Choosing the optimal way to deal with varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of pathology development, mostly conservative methods of treatment are used, which make it possible to preserve varicose veins. However, if such a technique proves ineffective, the only suitable option that can change the situation for the better is surgery to remove the veins in the legs. Surgery is the most radical method of dealing with varicose veins, as the remote areas of the damaged vessels simply cannot change the varicose veins again.
In this article we will look at the types of varicose vein removal surgeries that modern vascular surgery can offer: their characteristics, pros and cons, characteristics of preparation and performance, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Surgical intervention for varicose veins is aimed at solving the following problems:
- Elimination of reflux - pathological reflux caused by venous valve insufficiency.
- Removal of varicose veins. It is recommended if the vein has undergone a serious transformation and there is no hope of restoring normal blood flow in it. In this case, the area of the vessel that has affected the varicose veins is removed and the blood from it is redistributed through healthy veins.
- Fighting cosmetic defects. As CVI (chronic venous insufficiency) and varicose veins caused by it do not change the appearance of the lower extremities in the best way, the operation should be aimed, inter alia, at eliminating the aesthetic defects.
Types of vein surgery
The types of surgical interventions that modern angiosurgery can offer to combat varicose veins are divided into two groups:
- Operations aimed at mechanical resection of varicose veins affected by varicose veins with their subsequent ligation.
- Operations involving thermal or chemical exposure to varicose veins.
The choice of the most appropriate operation for the veins of the legs depends on the stage of development of the pathology, the age and general health of the patient, as well as the goals 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 surgical practice for the treatment of varicose veins.
This method is aimed at removing varicose veins.
The operation has several variants, each of which is named after its inventor: phlebectomy according to Bebcock, according to Narat, according to Mueller, which are performed under local (with extensive vascular lesions - under general) anesthesia.
Despite the differences, all of these operations to remove leg veins have one thing in common: they involve making cuts or punctures in the skin 1 mm to 5-6 cm long, through which the angiosurgeon pulls the affected vein to the surface using special hooks. The veins are cut, tied and removed, after which sutures or a special patch are applied to the skin. This operation to remove varicose veins in the legs is highly effective and allows you to achieve positive results in the treatment of venous pathology.
Laser vein surgery
With the development of medicine in the arsenal of vascular surgeons began to appear more modern and less traumatic methods of performing surgery to remove veins compared to classical surgery. With their help it is possible to reduce the time of the procedure, to minimize postoperative scars, as well as to reduce the likelihood of complications and side effects. One of these methods is laser surgery of the veins of the lower extremities (endovenous, endovasal or endovascular laser coagulation).
A special laser light guide is inserted into the cavity of the affected vessel, which heats the blood and the walls of the veins. Under the influence of high temperatures up to 120 degrees, the walls of the vessel stick together, as a result of which blood stops flowing in this part of the circulatory system.
Expert opinion
Depending on the area of the lesion and the number of veins to be removed, treating varicose veins in this way usually requires several procedures lasting 30-60 minutes.
Laser vein removal surgery is low-traumatic, gives a good cosmetic effect (after it there are no visible scars and scars on the skin), does not require prolonged hospitalization. However, it should be borne in mind that this technique is not suitable for the treatment of late-stage varicose veins, when the diameter of the veins is significantly increased and there is varicose veins; traditional surgery will be needed to eliminate them.
Sclerotherapy
This is another modern vein removal operation that allows you to achieve noticeable results with minimal trauma. Sclerosant is injected into the lumen of the dilated vessel - a special liquid or foam that sticks to the walls of the affected area of the vein. Performing a course of sclerotherapy allows you to achieve a quick cosmetic effect without scars, which makes it very popular. However, this procedure is only suitable for the initial stage of varicose veins, as well as for telangiectasias.
Radiofrequency vein surgery
RFA (radiofrequency erasure) is the effect on the affected areas of blood vessels with radio signals of a certain frequency, leading to heating of the vein walls, destruction of the endothelium and subsequent thickening of the vascular lumen. The procedure is minimally invasive and does not require hospitalization.
Preparing for vein surgery
Before the operation it is necessary to perform preparatory measures: ultrasound of the veins of the lower extremities, clinical blood test and coagulogram. On the eve of the procedure you should shave your legs without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, you should abstain from food for 8 hours before the procedure (although in some cases your doctor may allow a snack). Also, a cleansing enema may be needed before general anesthesia.
Contraindications for surgery of the veins of the legs
These surgeries are not recommended during pregnancy, with serious endocrine and cardiovascular pathologies, during exacerbation of chronic diseases, in the presence of infectious and inflammatory processes in the legs.
Recovery after vein surgery
The duration of the recovery period depends on the number of removed veins, the general health of the patient and his compliance with the recommendations of the phlebologist.
The recovery period usually lasts from 2 months to six months.
Depending on the type of surgery, limited patient activity during the recovery period may be recommended. For example, after laser coagulation and sclerotherapy you can immediately get up and move, after sclerotherapy you have to walk for about an hour, while combined phlebectomy requires a certain period of restriction of mobility.
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 appropriate level of compression. Tights or tights after vein surgery are a prerequisite for the normal restoration of blood flow in the lower extremities.
- Adjust the load on the legs. It is important to choose the "golden environment" here: not to allow both complete immobilization and prolonged standing, sitting, running.
- Do not lift weights (during the recovery period, the maximum allowable weight is up to 5 kg).
- Do not take a hot bath, do not take a steam bath or sauna, avoid contact with the skin in the area of distant veins in direct sunlight for some time.
- Wear baggy pants or skirts, give up tight, uncomfortable shoes (especially with heels).
- Take medication prescribed by your doctor. The most commonly prescribed intake of venotonics, anticoagulants, antioxidants.
Consequences and complications after vein surgery
Any surgery can have side effects and surgery on the veins of the lower extremities is no exception. Potential complications include the following:
- Recurrences of varicose veins. If the root cause of varicose veins is not eliminated, chances are that the disease will return. 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 removed veins is normal in the postoperative period. Also, for 1-2 days after the end of the procedure, the total body temperature may remain at subfebrile levels.
- Hematomas. Bruising after vein surgery is a common complication after vein removal. It is caused by the perforation of the vessel. Small bruises usually go away without further treatment within a few weeks. However, if you have a large, painful bruise that does not go away in about 2 weeks, report it to your phlebologist.
- Disorders of pigmentation. Discoloration of the skin at the site of surgery usually lasts several weeks and then subsides. It should be borne in mind that hyperpigmentation is a very common complication after sclerotherapy.
To avoid these unpleasant phenomena, do not ignore medical recommendations, do not forget to wear compression stockings and take medication recommended by a phlebologist.