Varicose veins or varicose veins, these preparations in phlebology are pathologies associated with modification, i. e. deformation of veins. The blood vessels that carry blood to the heart dilate, lengthen, taper on their walls, and also interfere with the work of 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, and drugs and other methods can only stop the progression of the pathology. This article will focus on the main surgical methods of treating varicose veins, the characteristics of their implementation, and so on.
Indications for surgery
Given that surgical intervention is extremely rare in the first stage of varicose veins due to a lack of need, the indication for surgery is a very important factor. The decision is based on data obtained during detailed vascular diagnosis and is made by the patient together with the physician.
The phlebologist is required to describe the risk of the planned surgery, the duration and nuances of postoperative rehabilitation, which will be performed later only with the patient's consent.
As for the indications themselves, varicose vein surgery is required in the following cases:
- Pathological dilatation and subsequent deformation of purely saphenous veins of second degree and higher.
- Extensive forms of varicose veins, the disease affects not only the saphenous but also deep veins, or the deformity of the blood vessels extends too much to the lower extremities.
- There is a serious circulatory disorder accompanied by worsening stagnant blood processes.
- Severe forms of edema, a high-intensity pain syndrome accompanied by distinct external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to deterioration of vascular integrity;
- Progression of the pathological process until venous occlusion and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, i. e. , when medication and other methods to treat varicose veins are weak.
Limitations and Contraindications of the Action
Unfortunately, the development of severe varicose veins, complications and a severe clinical picture is not always possible in the patient.
There are a number of contraindications which, unless the possibility of surgery is completely ruled out, force the operation to be postponed for some time:
- Ischemic heart disease - in which case a more comprehensive study should be performed.
- The same applies to grade 3 hypertension.
- Active infectious and inflammatory processes in the body - you must fight the infection or stop the inflammation before performing an operation to treat the varicose veins.
- 2nd and 3rd trimesters of pregnancy - For pregnant women, it is better to postpone all surgical procedures until the woman is born. The only exceptions are cases where the life of the mother or child is in serious danger and surgery can help.
- Skin disease in the field of varicose vein surgery. About eczema, various forms of dermatosis, etc. We are talking.
- There are also certain age limits, of course for the elderly. In some cases, old age, as well as the associated diseases of old age, increase the risk of postoperative complications or endanger the life of the person on the operating table.
Methods of Surgery for Varicose Veins
If, nevertheless, the physician is convinced of the need for surgery based on the diagnosis and examination of the patient, the most appropriate and effective method should continue to be chosen, depending on the degree of varicose vein progression and a number of other factors. To understand what surgery is and in what cases it is performed, we consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A full-argument operation performed under general anesthesia that can take up to 2 hours, depending on the complexity of the task. Phlebectomy can be used to treat initial forms of varicose veins, but is more commonly used in advanced cases when the disease is severely advanced.
During surgery, the surgeon makes an incision of up to 2 centimeters in length to the ankle, or an incision of up to 5 centimeters in a wider area, such as the groin. Often, these incisions are shallow because they primarily remove the superficial veins.
The principle of the operation is to ligate the anastomosis of the vessel by subsequent removal of the vein affected by the vein. During surgery, the surgeon may repair the venous valves to restore normal blood flow.
At the end of the surgery, cosmetic sutures are made into the incisions, a bandage is made, and an elastic bandage is applied to the surgical area to prevent bleeding.
Miniflebectomy
During this procedure, the affected area of the vein is also excised, but the size of the operation is smaller and can be considered more of a purely cosmetic nature. 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 excised. This operation is mainly performed on small blood vessels, with the advantages of pain relief (due to local anesthesia) and a minimal recovery period.
Sclerotherapy
A relatively young technique, a minimally invasive method known for its effectiveness and lack of painful feelings due to the same local anesthesia and virtually no rehabilitation period.
During the procedure, a special substance is introduced into the lumen of a vein - a foaming sclerosant. This material leads to collapse of the vessel walls and subsequent gluing. As a result, the vein ceases to be involved in the circulatory process, gradually dissolves and is replaced by connective tissue.
The method of sclerotherapy is primarily used to eliminate small superficial blood vessels and to rid the so-called “spider veins”.
Laser coagulation
The most modern and many experts say it is an effective way to treat varicose veins. The point is that the laser light guide enters the venous lumen only through an opening of 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 vessel walls collapse and stick together. The vessel then disappears on its own, being replaced by connective tissue.
Of course, the main advantages of this procedure are the almost complete absence of visible lesions on the skin, as well as the need for a period of rehabilitation.
Possible Consequences
Even the most gentle operation leaves traces and can have consequences. First, it is due to the fact that the anatomical component of the body is removed - a complete vessel. Of course, in the case of combined phlebectomy, such consequences can be much more severe than a couple of bruises after laser coagulation.
Let's examine the most basic consequences that occur periodically after a particular type of surgical treatment:
- There is a risk of relapse when varicose veins are eliminated with minimally invasive methods, except for removal of the vessel. This risk is minimal only during laser coagulation, only 5%.
- Burns - occur after operations in which heat effects have been applied.
- Bleeding - may begin after any type of procedure, but is more likely after phlebectomy.
- There are also known cases of nerve damage, but this factor refers solely to the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, or post-operative recovery, is required in all cases described, but if this process takes only a few days after coagulation, it may take several weeks after the combined phlebectomy. In order for the recovery to go smoothly and quickly, it's important to follow these simple recommendations:
- Follow your doctor's advice carefully.
- Wear compression clothing or elastic bandages.
- If incisions have been made, it is important to wait for them to heal.
- It is important to restore physical activity after the incisions have healed, and exercise and regular walking will help.
- If your doctor has prescribed any medicine, take it by following these instructions.
- It is also helpful to visit a masseur after surgery and prevent varicose veins.
- Avoid strenuous exercise for at least 2-3 months.
If the surgery was successful and the patient fully followed the doctor's instructions for recovery, the likelihood of a favorable outcome is very high. In most cases, the varicose veins can be cured, but this does not mean that the disease does not affect other blood vessels. Therefore, prevention of varicose veins should always be performed if there have been cases of pathology.