Choosing the best way to manage varicose veins is an urgent problem for patients and phlebologists. In the early stages of the development of the pathology, conservative methods of treatment are used predominantly, which make it possible to obtain varicose veins. However, should such a technique prove ineffective, the only suitable way to change the situation for the better is to have surgery to remove the veins in the legs. 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 consider the types of operations for removing varicose veins that modern vascular surgery can offer: their features, advantages and disadvantages, features of preparation and implementation, as well as rehabilitation and possible complications.
What can leg vein surgery do?
Surgical intervention for varicose veins is aimed at solving the following problems:
- Elimination of reflux - a pathological reflux caused by venous valve failure.
- Removal of varicose veins. Recommended when the vein has undergone a serious change and there is no hope of restoring normal blood flow. In this case, the section of the vessel that infected 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 caused by it do not change the appearance of the lower extremities optimally, the operation should aim, among other things, at eliminating aesthetic defects.
Types of vein surgery
The types of surgical interventions that modern angiosurgery can offer to combat varicose veins are divided into two groups:
- Operations for the mechanical resection of varicose veins affected by varicose veins with subsequent ligature.
- 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, and the goals pursued during the procedure.
Phlebectomy of the veins of the lower extremities: the course of the operation
The combined phlebectomy (venectomy) is the "gold standard" in surgical practice for the treatment of varicose veins.
This method aims to remove enlarged varicose veins.
The operation has several variants, each of which is named after its inventor: phlebectomy according to Bebkokk, according to Narat, according to Müller, which are performed under local (with extensive vascular lesions - under general anesthesia).
Despite all the differences, all of these operations to remove leg veins have one thing in common: cuts or punctures are made in the skin with a length of 1 mm to 5-6 cm, through which the angio surgeon uses special tools to target the affected vein. hooks to the surface. The veins are cut out, tied off and removed, after which sutures or a special plaster are applied to the skin. This operation to remove varicose veins in the legs is highly effective and allows you to get positive results in the treatment of venous pathologies.
Laser vein surgery
With the development of medicine in the arsenal of vascular surgeons, more modern and less traumatic methods of performing an operation to remove veins appeared, compared to classic surgical interventions. With their help, it is possible to shorten the time of the procedure, minimize postoperative scars, and also reduce the likelihood of complications and side effects. One of these methods is laser surgery on the veins of the lower extremities (endovenous, endovascular or endovascular laser coagulation).
A special laser light guide is inserted into the cavity of the affected vessel and heats the blood and vein walls. Under the influence of high temperatures of up to 120 degrees, the vessel walls stick together, which means that the blood no longer flows into this part of the circulation.
Expert opinion
Depending on the area of the lesion and the number of veins to be removed, such treatment of varicose veins usually requires several interventions lasting 30-60 minutes.
The operation to remove veins with a laser is not very traumatic, has a good cosmetic effect (after which there are no visible scars and scars on the skin), does not require long-term hospitalization. It should be noted, however, that this technique is not suitable for the treatment of late-stage varicose veins, when the diameter of the veins is significantly increased and varicose veins are present; traditional surgical intervention is required to get rid of them.
Sclerotherapy
This is another modern vein removal surgery that allows you to get noticeable results with minimal trauma. A sclerosant is injected into the lumen of the enlarged vessel - a special liquid or foam substance that glues the walls of the affected area of the vein together. By performing sclerotherapy, you can get a quick cosmetic effect without scarring, which makes it very popular. However, this procedure is only suitable for the initial stages of varicose veins, as well as telangiectasias.
Radiofrequency vein surgery
RFA (Radio Frequency Obliteration) is the influencing of the affected areas of blood vessels with radio signals of a certain frequency, which leads to heating of the vein walls, destruction of the endothelium and subsequent sealing of the vascular lumen. The procedure is minimally invasive and does not require hospitalization.
Preparing for a vein operation
Before the operation, 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 need to shave your leg without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, avoid food for 8 hours before the procedure (although the doctor may allow a light snack in some cases). A cleansing enema may also be required prior to general anesthesia.
Contraindications for leg vein surgery
These surgical interventions are not recommended during pregnancy, with severe endocrine and cardiovascular pathologies, at the time of exacerbation of chronic diseases, with infectious and inflammatory processes on the legs.
Recovery after vein surgery
The duration of the recovery period depends on the number of veins removed, the general state of health of the patient and his compliance with the recommendations of the phlebologist.
The recovery phase usually lasts 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 about immediately, after sclerotherapy you have to walk for about an hour, while the combined phlebectomy requires a certain amount of movement restriction.
Recommendations for rehabilitation after leg vein surgery
To reduce the risk of recurrence and complications after surgery, there are some limitations and recommendations that should be followed:
- You should wear knitwear with a suitable compression level. Tights or stockings after a vein operation are a prerequisite for the normal restoration of blood flow to the lower extremities.
- Correct the load on the legs. Here it is important to choose the "golden mean": not to allow both complete immobility and long periods of standing, sitting and walking.
- Do not lift any weights (during the recovery phase, the maximum weight allowed is up to 5 kg).
- Do not take a hot bath, steam bath or sauna, avoid contact with the skin in the area of the distant veins in direct sunlight for some time.
- Wear wide trousers or skirts and avoid tight, uncomfortable shoes (especially with heels).
- Take medication prescribed by your doctor. Most often, the use of venotonics, anticoagulants, and antioxidants is prescribed.
Consequences and complications after vein surgery
Any surgical procedure can have undesirable consequences, and operations on the veins of the lower extremities are no exception. Possible complications include the following:
- Varicose veins relapses. If the cause of varicose veins is not eliminated, there is a good chance that the disease will return. Therefore, in addition to the operation on the leg veins, it is necessary to conduct a comprehensive treatment of the pathology and eliminate the provoking factors.
- The temperature rise. A slight increase in local temperature in the area of the distant veins is normal in the postoperative period. The total body temperature can remain at subfebrile levels for 1-2 days after the end of the procedure.
- Hematomas. Bruising after vein surgery is a common complication after vein removal. It is caused by the perforation of the vessel. Small bruises usually go away within a few weeks without additional treatment. However, if you have a large, painful bruise that doesn't go away after about 2 weeks, report it to your phlebologist.
- Pigment disorders. The discoloration of the skin at the surgical site usually lasts for several weeks and then disappears. It should be noted 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 drugs recommended by a phlebologist.