Varicose veins or varicose veins, these formulations in phlebology mean a pathology accompanied by a modification, ie. deformation of the veins. The vessels that transport blood to the heart dilate, lengthen, thin out their walls, and also interfere with the work of the 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 only be cured by surgery, medicine and other methods can only stop the development of the pathology. This article will focus on the main surgical methods of treating varicose veins, the features of their implementation, etc.
Indications for surgery
Given the fact that surgery in the first stage of varicose vein development is extremely rare due to lack of need, a very important factor is the indications for surgery. The decision is based on the data obtained during detailed vascular diagnosis and is made by the patient together with the doctor.
A phlebologist is obliged to tell about the risk of the proposed operation, the duration and nuances of rehabilitation after the operation, which is subsequently performed only with the patient's consent.
As for the indications themselves, varicose vein surgery is needed in such cases:
- 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 deep veins, or the deformation of the vessels extends to a too large area of the lower extremities.
- There is a serious circulatory disease accompanied by worsening stagnant blood processes.
- Severe forms of edema, high-intensity pain syndrome accompanied by obvious 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 up to blockage of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, that is, when medications and other methods of dealing with varicose veins are powerless.
Restrictions and Contraindications to Surgery
Unfortunately, it is not always possible for a patient to undergo surgery even with the development of severe varicose veins accompanied by complications and a serious clinical picture.
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:
- Ischemic heart disease - in this case it is necessary to perform a more complete comprehensive examination.
- The same is true for class 3 hypertension.
- Active Infectious and Inflammatory Processes in the Body - Before performing surgery to treat varicose veins, clear the infection or eliminate inflammation.
- 2nd and 3rd trimesters of pregnancy - for pregnant women it is better to postpone surgical procedures until the woman gives birth. The only exceptions are cases where there is a serious danger to the life of the mother or child and the surgery can help.
- Skin disease in the area of surgery to combat varicose veins. We are talking about eczema, various forms of dermatosis and so on.
- Of course, there are also age restrictions for the elderly. In some cases, old age as well as concomitant old age diseases increase the risk of postoperative complications or endanger a person's life on the operating table.
Methods of varicose vein surgery
Nevertheless, on the basis of the diagnosis and after examination of the patient, the physician is sure of the need for surgery, it remains to choose the most appropriate and effective method depending on the degree of varicose veins and a number of other factors. To understand what surgeries are and in what cases they are performed, we will consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A full-fledged operation performed under general anesthesia and lasting 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 become severe.
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 such as the groin. Often these incisions are low as mainly superficial veins are removed.
The principle of surgery is to ligate the anastomosis into the vessel with the subsequent removal of the part of the vein affected by varicose veins. Also during surgery, the surgeon can correct the venous valves to restore normal blood flow.
At the end of the operation, cosmetic stitches are applied to the incisions, a bandage is made, and an elastic bandage is applied to the operated area to prevent bleeding.
Miniflebectomy
During this procedure, the excision of the affected area of the vein is also performed, but the extent of the operation is smaller, it can rather be considered purely cosmetic. The point is that the doctor makes a small puncture in the skin, through which he pulls out a part of the vein that needs to be cut out. This surgery is performed mainly on small vessels and its benefits are pain relief (due to local anesthesia) and a minimal recovery period.
Sclerotherapy
A relatively young technique, a minimally invasive method, famous for its effectiveness, as well as the absence of painful sensations due to the same local anesthetic and virtually no rehabilitation period.
The procedure involves the introduction of a special substance into the lumen of the vein - a foaming sclerosant. This fabric leads to the collapse of the walls of the ship with their subsequent gluing. As a result, the vein ceases to participate in the blood circulation process, gradually dissolves and is replaced by connective tissue.
The method of sclerotherapy is mainly used to eliminate small superficial vessels as well as to get rid of the so-called "spider veins".
Laser Coagulation
The most modern and according to many experts an 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 vein walls collapse and stick together. Then the vessel disappears alone, replaced by connective tissue.
Of course, the main advantage of this procedure is the almost complete absence of visible lesions on the skin as well as the absence of the need for a rehabilitation period.
Possible Consequences
Even the most gentle action leaves traces and can have consequences. First and foremost, this is because the anatomical component of the body is removed - a full-fledged vessel. Of course, such consequences of combined phlebectomy can be much more severe than a few bruises after laser coagulation.
Let's consider the most basic consequences that periodically occur after some type of surgical treatment:
- By eliminating varicose veins using minimally invasive methods, except removal of the vessel, there is a risk of recurrence. This risk is minimal only during laser coagulation, only 5%.
- Burns - occurs after operations where thermal effects were applied.
- Bleeding - may start after any intervention, but more likely after phlebectomy.
- There are also known cases of nerve damage, but this factor refers exclusively to the professionalism of the surgeon.
Rehabilitation process
Rehabilitation, ie. recovery after surgery is required in each of the cases described, but if this process after coagulation takes only a few days, after a combined phlebectomy it may take several weeks after a coagulation. In order for the recovery to go smoothly and quickly, it is important to adhere to simple recommendations:
- Follow your doctor's advice carefully.
- Wear compression garments or elastic bandages.
- If cuts have occurred, it is important to wait for them to heal.
- Once the incisions are healed, it is important to restore physical activity, exercise therapy and regular walks help with this.
- If your doctor has prescribed medicine, take it according to these instructions.
- It is also useful after surgery and for the prevention of varicose veins to visit a masseur.
- Avoid severe physical exertion for at least 2-3 months.
If the operation went well and the patient fully followed the doctor's instructions for recovery, the probability of a favorable result is very high. In most cases, varicose veins can be cured, but that does not mean that the disease can not affect other vessels. For this reason, prevention of varicose veins should always be performed if there have been cases of development of this pathology.