Choosing the optimal way to treat varicose veins is an urgent problem that patients and phlebologists face. In the early stages of pathology development, predominantly conservative treatment methods are used that allow varicose veins to be preserved. However, if such a technique proves ineffective, the only appropriate option that can improve the situation is surgery to remove the veins in the leg. Surgery is the most radical way to treat varicose veins, as distant areas of damaged blood vessels simply cannot change the varicose vein again.
In this article, we examine the types of varicose vein removal operations that modern vascular surgery can offer: their characteristics, advantages and disadvantages, their preparation and execution characteristics, and rehabilitation and possible complications.
What can be achieved with leg venous surgery?
Surgery for varicose veins is aimed at solving the following problems:
- Elimination of reflux - abnormal reflux caused by venous valve failure.
- Varicose vein removal. It is recommended if the vein has undergone a major transformation and there is no hope of restoring normal blood flow. In this case, the part of the vessel that touched the varicose veins is removed and the blood from it is redistributed through healthy veins.
- Fight against cosmetic defects. Since CVI (chronic venous insufficiency) and the varicose veins it causes do not change the appearance of the lower extremities in the best way, the surgery should be aimed, among other things, at eliminating aesthetic defects.
Types of venous surgery
The types of surgical interventions that modern angiosurgery can offer to combat varicose veins can be divided into two groups:
- Operations for varicose veins affected by varicose veins and their subsequent ligation.
- Operations related to thermal or chemical exposure of the varicose veins.
The selection of the most appropriate leg venous surgery depends on the stage of development of the pathology, the age and general health of the patient, and the goals pursued during the procedure.
Phlebectomy of the veins of the lower extremities: the course of surgery
Combined phlebectomy (venectomy) is the "gold standard" in the surgical practice of treating varicose veins.
This method is aimed at removing dilated varicose veins.
There are several types of the operation, each named after its inventor: phlebectomy according to Bebkokk, Narat according to Mueller, which are performed under local (with extensive vascular changes - general) anesthesia.
Despite the differences, these leg vein removal operations have one thing in common: they make cuts or punctures in the skin ranging in length from 1 mm to 5–6 cm, through which the angiosurgeon draws the affected vein to the surface using special lines. hooks. The veins are excised, bandaged and removed, and sutures or special plasters are applied to the skin. This operation is extremely effective in removing varicose veins of the legs and allows you to achieve positive results in the treatment of venous pathology.
Venous laser surgery
With the development of medicine, more modern and less traumatic methods for performing venous removal surgery began to appear in the arsenal of vascular surgeons compared to classical surgery. They help reduce procedure time, minimize post-surgery scars, and reduce the likelihood of complications and side effects. One such method is laser surgery of the veins of the lower extremities (endovenous, endovascular or endovascular laser coagulation).
A special laser light guide is placed in the cavity of the affected vessel, heating the blood and the walls of the vein. High temperatures of up to 120 degrees cause the walls of the vessel to stick together, causing blood to stop in 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 manner usually requires several procedures lasting 30 to 60 minutes.
The operation of laser vein removal is low traumatic, has a good cosmetic effect (there are no visible scars and scars on the skin afterwards), and does not require long-term hospital treatment. However, it should be borne in mind that this technique is not suitable for treatment in the late stage of varicose veins, when the diameter of the veins increases significantly and there are varicose veins; traditional surgery will be required to eliminate these.
Sclerotherapy
This is another modern vein removal operation that allows you to achieve noticeable results with minimal trauma. A sclerosing agent is injected into the lumen of the dilated vessel - a special fluid or foam that sticks together the walls of the affected area of the vein. Completing a sclerotherapy course allows you to achieve a quick cosmetic effect without scarring, which makes it very popular. However, this procedure can only be used in the early stages of varicose veins as well as in telangiectasias.
Radiofrequency venous surgery
RFA (Radio Frequency Clearance) is the effect of a certain frequency of radio signals on the affected areas of blood vessels, leading to heating of the vein walls, destruction of the endothelium, and closure of the lumen of the blood vessels. The procedure is minimally invasive and does not require hospitalization.
Preparing for venous surgery
Preparatory measures should be performed before surgery: ultrasound of the veins of the lower extremities, clinical blood test and coagulogram. On the eve of the procedure, you should shave your feet without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, abstain from food for 8 hours before the procedure (although in some cases your doctor may allow light snacks). In addition, a cleansing enema may be required before general anesthesia.
Contraindications to leg venous 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 in the legs.
Recovery after venous surgery
The length of the recovery period depends on the number of veins removed, the patient's general health, and the phlebologist's recommendations.
Generally, the recovery period is from 2 months to six months.
Depending on the type of surgery, you may suggest limited activity to the patient during the recovery period. For example, you can get up and move immediately after laser coagulation and sclerotherapy, you have to walk for about an hour after sclerotherapy, while combined phlebectomy requires some time to limit your mobility.
Recommendations for rehabilitation after leg venous surgery
To reduce the risk of postoperative recurrence and complications, certain restrictions and recommendations should be followed:
- You must wear knitwear with the appropriate degree of compression. Tights or stockings after venous surgery are a prerequisite for normal restoration of blood flow to the lower extremities.
- Repair the load on the legs. It is important to choose the "golden mean" here: do not allow complete immobility and prolonged standing, sitting, running.
- Do not lift weights (maximum weight allowed during the recovery period is 5 kg or less).
- Do not take a hot bath, steam bath or sauna, avoid skin contact in the area of distant veins of direct sunlight.
- Wear loose pants or a skirt, give up tight, uncomfortable shoes (especially with heels).
- Take the medication prescribed by your doctor. The intake of venotonics, anticoagulants and antioxidants is most often prescribed.
Consequences and complications after venous surgery
Any surgical procedure can have undesirable consequences, and surgery on the veins in the lower extremities is no exception. Possible complications include:
- Relapses of varicose veins. If the cause of varicose veins is not eliminated, there is a high probability that the disease will return again. Therefore, in addition to surgery on the veins of the legs, there is a need for comprehensive treatment of the pathology and elimination of provocative factors.
- Temperature rise. A slight increase in local temperature in the area of the removed veins is normal in the postoperative period. In addition, total body temperature may remain subfebrile for 1-2 days after completion of the procedure.
- Hematomas. Bruising after vein surgery is a common complication after vein removal. This is caused by the perforation of the vessel. Tiny bruises usually disappear within a few weeks without further treatment. However, if you have a large, painful bruise that does not go away for about 2 weeks, report it to your phlebologist.
- Pigmentation disorders. Discoloration of the skin at the site of surgery usually lasts for several weeks and then disappears. It should be borne in mind that hyperpigmentation is a very common complication after sclerotherapy.
To avoid these unpleasant phenomena, do not ignore medical recommendations, be sure to wear compression stockings, and take medications recommended by a phlebologist.