Varicose veins or varicose veins, these formulations in phlebology mean pathology followed by modification or deformation of veins. The vessels that transport blood to the heart expand, elongate, thin their walls, and also disrupt the functioning of the venous valves.
If the first stage of varicose veins is very effectively treated by conservative methods, then the progression of the disease to stages 2 and 3 can be cured only by surgery, drugs and other methods can only stop the progression of the pathology. This article will focus on the main surgical methods for the treatment of varicose veins, the features of their application, etc.Indications for surgery
Given the fact that in the first stage of development of varicose veins, surgical intervention is extremely rare due to lack of need, a very important factor is the indication for surgery. The decision is based on the data obtained during the detailed vascular diagnosis, and is made by the patient together with the doctor.
The phlebologist is obliged to tell about the risks of the proposed operation, duration and nuances of rehabilitation after the operation, which is subsequently performed only with the consent of the patient.
As for the indications themselves, varicose vein surgery is required in such cases:
- Pathological dilatation and subsequent deformation of pure saphenous veins of the second degree of severity and more.
- Extensive forms of varicose veins, the disease affects not only the saphenous but mainly the deep veins, or the deformation of the veins extends to an oversized area of the lower extremities.
- There is a serious circulatory disorder, accompanied by difficult stagnant blood processes.
- Severe forms of edema, high-intensity pain syndrome, accompanied by pronounced external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to damage to vascular integrity;
- Progression of the pathological process to the blockage of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, ie when medications and other methods of resolving varicose veins are impossible.
Limitations and contraindications for surgery
Unfortunately, even with the development of severe forms of varicose veins, accompanied by complications and a serious clinical picture, it is not always possible for the patient to undergo surgery.
There are a number of contraindications that, if they do not completely rule out the possibility of surgical intervention, necessarily delay the operation for a while:
- Ischemic heart disease - in this case it is necessary to perform a more comprehensive examination.
- The same applies to grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing a procedure to treat varicose veins, you must deal with the infection or remove the inflammation.
- 2nd and 3rd trimester of pregnancy - it is better for pregnant women to postpone all surgical procedures until the woman gives birth. The only exceptions are cases where there is a serious danger to the life of the mother or child, and surgery can help.
- Skin diseases in the area of surgery to combat varicose veins. We are talking about eczema, various forms of dermatosis, etc.
- There are also certain age restrictions, of course, for the elderly. In some cases, age, as well as accompanying senile diseases, increase the risk of postoperative complications or endanger the life of a person on the operating table.
Methods of surgical intervention in varicose veins
If, however, the physician is confident in the need for surgical intervention based on the diagnosis and after examination of the patient, it remains to choose the most appropriate and effective method, depending on the degree of progression of varicose veins and a number of other factors. To understand what surgeries 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 performed under general anesthesia and can take 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 seriously progressed.
During the operation, the surgeon makes an incision up to 2 centimeters long to the ankle or up to five centimeters in a wider area like the groin. These incisions are often shallow, because superficial veins are mostly removed.
The principle of the operation is ligation of the anastomosis of the vessel with subsequent removal of the part of the vein affected by varicose veins. Also, during the operation, the surgeon can correct the venous valves in order to restore normal blood flow.
After the procedure, cosmetic sutures, a bandage and an elastic bandage are placed on the operated area to prevent bleeding.
Miniphlebectomy
During this procedure, the affected area of the vein is also excised, however, the scope of the operation is smaller, and before it can be considered purely cosmetic. The conclusion is that the doctor makes a small puncture in the skin through which he pulls out the part of the vein that needs to be cut. This operation is performed mainly on small vessels, and its advantages are painlessness (due to local anesthesia) and a minimal recovery period.
Sclerotherapy
Relatively young technique, a minimally invasive method that is known for its efficiency, as well as the absence of painful sensations due to the same local anesthesia and practically no rehabilitation period.
The procedure involves the introduction of a special substance into the lumen of the vein - foam sclerosant. This substance causes the walls of the vessel to collapse 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 sclerotherapy method is used mainly for the removal of small superficial vessels, as well as for the removal of so-called "spider veins".
Laser coagulation
The most modern and, according to many experts, effective way to combat varicose veins. Its essence lies in the fact that the laser light guide is introduced into the lumen of the vein through an opening of only 2 mm. When the latter is activated, it begins to emit laser waves, the temperature rises inside the vessel, and as the laser is removed, the vein walls collapse and become beautiful. After that, the vessel disappears on its own, being replaced by connective tissue.
Of course, the main advantage of this procedure is the almost complete absence of visible skin lesions, 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 combined phlebectomy such consequences can be much more serious than a few bruises after laser coagulation.
Consider the most basic consequences that occasionally occur after one or another type of surgical treatment:
- There is a risk of recurrence when removing varicose veins by minimally invasive methods, excluding the removal of a vein. This risk is minimal only during laser coagulation, only 5%.
- Burns - occur after operations during which thermal effects are applied.
- Bleeding - can start after any type of intervention, but more likely after a phlebectomy.
- Cases of nerve damage are also known, but this factor refers exclusively to the level of professionalism of the surgeon.
Rehabilitation procedure
Rehabilitation, ie recovery after surgery, is required in each of the described cases, but if after coagulation this process lasts only a few days, after a combined phlebectomy it can take several weeks. In order for the recovery to run smoothly and quickly, it is important to follow simple recommendations:
- Follow your doctor's advice carefully.
- Wear compression garments or elastic bandages.
- If they have cut, it is important to wait for it to heal.
- After the incisions have healed, it is important to return to physical activity, exercise and regular walks will help.
- If your doctor has prescribed any medicine, take it according to these instructions.
- It is useful to visit a masseur both after the operation and for the prevention of varicose veins.
- Do not expose yourself to serious physical activity for at least 2-3 months.
If the surgery went well and the patient followed the doctor's recovery instructions, the likelihood of a favorable outcome is very high. In most cases, varicose veins can be cured, but that doesn’t mean the disease can’t affect other blood vessels. For that reason, the prevention of varicose veins must always be carried out if there have been cases of development of this pathology.