Choosing the optimal way to deal with varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of the development of pathology, mainly conservative methods of treatment are used, which allow 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 leg veins. Surgery 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 operations to remove veins for varicose veins that modern vascular surgery can offer: their features, pros and cons, features of preparation and implementation, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Varicose vein surgery is aimed at solving the following problems:
- Elimination of reflux - a pathological reflux caused by the insufficiency 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 section of the vessel that affected the varicose veins is removed and the blood from it is redistributed through the healthy veins.
- Fight against aesthetic defects. Since CVI (chronic venous insufficiency) and the varicose veins it causes do not modify the appearance of the lower limbs in the best possible way, the intervention must be aimed, among other things, at eliminating aesthetic defects.
Types of venous surgery
The types of surgeries that modern angiosurgery can offer to combat varicose veins fall into two groups:
- Interventions 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 appropriate venous leg surgery depends on the stage of development of the disease, the age and general health of the patient, as well as the objectives 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 of which is named after its inventor: phlebectomy according to Bebkokk, according to Narat, according to Mueller, which are performed under local anesthesia (with extensive vascular lesions - in general).
Despite the differences, all these operations to remove leg veins have one thing in common: they involve making cuts or punctures in the skin from 1 mm to 5-6 cm in length, through which the angiosurgeon pulls the affected vein using special hooks. The veins are excised, tied and removed, after which sutures or a special patch are applied to the skin. This operation to remove varicose veins in the legs is highly effective and allows to obtain 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 an operation to remove veins began to appear than with classical surgical intervention. With their help, it is possible to reduce the time of the procedure, minimize postoperative scarring, and also reduce the likelihood of complications and side effects. One of these methods is laser surgery on the veins of the lower limbs (intravenous, intravascular or endovascular laser coagulation).
A special laser light guide is inserted into the cavity of the affected vessel, heating the blood and vein walls. Under the influence of high temperatures up to 120 degrees, the walls of the vessel merge, as a result of which the blood stops flowing to this part of the circulatory system.
Expert opinion
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 30-60 minutes.
The operation to remove veins with a laser is not very 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 treatment in the advanced stages of varicose veins, when the diameter of the veins is significantly increased and varices are present; traditional surgery will be required to eliminate them.
Sclerotherapy
This is another modern vein removal operation that allows for noticeable results with minimal trauma. A sclerosing agent is injected into the lumen of the dilated vessel - a special liquid or foamy substance that adheres to the walls of the affected area of the vein. Carrying out a course of sclerotherapy allows you to achieve a quick cosmetic effect without scars, which makes it very popular. However, this procedure is only suitable for the initial stage of varicose veins and telangiectasias.
Radiofrequency venous surgery
RFA (radio frequency obliteration) is the effect on the affected areas of blood vessels with radio signals of a certain frequency, which leads 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 venous surgery
Before surgery, it is necessary to carry out preparatory measures: ultrasound of the veins of the lower extremities, clinical blood test and coagulogram. On the eve of the procedure, you need to shave your leg without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, it is necessary to abstain from food 8 hours before the procedure (although in some cases the doctor may allow a light snack). Also, a cleansing enema may be needed before general anesthesia.
Contraindications to leg vein surgery
These surgeries are not recommended in pregnancy, with severe endocrine and cardiovascular pathologies, at the time of exacerbation of chronic diseases, in the presence of infectious and inflammatory processes in the legs.
Recovery after venous surgery
The duration of the recovery period depends on the number of veins removed, the general health of the patient and his 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 have 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, there are some restrictions and recommendations that should be followed:
- You should wear knitwear with an adequate level of compression. Pantyhose or stockings after venous surgery are a prerequisite for the normal restoration of blood flow in the lower extremities.
- Correct the load on the legs. It is important to choose here the "golden mean": not to allow both complete immobility and prolonged standing, sitting, running.
- Do not lift weights (during the recovery period, the maximum allowable 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 remote vein area of direct sunlight for some time.
- Wear baggy pants or skirts, give up on tight and uncomfortable shoes (especially with heels).
- Take medications prescribed by your doctor. Most often, the intake of venotonics, anticoagulants, antioxidants is prescribed.
Consequences and complications after venous surgery
Any surgery can have undesirable consequences, and surgery on the veins of the lower extremities is no exception. Potential complications include the following:
- Relapses of varicose veins. If the root cause of varicose veins is not eliminated, the disease is very likely to return. Therefore, in addition to surgical intervention on the veins of the legs, it is necessary to carry out a 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. Also, for 1-2 days after the procedure ends, the total body temperature can remain at subfebrile levels.
- Hematomas. Bruising after vein surgery is a common complication after vein removal. It is caused by the perforation of the ship. Small bruises resolve most of the time without further treatment within a couple of weeks. However, if you have a large, painful bruise that does not go away for about 2 weeks, report it to your phlebologist.
- Pigmentation disorders. Skin discoloration at the surgery site usually persists for several weeks and then resolves. 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 medications recommended by a phlebologist.