Varicose veins or varicose veins, these formulations in phlebology mean a pathology that is accompanied by a modification, that is, a deformation of the veins. The vessels that carry blood to the heart expand, lengthen, thin their walls, and also disrupt the functioning of the venous valves.
If the first stage of varicose veins is treated very effectively with conservative methods, then only surgery can cure the progression of the disease into stages 2 and 3. Drugs and other methods can only stop the progression of the pathology. This article explains the main surgical methods of treating varicose veins, the specifics of their use, etc.
Indications for surgical interventions
Given that surgical interventions in the first stage of the development of varicose veins are extremely rare due to the lack of necessity, the indication for the operation is a very important factor. The decision is based on the data obtained as part of a detailed vascular diagnosis and is made by the patient together with the doctor.
A phlebologist is obliged to inform about the risks of the proposed operation, the duration and nuances of rehabilitation after the operation, which is then carried out only with the consent of the patient.
Regarding the indications themselves, surgery for varicose veins is required in the following cases:
- Pathological dilatation and subsequent deformation of purely saphenous veins from the second degree of severity.
- With extensive forms of varicose veins, the disease affects not only the saphenous vein, but mainly the deep veins, or the deformation of the vessels extends to too large an area of the lower extremities.
- There is a severe circulatory disorder, which is accompanied by aggravated stagnant blood processes.
- Severe forms of edema, high intensity pain syndrome, accompanied by clear external (aesthetic) signs of varicose veins.
- formation of trophic ulcers on the skin or subcutaneous hematomas due to impaired vascular integrity;
- the progression of the pathological process up to the occlusion of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics in the course of conservative treatment, that is, when drugs and other methods of dealing with varicose veins are powerless.
Limitations and contraindications for the operation
Unfortunately, despite the development of severe forms of varicose veins, accompanied by complications and a severe clinical picture, it is not always possible for a patient to undergo an operation.
There are a number of contraindications which, if they do not completely exclude the possibility of surgical intervention, force the operation to be postponed for a certain period of time:
- Ischemic heart disease - in this case, a more extensive examination is required.
- The same applies to 3rd degree high blood pressure.
- Active infectious and inflammatory processes in the body - before performing surgery for the treatment of varicose veins, you need to cope with the infection or get rid of inflammation.
- 2nd and 3rd trimesters of pregnancy - for pregnant women, it is better to postpone surgery until the woman's birth. The only exceptions are cases where there is a serious risk to the life of the mother or child and the operation can help.
- Skin diseases in the area of surgery to combat varicose veins. We're talking about eczema, different forms of dermatosis and so on.
- Of course there are also certain age restrictions for the elderly. In some cases, age and the associated age-related diseases increase the risk of postoperative complications or endanger the life of a person on the operating table.
Methods of surgical intervention for varicose veins
However, if, on the basis of the diagnosis and after examining the patient, the doctor is certain that surgical intervention is necessary, he must choose the most appropriate and effective method, depending on the degree of progression of the varicose veins and a number of other factors. To understand what operations are and in what cases they are performed, we will consider the most effective methods of surgical treatment for varicose veins.
Combined phlebectomy
A full-fledged operation that is performed under general anesthesia and, depending on the complexity of the task, can take up to 2 hours. Phlebectomy can be used to treat the first forms of varicose veins. However, this method is more commonly used in advanced cases when the disease has progressed seriously.
During the operation, the surgeon makes an incision up to 2 centimeters long for the ankle or up to 5 centimeters for a larger area such as the groin. Often times, these incisions are shallow because mostly superficial veins are removed.
The principle of the operation is to ligate the anastomosis of the vessel and then remove the part of the vein affected by varicose veins. During the surgery, the surgeon can also correct the venous valves to restore normal blood flow.
After the operation, cosmetic stitches are applied to the incisions, a bandage is applied and an elastic bandage is applied to the operated area to prevent bleeding.
Miniflebectomy
During this process, the affected area of the vein is also cut out. However, the scope of the operation is smaller and can be viewed more as purely cosmetic. The bottom line is that the doctor makes a small puncture in the skin through which they pull out part of the vein that needs to be cut out. This operation is mainly performed on small vessels. The benefits are painlessness (due to local anesthesia) and minimal recovery time.
Sclerotherapy
A relatively young technique, a minimally invasive method known for its effectiveness as well as the absence of painful sensations due to the same local anesthesia and practically no rehabilitation phase.
The procedure involves the introduction of a special substance into the lumen of the vein - a foaming sclerosant. This substance leads to the collapse of the vessel walls with their subsequent adhesion. As a result, the vein ceases to participate in the bloodstream, gradually dissolves and is replaced by connective tissue.
The sclerotherapy method is mainly used to remove small superficial vessels and to remove so-called "spider veins".
Laser coagulation
The most modern and, according to many experts, an effective way to deal with varicose veins. Its essence lies in the fact that a laser light guide is inserted into the venous lumen through an opening of only 2 mm. When the latter is activated, it begins to emit laser waves, the temperature in the vessel rises and when the laser is removed, the vein walls collapse and stick together. The vessel then disappears on its own and is replaced by connective tissue.
The main advantage of this procedure is, of course, the almost complete absence of visible skin lesions, as well as the absence of a rehabilitation phase.
Possible consequences
Even the gentlest operation leaves its mark 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.
Let's consider the most fundamental consequences that occur regularly after one type of surgical treatment or another:
- When eliminating varicose veins using minimally invasive methods, with the exception of removing the vessel, there is a risk of relapse. This risk is minimal only during laser coagulation, only 5%.
- Burns - occur after operations where thermal effects have been 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 relates solely to the level of professionalism of the surgeon.
Rehabilitation process
In each of the cases described, rehabilitation is required, ie recovery after the operation. However, if this process only takes a few days after coagulation, it can take several weeks after a combined phlebectomy. In order for the recovery to go smoothly and quickly, it is important to follow simple recommendations:
- Follow your doctor's instructions carefully.
- Wear compression clothing or elastic bandages.
- If cuts have occurred, it is important to wait for them to heal.
- After the cuts have healed, it is important to restore physical activity. Exercise therapy and regular walks will help.
- If your doctor has prescribed medication, take it according to these instructions.
- It is also useful to see a masseur after the operation and for the prevention of varicose veins.
- Avoid serious physical exertion for at least 2-3 months.
If the operation went well and the patient followed the doctor's instructions for recovery, the likelihood of a favorable outcome is very high. In most cases, varicose veins can be cured, but this does not mean that the disease cannot affect other vessels. For this reason, prevention of varicose veins must be carried out whenever there have been cases of the development of this pathology.