Varicose veins or varicose veins, these formulations in phlebology mean pathology accompanied by modification, ie deformation of the veins. The vessels that transport blood to the heart dilate, lengthen, thin their walls, and also disrupt 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 be cured only by surgery, drugs and other methods can only stop the progression of the pathology. This article will focus on the main surgical methods for the treatment of varicose veins, the peculiarities of their application, etc.
Indications for surgical intervention
Given the fact that in the first stage of the development of varicose veins, surgery is extremely rare due to lack of need, a very important factor is the indication for surgery. The decision is based on the data obtained in the course of a detailed vascular diagnosis and is taken by the patient together with the doctor.
The phlebologist is obliged to tell about the risks of the proposed operation, the duration and the nuances of rehabilitation after surgery, which are subsequently performed only with the consent of the patient.
As for the indications themselves, in such cases surgery is needed for varicose veins:
- Pathological dilatation 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 worsening stagnant blood processes.
- Severe forms of edema, high-intensity pain syndrome, accompanied by distinct 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 to occlusion of venous vessels and development of an acute form of thrombophlebitis.
- Lack of positive dynamics in the course of conservative treatment, ie when drugs and other methods of dealing with varicose veins are powerless.
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 the patient to undergo surgery.
There are a number of contraindications which, if they do not completely rule out the possibility of surgery, are forced to postpone the operation for a certain period of time:
- Ischemic heart disease - in this case it is necessary to perform a more comprehensive examination.
- The same goes for grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing surgery to treat varicose veins, you need to deal with the infection or eliminate the inflammation.
- 2nd and 3rd trimesters of pregnancy - for pregnant women it is better to postpone any surgical procedures until the woman gives birth. Exceptions are only cases where there is a serious danger to the life of the mother or child and surgery can help.
- Skin disease in the area of surgery to combat varicose veins. We are talking about eczema, various forms of dermatosis, etc.
- There are also certain age restrictions, of course, for the elderly. In some cases, old age, as well as concomitant diseases of old age, increase the risk of postoperative complications or endanger a person's life on the operating table.
Methods of surgery for varicose veins
If, however, the doctor, based on the diagnosis and after the examination of the patient, is sure of the need for surgery, it remains to choose the most appropriate and effective method depending on the degree of progression of varicose veins and a number of other factors. To understand what surgeries are and in what cases they are performed, we will look at the most effective methods for surgical treatment of varicose veins.
Combined phlebectomy
A complete operation that is performed under general anesthesia and can last up to 2 hours, depending on the complexity of the task. Phlebectomy can be used to treat the initial forms of varicose veins, but more often this method is used in advanced cases when the disease has progressed severely.
During the operation, the surgeon makes an incision up to 2 centimeters long for the ankle or up to 5 centimeters for a wider area such as the groin. Often these incisions are shallow, as mostly superficial veins are removed.
The principle of the operation is ligation of the vascular anastomosis with subsequent removal of the part of the vein affected by varicose veins. Also, during the operation, the surgeon can adjust the venous valves to restore normal blood flow.
After the operation, cosmetic sutures are applied to the incisions, a bandage is made and an elastic bandage is applied to the operated area to prevent bleeding.
Miniphlebectomy
During this procedure, the affected area of the vein is also excised, but the scale of the operation is smaller, rather it can be considered purely cosmetic. The conclusion is that the doctor makes a small puncture of the skin, through which he removes part of the vein that needs to be excised. This operation is performed mainly on small vessels, and its advantages are painlessness (due to local anesthesia) and a minimum recovery period.
Sclerotherapy
A relatively young technique, a minimally invasive method that is famous for its effectiveness as well as the lack of painful sensations due to the same local anesthesia and virtually no rehabilitation period.
The procedure involves the introduction of a special substance into the lumen of the vein - foam sclerosant. This substance causes the walls of the vessel to collapse with their subsequent gluing. As a result, the vein ceases to participate in the circulatory process, gradually resolves and is replaced by connective tissue.
The sclerotherapy method is mainly used to eliminate small superficial vessels, as well as to remove so-called "spider veins".Laser coagulation
The most modern and according to many experts effective way to deal with 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 when the laser is removed, the walls of the veins collapse and stick together. Subsequently, the vessel disappears on its own, being replaced by connective tissue.
Of course, the main advantage of this procedure is the almost complete absence of visible skin lesions, as well as the lack of need for a rehabilitation period.
Possible consequences
Even the most delicate operation leaves traces and can have consequences. First of all, this is due to the fact that the anatomical component of the body is removed - a full-fledged vessel. Of course, in a combined phlebectomy, such consequences can be much more serious than a few bruises after laser coagulation.
Let's look at the most basic consequences that periodically occur after a certain type of surgical treatment:
- There is a risk of recurrence when varicose veins are eliminated using minimally invasive methods, with the exception of vessel removal. This risk is minimal only during laser coagulation, only 5%.
- Burns - occur after operations during which thermal effects are applied.
- Bleeding - may start after any type of intervention, but more likely after a phlebectomy.
- Cases of nerve damage are also known, but this factor only applies to the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, ie recovery after surgery, is required in each of the cases described, but if after coagulation this process takes only a few days, then after a combined phlebectomy it may take several weeks. In order for the recovery to go smoothly and quickly, 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.
- After cutting the incisions, it is important to restore physical activity, exercise and regular walks will help.
- If your doctor has prescribed any medicine, take it according to these instructions.
- It is also useful to visit a masseur after surgery and for the prevention of varicose veins.
- Do not undergo serious physical exertion for at least 2-3 months.
If the operation went well and the patient fully complied with 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 performed if there have been cases of development of this pathology.