Varicose veins or varicose veins, these formulations in phlebology indicate a pathology accompanied by a change, that is, a deformation of the veins. The vessels that carry blood to the heart dilate, stretch, thin their walls, and also disrupt the work of the venous valves.
If the first stage of varicose veins is treated very effectively with conservative methods, then the progression of the disease to stages 2 and 3 can only be cured by surgery, drugs and other methods can only stop the progression of the pathology. This article will discuss the main surgical methods for the treatment of varicose veins, the features of their implementation, and so on.
Indications for surgery
In view of the fact that in the early stage of development of varicose veins, surgical intervention is extremely rare due to the lack of necessity, a very important factor is the indication for the operation. The decision is based on the data obtained in the course of a detailed vascular diagnostics and is made by the patient together with the doctor.
A phlebologist is obliged to talk about the risks of the proposed operation, the duration and nuances of rehabilitation after surgery, which are subsequently carried out only with the consent of the patient.
As for the indications themselves, surgery for varicose veins is required in such cases:
- Pathological dilation and subsequent deformation of the purely saphenous veins of second degree of severity and higher.
- Extensive forms of varicose veins, the disease affects not only the saphenous, but mainly the deep veins, or the deformation of the vessels extends to too large an area of the lower limbs.
- There is a severe circulatory disturbance, accompanied by aggravated stagnant blood processes.
- Severe forms of edema, pain syndrome of high intensity, 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 up to the blockage of the venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics in the course of conservative treatment, that is, when drugs and other methods of treating varicose veins are powerless.
Limitations and contraindications for 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 numerous contraindications which, if they do not completely exclude the possibility of surgery, make it necessary to postpone the operation for a certain period of time:
- Ischemic heart disease: In this case, a more complete comprehensive examination is required.
- The same is true for grade 3 hypertension.
- Infectious and inflammatory processes active in the body: Before performing an operation for the treatment of varicose veins, it is necessary to address the infection or eliminate inflammation.
- 2nd and 3rd trimester of pregnancy: For pregnant women, it is best to postpone any surgery until delivery. The only exceptions are those cases when there is a serious danger to the life of the mother or baby and the operation can help.
- Skin disease in the area of the operation to combat varicose veins. We are talking about eczema, various forms of dermatosis and so on.
- There are also some age restrictions, of course, for the elderly. In some cases, old age, as well as concomitant old age diseases, increase the risk of postoperative complications or endanger the life of a person on the operating table.
Methods of surgery for varicose veins
If, however, the doctor, on the basis of diagnostics and after examining the patient, is sure of the need for surgical intervention, it remains to choose the most appropriate and effective method, depending on the degree of progression of varicose veins anda 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 last 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 severely 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 such as the groin. Often these incisions are superficial, as mainly superficial veins are removed.
The principle of the operation is to ligate the anastomosis of the vessel with subsequent removal of the part of the vein affected by varicose veins. Additionally, during surgery, the surgeon can correct the venous valves to restore normal blood flow.
At the end of the operation, cosmetic sutures 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, the affected area of the vein is also excised, however the scale of the operation is smaller, it can rather be considered purely cosmetic. The bottom line is that the doctor makes a small puncture in the skin, through which he extracts a portion of the vein that needs to be cut. This operation is mainly performed on small vessels and its advantages are painless (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 local anesthesia itself and practically no rehabilitation period.
The procedure involves introducing a special substance into the lumen of the vein, a foamy sclerosing agent. This substance leads to the collapse of the vessel walls with their subsequent gluing. As a result, the vein ceases to participate in the process of blood circulation, gradually dissolves and is replaced by connective tissue.
The method of sclerotherapy is mainly used to eliminate the small superficial vessels, as well as to eliminate the so-called "spider veins".
Laser coagulation
The most modern and, according to many experts, effective way to treat 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 walls of the veins collapse and merge. Subsequently, the vessel disappears by itself, it is 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 delicate operation leaves traces 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 couple of bruises after laser coagulation.
Consider the most basic consequences that occur periodically after a particular type of surgical treatment:
- When eliminating varicose veins using minimally invasive methods, excluding the removal of the vessel, there is a risk of relapse. This risk is minimal only during laser coagulation, only 5%.
- Burns: These occur after operations during which thermal effects have been applied.
- Bleeding: can begin after any type of surgery, but more likely after phlebectomy.
- There are also known cases of nerve damage, but this factor only refers 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 takes only a couple of days, then after combined phlebectomy it can take several weeks. In order for the recovery to go smoothly and quickly, it is important to stick to simple tips:
- Follow your doctor's advice carefully.
- Wear compression garments or elastic bandages.
- If incisions have occurred, it is important to wait for them to heal.
- After the incisions have healed, it is important to restore physical activity, physical therapy and regular walks will help with this.
- If your doctor has prescribed any medications, take them according to these instructions.
- It is also useful after surgery and for the prevention of varicose veins to visit a massage therapist.
- Avoid serious physical exertion for at least 2-3 months.
If the surgery went well and the patient followed the doctor's instructions for recovery, the chances of a successful outcome are very high. In most cases, varicose veins can be cured, but this 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.