Choosing the optimal way to deal with varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of pathology development, mainly conservative methods of treatment are used, which make it possible to preserve varicose veins. However, if such a technique turns out to be ineffective, the only suitable option that can change the situation for the better is surgery to remove the veins in the leg. Surgical intervention is the most radical method of treating varicose veins, as the remote areas of damaged vessels simply cannot change varicose veins again.
In this article, we will examine the types of vein removal operations for varicose veins that modern vascular surgery can offer: their characteristics, pros and cons, features of preparation and implementation, and rehabilitation and possible complications. .
What can be achieved with leg vein surgery?
Surgical intervention for varicose veins aims to solve the following problems:
- Elimination of reflux - a pathological reflux caused by venous valve failure.
- Removal of varicose veins. It is recommended if the vein has undergone a serious transformation and there is no hope of restoring normal blood flow to it. In this case, the part of the vessel that affected the varicose veins is removed, and blood from it is redistributed through healthy veins.
- Fight against cosmetic defects. Since CVI (chronic venous insufficiency) and varicose veins caused by it do not change the appearance of the lower extremities in the best way, 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 fight varicose veins are divided into two groups:
- Operations aimed at mechanical removal of varicose veins affected by varicose veins with their subsequent ligation.
- Operations related to thermal or chemical exposure to varicose veins.
The choice of the most appropriate leg vein surgery depends on the stage of development of the pathology, the age and general health of the patient, as well as the goals 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 aims to remove varicose veins.
The operation has several types, 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 of these operations to remove leg veins have one thing in common: they involve making incisions or punctures in the skin from 1 mm to 5-6 cm in length, through which the angiosurgeon pulls the affected vein to the surface. using special tools. hook. The veins are removed, tied and removed, after which sutures or a special plaster is applied to the skin. This operation to remove varicose veins in the leg is very effective and allows you to achieve 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 a vein removal surgery began to emerge compared to classical surgical intervention. With their help, it is possible to reduce the time of the procedure, minimize postoperative scars, and also reduce the possibility of complications and side effects. One of these methods is laser surgery in the veins of the lower extremities (laser coagulation endovenous, endovascular or endovascular).
A special laser light guide is inserted into the cavity of the affected vessel, heating the walls of blood and veins. Under the influence of high temperatures up to 120 degrees, the walls of the vessel stick together, as a result of which blood stops flowing 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 way usually requires several procedures lasting 30-60 minutes.
Laser vein removal surgery is low traumatic, gives a good cosmetic effect (behind it there are no scars and visible wounds 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 late stages of varicose veins, when the diameter of the veins has increased significantly and there are varicose veins; to eliminate them, traditional Me intervention will be required
Sclerotherapy
This is another modern vein removal operation that allows you to achieve visible results with minimal trauma. A sclerosant is injected into the lumen of the enlarged vessel - a special liquid or foamy substance that sticks together the walls of the affected area of the vein. Performing a course of sclerotherapy allows you to achieve a fast scar-free cosmetic effect, which makes it very popular. However, this procedure is only suitable for the initial stage of varicose veins as well as telangiectasias.
Radiofrequency venous surgery
RFA (radiofrequency ablation) is the effect on the affected areas of blood vessels with radio signals of a certain frequency, leading to heating of the venous walls, destruction of the endothelium, and subsequent closure of the vascular lumen. The procedure is minimally invasive and does not require hospitalization.
Preparing for venous surgery
Before surgery, it is necessary to carry out preparatory measures: ultrasound of the veins of the lower extremities, a clinical blood test and a coagulogram. On the eve of the procedure, you should shave your leg without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, you should abstain from food 8 hours before the procedure (although in some cases your doctor may allow a snack). Also, a cleansing enema may be required before general anesthesia.
Contraindications to leg vein surgery
These surgical interventions are not recommended during pregnancy, with serious endocrine and cardiovascular pathology, 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 should walk for about an hour, while combined phlebectomy requires a certain period of limited mobility.
Recommendations for rehabilitation after leg vein surgery
To reduce the risk of recurrence and postoperative complications, there are some limitations and recommendations that should be followed:
- You need to wear knitwear with an appropriate level of compression. Knitwear or socks after venous surgery are a prerequisite for restoring normal blood flow to the lower extremities.
- Correct the load on the feet. It is important to choose the "golden mean" here: not to allow complete immobility and prolonged standing, sitting, running.
- Do not lift weights (during the recovery period, the maximum weight allowed is up to 5 kg).
- Do not take a hot bath, do not take a steam bath or sauna, avoid skin contact in the area of distant veins of direct sunlight for some time.
- Wear skirts or skirts, get rid of tight and uncomfortable shoes (especially heels).
- Take medication prescribed by your doctor. Most often, it is recommended to take venotonics, anticoagulants, antioxidants.
Consequences and complications after venous surgery
Any surgical intervention can have undesirable consequences, and surgery on the veins of the lower extremities is no exception. Possible complications include the following:
- Varicose vein relapses. If the underlying cause of varicose veins is not eliminated, the chances are high that the disease will come back. Therefore, in addition to surgery on the veins of the legs, it is necessary to carry out a comprehensive treatment of the pathology and eliminate the provocative factors.
- Rising 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 is completed, the total body temperature may remain at subfebrile levels.
- Hematoma. Bruising after vein surgery is a common complication after vein removal. Caused by perforation of the vessel. Minor bloating is most often resolved without additional treatment within a few weeks. However, if you have a large, painful bruise that does not go away in about 2 weeks, report it to your phlebologist.
- Pigmentation disorders. Skin staining at the site of surgery usually continues 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 medication recommended by a phlebologist.