Varicose veins or varicose veins, these formulations in phlebology mean a pathology accompanied by a modification, that is, deformation of the veins. The vessels that transport blood to the heart dilate, lengthen, thin out their walls, and also disrupt the work of the venous valves.
If the first stage of varicose veins is very effectively treated with conservative methods, then the progression of the disease to stages 2 and 3 can be cured only by surgery, medicines and other methods can only stop the progression of the pathology. This article will discuss the main surgical methods for treating varicose veins, the peculiarities of their implementation, and so on.
Indications for surgical intervention
Due to the fact that at the first stage of development of varicose veins, surgical intervention is extremely rare due to the lack of need, a very important factor is the indication for surgery. The decision is based on the data obtained in the course of detailed vascular diagnostics and is made by the patient together with the doctor.
A phlebologist is obliged to tell about the risks of the proposed operation, the duration and nuances of rehabilitation after surgery, which are subsequently carried out only with the consent of the patient.
As for the indications themselves, surgery for varicose veins is needed in such cases:
- Pathological expansion and subsequent deformation of the purely saphenous veins of the second degree of severity and higher.
- Extensive forms of varicose veins, the disease affects not only the saphenous, but mainly deep veins, or the deformation of the vessels extends to a too large area of the lower extremities.
- There is a serious circulatory disorder, accompanied by aggravated stagnant blood processes.
- Severe forms of edema, pain syndrome of high intensity, accompanied by distinct external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to impaired vascular integrity;
- Progression of the pathological process up to the blockage 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 medication and other methods of dealing with varicose veins are powerless.
Limitations and contraindications for the operation
Unfortunately, even with 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 surgery.
There are a number of contraindications, which, if they do not completely exclude the possibility of surgical intervention, force to postpone the operation for a certain period of time:
- Ischemic heart disease - in this case, it is necessary to carry out a more complete comprehensive examination.
- The same applies to grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing an operation to treat varicose veins, you need to cope with the infection or eliminate inflammation.
- 2nd and 3rd trimesters of pregnancy - for pregnant women, it is better to postpone any surgical procedures until the woman gives birth. The only exceptions are cases when there is a serious danger to the life of the mother or child, and the operation can help.
- Skin disease in the area of the operation to combat varicose veins. We are talking about eczema, various forms of dermatosis, and so on.
- There are also certain age restrictions, of course, for the elderly. In some cases, old age, as well as the concomitant old age 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
If, nevertheless, the doctor, on the basis of the diagnosis and after examining the patient, is sure of the need for surgical intervention, 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 operations are and in what cases they are performed, we will consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A full-fledged operation that is performed under general anesthesia and can last 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 for the ankle, or up to 5 centimeters for a wider area such as the groin. Often, these incisions are shallow, since mainly superficial veins are removed.
The principle of the operation is to ligate the anastomosis of the vessel with the subsequent removal of the part of the vein affected by varicose veins. Also, during surgery, the surgeon can correct the venous valves in order to restore normal blood flow.
At the end of the operation, cosmetic sutures are applied to the incisions, a dressing is made and an elastic bandage is applied to the operated area to prevent bleeding.
Miniflebectomy
During this procedure, the affected area of the vein is also excised, however, the scale of the operation is smaller, it can rather be considered purely cosmetic. The bottom line is that the doctor makes a small puncture in the skin, through which he pulls out a part of the vein that needs to be cut out. This operation is performed mainly on small vessels, and its advantages are painlessness (due to local anesthesia) and a minimal recovery period.
Sclerotherapy
A relatively young technique, a minimally invasive method, which is famous for its effectiveness, 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 - a foaming sclerosant. This substance leads to the collapse of the walls of the vessel with their subsequent gluing. As a result, the vein ceases to participate in the blood circulation process, gradually dissolves and is replaced by connective tissue.
The method of sclerotherapy is used mainly to eliminate small superficial vessels, as well as to get rid of the 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 rises inside the vessel, and as the laser is removed, the vein walls collapse and stick together. Subsequently, the vessel disappears on its own, is replaced by connective tissue.
Of course, the main advantage of this procedure is the almost complete absence of visible lesions on the skin, as well as the absence of the need for a rehabilitation period.
Possible consequences
Even the most gentle 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 a combined phlebectomy, such consequences can be much more serious than a couple of bruises after laser coagulation.
Let's consider the most basic consequences that periodically arise after one or another type of surgical treatment:
- When eliminating varicose veins using minimally invasive methods, excluding the removal of the vessel, there is a risk of relapse. This risk is minimal just during laser coagulation, only 5%.
- Burns - occur after operations during which thermal effects were applied.
- Bleeding - can start after any type of intervention, but more likely after phlebectomy.
- There are also known cases of nerve damage, but this factor refers exclusively to the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, that is, recovery after surgery, is required in each of the described cases, but if after coagulation this process takes only a couple of days, after combined phlebectomy it can take several weeks. In order for the recovery to go smoothly and quickly, it is important to adhere to simple recommendations:
- Follow your doctor's advice carefully.
- Wear compression garments or elastic bandages.
- If incisions have occurred, it is important to wait for them to heal.
- After the incisions have healed, it is important to restore physical activity, exercise therapy and regular walks will help in this.
- If your doctor has prescribed any medication, take it according to these instructions.
- It is also useful after surgery and for the prevention of varicose veins to visit a masseur.
- For at least 2-3 months, do not subject yourself to serious physical activity.
If the surgery went well and the patient fully 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, the prevention of varicose veins must always be carried out if there have been cases of the development of this pathology.