidants is prescribed.
Consequences and complications after vein surgery.
Any surgical intervention can have undesirable consequences, and surgery on the veins of the lower extremities is no exception. Possible complications include the following:
- Relapses of varicose veins. If the main cause of varicose veins is not eliminated, it is very likely that the disease will reappear. Therefore, in addition to surgery on the veins of the legs, it is necessary to carry out a comprehensive treatment of the pathology and eliminate the provoking factors.
- The rise in temperature. A slight increase in local temperature in the area of the excised veins is normal postoperatively. Also, for 1-2 days after the end of the procedure, the total body temperature may remain at subfebrile levels.
- BruisingBruising after vein surgery is a common complication after vein removal. It is caused by the perforation of the vessel. Small bruises usually resolve without further treatment in a couple of weeks. However, if you have a large, painful bruise that does not go away for about 2 weeks, report it to your phlebologist.
- Pigmentation disorders. Skin discoloration at the surgery site usually persists for several weeks and then resolves. It must be taken into account that hyperpigmentation is a very common complication after sclerotherapy.
To avoid these unpleasant phenomena, do not neglect medical recommendations, be sure to wear compression stockings and take the drugs recommended by a phlebologist.