The choice of the optimal way to deal with varicose veins is an urgent problem for patients and phlebologists. In the early stages of the development of pathology, predominantly conservative treatment methods are used, which make it possible to preserve varicose veins. However, if such a technique proves to be ineffective, the only appropriate solution that can change the situation for the better is surgery to remove the veins in the legs. Surgical intervention is the most radical method of treating varicose veins, as remote areas of damaged vessels simply cannot change varicose veins again.
In this article, we will consider the types of varicose vein removal surgeries that modern vascular surgery can offer: their features, advantages and disadvantages, preparation and implementation features, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Surgical intervention for varicose veins aims to solve the following problems:
- Elimination of reflux - a pathological reflux caused by failure of the venous valve.
- Removal of varicose veins. Recommended if the vein has undergone a severe transformation and there is no hope of restoring normal blood flow in it. In this case, the part of the vessel that affected the varicose veins is removed and the blood from it is redistributed through healthy veins.
- Fight cosmetic defects. Since 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, among other things, aim to eliminate aesthetic defects.
Types of venous surgery
The types of surgery that modern angiosurgery can offer to fight varicose veins are divided into two groups:
- Operations targeting 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 appropriate leg surgery 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 the surgical practice of treating varicose veins.
This method is aimed at removing dilated varicose veins.
The operation has several varieties, each named after its inventor: phlebectomy according to Bebkokk, according to Narat, according to Mueller, which is performed under local (with extensive vascular lesions - under general) anesthesia.
Despite the differences, all these operations to remove veins have one thing in common: they involve making incisions or punctures in the skin from 1 mm to 5-6 cm in length, through which the angiosurge draws the affected vein to the surface using special hooks. The veins are excised, tied up and removed, after which sutures or a special plaster is applied to the skin. This operation to remove varicose veins in the legs is extremely 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, more modern and less traumatic methods of performing surgery to remove veins began to emerge in comparison with classical surgical intervention. With their help, it is possible to reduce the time of the procedure, minimize postoperative scars and also reduce the likelihood of complications and side effects. One of these methods is laser surgery on 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 and heats the blood and vein walls. Under the influence of high temperatures up to 120 degrees, the walls of the vessel stick together, resulting in the blood stopping flowing into this part of the circulatory system.
Expert opinion
Depending on the area of the lesion and the number of veins to be removed, treatment of varicose veins in this way usually requires several procedures lasting 30-60 minutes.
The operation to remove veins with a laser is low traumatic, gives a good cosmetic effect (after that there are no visible scars and scars on the skin), does not require prolonged hospitalization. It should be borne in mind, however, that this technique is not suitable for treatment in the late stages of varicose veins when the diameter of the veins is significantly increased and there are varicose veins; to eliminate them, traditional surgery will be required.
Sclerotherapy
This is another modern vein removal surgery that allows you to achieve noticeable results with minimal trauma. A sclerosant is injected into the lumen of the dilated vessel - a special fluid or foam that adheres the walls of the affected area of the vein together. By completing a course of sclerotherapy you can achieve a quick cosmetic effect without scarring, which makes it very popular. However, this procedure is only suitable for the initial stage of varicose veins as well as telangiectasia.
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 venous walls, destruction of the endothelium and subsequent sealing of the vascular lumen. The procedure is minimally invasive and does not require hospitalization.
Preparation for a vein operation
Prior to 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, shave your leg without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, you should refrain from food 8 hours before the procedure (although in some cases the doctor may allow a light snack). A cleansing enema may also be needed before general anesthesia.
Contraindications to bone vein surgery
These surgeries 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 recovery depends on the number of veins removed, the patient's general health, and his compliance with the phlebologist's recommendations.
Typically, the recovery period lasts from 2 months to six months.
Depending on the type of surgery, the patient may recommend limited activity during the recovery period. For example, after laser coagulation and sclerotherapy, you can get up and move right away, after sclerotherapy you have to walk for about an hour, while combined phlebectomy requires a certain period of limitation of mobility.
Recommendations for rehabilitation after leg surgery
To reduce the risk of recurrence and complications after surgery, there are some limitations and recommendations that must be followed:
- You should wear knitwear with an appropriate level of compression. Tights or stockings after a vein surgery are a prerequisite for normal restoration of blood flow in the lower extremities.
- Correct the load on the legs. It is important to choose the "golden mean" here: not to allow both complete immobility and prolonged standing, sitting, running.
- Do not lift weights (during the recovery period, the maximum permissible 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 the distant veins with direct sunlight for some time.
- Wear loose pants or skirts, give up tight, uncomfortable shoes (especially with heels).
- Take medication prescribed by your doctor. Most often, the intake of venotonics, anticoagulants, antioxidants is prescribed.
Consequences and complications after a vein operation
Any surgical procedure can have undesirable consequences, and surgery in the veins of the lower extremities is no exception. Potential complications include the following:
- Relapse of varicose veins. If the main cause of varicose veins is not eliminated, the chances are high that the disease will return again. Therefore, in addition to surgery on the veins in the legs, it is necessary to perform a comprehensive treatment of the pathology and eliminate the provocative factors.
- The temperature rise. 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 can remain at subfebrile levels.
- Hematomas. Bruising after a vein surgery is a common complication after vein removal. It is caused by perforation of the vessel. Small bruises usually disappear 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.
- Pigmentation disorders. The discoloration of the skin at the surgical site usually persists for several weeks and then disappears. It should be remembered that hyperpigmentation is a very common complication after sclerotherapy.
To avoid these unpleasant phenomena, do not neglect medical recommendations, make sure to wear compression stockings and take medication recommended by a phlebologist.