Choosing the optimal way to treat varicose veins is an urgent problem facing both patients and phlebologists. In the early stages of the development of pathology, mainly conservative methods of treatment are used, which helps 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 from the legs. Surgery is the most radical method of treating varicose veins, because areas far from damaged vessels simply cannot change varicose veins again.
In this article, we will consider the types of operations to remove the veins of varicose veins that modern vascular surgery can offer: their characteristics, advantages and disadvantages, characteristics of preparation and implementation, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Surgery for varicose veins is aimed at solving the following problems:
- Elimination of reflux - a pathological reflux caused by a failure of the venous valve.
- Removal of varicose veins. Recommended if the vein has undergone serious transformation and there is no hope of restoring normal blood flow. In this case, the section of the vessel that affected the varicose veins is removed and its blood is redistributed to healthy veins.
- Fight against cosmetic defects. Since CVI (chronic venous insufficiency) and the varicose veins it causes do not modify the appearance of the lower limbs as much as possible, the operation should aim, among other things, to eliminate cosmetic defects.
Types of venous surgery
The types of surgeries that modern angiosurgery can offer to combat varicose veins are divided 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 suitable leg vein surgery depends on the stage of development of the pathology, the age and general state of 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
Combination phlebectomy (phlebectomy) is the "gold standard" in the surgical practice of treating varicose veins.
This method is aimed at removing dilated varicose veins.
The operation has several varieties, each bearing 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 anesthesia).
Despite the differences, all these leg vein removal operations have one thing in common: they consist of making incisions or punctures in the skin 1 mm to 5 to 6 cm in length, through which the angiosurgeon pulls theaffected vein to the surface with the help of special tools. hooks. The veins are excised, tied and removed, after which sutures or a special bandage is applied to the skin. This operation to remove varicose veins from 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 of performing vein removal operation began to appear compared to conventional surgical intervention. With their help, it is possible to reduce the duration of the procedure, minimize postoperative scarring, and also reduce the risk of complications and side effects. One of these methods is laser surgery on the veins of the lower limbs (endovenous, endovasal or endovascular laser coagulation).
A special laser light guide is inserted into the cavity of the affected vessel, heating the blood and venous walls. Under the influence of high temperatures of up to 120 degrees, the walls of the vessel stick together, which prevents blood from flowing into this part of the circulatory system.
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 to 60 minutes.
The operation for laser vein removal is minimally traumatic, gives a good cosmetic effect (after it there are no visible scars and scars on the skin), does not require long-term hospitalization. However, it should be borne in mind that this technique is not suitable for the treatment of advanced 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 necessary.
This is another modern vein removal operation that allows you to achieve noticeable results with minimal trauma. A sclerosant is injected into the lumen of the dilated vessel - a special liquid or foamy substance that sticks to the walls of the affected area of the vein. Performing a sclerotherapy cure allows you to obtain a rapid 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 venous surgery
RFA (radiofrequency erasure) is the effect on affected areas of blood vessels with radio signals of a certain frequency, leading to heating of the venous walls, destruction of the endothelium and subsequent sealing of the vascular lumen. The procedure is minimally invasive and does not require hospitalization.
Prepare for venous surgery
Before surgery, it is necessary to perform 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.
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). In addition, a cleansing enema may be necessary before general anesthesia.
Contraindications to 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 on the legs.
Recovery after venous surgery
The duration of the recovery period depends on the number of veins removed, the general state of health of the patient and compliance with the recommendations of the phlebologist.
Typically, the recovery period lasts from 2 months to six 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 need 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, certain restrictions and recommendations should be followed:
- You should wear knits with an appropriate level of compression. Pantyhose or stockings after venous surgery are a prerequisite for restoring normal blood flow to the lower extremities.
- Correct the load on the legs. It is important to choose the "golden mean" here: not to allow complete immobility and prolonged standing, sitting or running at the same time.
- Do not lift any weight (during the recovery period, the maximum allowable weight is 5 kg maximum).
- Do not take a hot bath, do not take a steam bath or sauna, avoid contact with the skin in the area of the veins away from direct sunlight for some time.
- Wear loose pants or skirts, ditch tight, uncomfortable shoes (especially with heels).
- Take any medications prescribed by your doctor. Most often, taking venotonics, anticoagulants, antioxidants is prescribed.
Consequences and complications after venous surgery
Any surgery can have unwanted consequences, and lower limb vein surgery is no exception. The potential complications are as follows:
- Relapses of varicose veins. If the root cause of varicose veins is not ruled out, there is a good chance that the disease will return. Therefore, in addition to surgery on the veins of the legs, it is necessary to carry out 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. In addition, for 1 to 2 days after the end of the procedure, the total body temperature may remain at subfebrile levels.
- Hematomas. Bruising after venous surgery is a common complication after vein removal. It is caused by the perforation of the vessel. Small bruises most often go away without additional treatment within a few weeks. However, if you have a big, painful bruise that doesn't go away for about 2 weeks, report it to your phlebologist.
- Pigmentation disorders. The discoloration of the skin at the site of the surgery usually persists for several weeks and then goes away. It should be borne in mind 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.