Varicose veins or varicose veins, these formulations in phlebology signify a pathology accompanied by a modification, that is to say a deformation of the veins. The vessels that carry blood to the heart dilate, lengthen, thin their walls, and also disrupt the work of venous valves.
If the first stage of varicose veins is treated very effectively with conservative methods, the progression of the disease to stages 2 and 3 can be cured only with surgery, drugs and other methods can only stop the progressionpathology. This article will discuss the main surgical methods of treating varicose veins, features of their implementation, etc.
Indications for surgery
Considering the fact that at the first stage of development of varicose veins, surgery is extremely rare due to the lack of need, the indication for surgery is a very important factor. The decision is based on data obtained during detailed vascular diagnostics and is made by the patient in conjunction with the physician.
A phlebologist is obliged to talk about the risks of the proposed operation, the duration and nuances of rehabilitation after surgery, which is then 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 the second degree of severity and above.
- Extensive forms of varicose veins, the disease affects not only the saphenous veins, but mainly the deep veins, or the deformation of the vessels extends to too large an area of the lower extremities.
- There is a severe circulatory disorder with aggravated 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 the blockage of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative therapy, that is, when drugs and other methods of treating varicose veins are powerless.
Limitations and contraindications of 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, which, if they do not completely exclude the possibility of surgical intervention, make it necessary to postpone the operation for a certain period:
- Ischemic heart disease - in this case it is necessary to conduct a more comprehensive comprehensive examination.
- The same goes for grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing an operation 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 best to postpone any surgery until delivery. The only exceptions are cases when there is a serious danger to the life of the mother or child and the operation can help.
- Skin disease in the area of the operation for varicose veins. We are talking about eczema, various forms of dermatosis, etc.
- There are also some age restrictions, of course, for the elderly. In some cases, old age, as well as accompanying 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, nevertheless, the doctor, on the basis of the diagnosis and after examination of the patient, is sure of the need for surgical intervention, it remains to choose the most suitable and effective method, depending on the degreeprogression of varicose veins 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.
Combined phlebectomy
A full-fledged 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 more often this method is used in advanced cases when the disease has seriously progressed.
During the operation, the surgeon makes an incision up to 2 centimeters long for the ankle, or up to 5 centimeters for a larger area like the groin. Often, these incisions are shallow, as the mostly superficial veins are removed.
The principle of the operation is to ligate the anastomosis of the vessel with the subsequent removal of the part of the vein affected by varicose veins. In addition, during surgery, the surgeon may correct the venous valves in order 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.
Miniflebectomy
During this procedure, excision of the affected area of the vein is also performed, however, the scale of the operation is smaller, rather it can be considered purely cosmetic. The main thing is that the doctor makes a small puncture in the skin, through which he extracts a part of the vein that needs to be cut. This operation is performed mostly on small vessels, and its advantages are painlessness (due to local anesthesia) and minimal recovery period.
Sclerotherapy
A relatively young technique, a minimally invasive method, renowned for its effectiveness, as well as the absence of painful sensations due to the same local anesthesia and hardly any period of rehabilitation.
The procedure involves the introduction of a special substance into the lumen of the vein - a foaming sclerosant. This substance leads to the collapse of the walls of the ship with their subsequent sticking. As a result, the vein ceases to participate in the process of blood circulation, gradually resolves itself 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".
Laser coagulation
The most modern and, according to many experts, an effective way to treat varicose veins. Its essence is 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 withdrawn, the venous walls collapse and stick together. Subsequently, the vessel disappears on its own, 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 period of rehabilitation.
Possible consequences
Even the most gentle operation leaves its mark 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, with a combined phlebectomy, such consequences can be much more serious than a few bruises after laser coagulation.
Consider the most basic consequences that periodically arise after one or another type of surgical treatment:
- When removing varicose veins by minimally invasive methods, excluding the removal of the vessel, there is a risk of relapse. This risk is minimal just during laser coagulation, only 5%.
- Burns - occurs after operations in which thermal effects have been applied.
- Bleeding - can start after any type of procedure, but more likely after a phlebectomy.
- There are also known cases of nerve damage, but this factor refers exclusively to the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, i. e. recovery after surgery, is necessary in each of the cases described, but if after coagulation this process only takes a few days, after combined phlebectomy it may take several weeks. In order for the recovery to proceed smoothly and quickly, it is important to adhere to simple recommendations:
- Follow your doctor's advice carefully.
- Wear compression garments or elastic bandages.
- If any 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 walking will help.
- If your doctor has prescribed medicine for you, take it according to these instructions.
- It is also useful to see a masseur after surgery and for the prevention of varicose veins.
- Avoid severe physical exertion for at least 2-3 months.
If the surgery went well and the patient followed the doctor's instructions for healing, the chances of a favorable outcome are very high. In most cases, varicose veins can be cured, but that 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 have been cases of the development of this pathology.