The choice of the optimal way to deal with varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of the development of pathology, predominantly 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 legs. Surgical intervention is the most radical method of dealing with varicose veins, since remote areas of damaged vessels simply cannot change varicose veins again.
In this article, we will consider the types of operations to remove veins for varicose veins that modern vascular surgery can offer: their characteristics, pros and cons, preparation and implementation features, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Surgical intervention for varicose veins is aimed at solving the following problems:
- Elimination of reflux - a pathological reflux of blood caused by the failure of the venous valve.
- Removal of varicose veins. Recommended if the vein has undergone a serious transformation and there is no hope of restoring normal blood flow in it. In this case, the section of the vessel that affected 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 varicose veins caused by it does not change the appearance of the lower extremities in the best way, the operation should be aimed, inter alia, 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 aimed at mechanical resection of varicose veins affected by varicose veins with their subsequent ligation.
- Operations associated with 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 that are 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 is aimed at removing dilated varicose veins.
The operation has several varieties, each of which is named after its inventor: phlebectomy according to Bebkokk, according to Narat, according to Mueller, which are performed under local (with extensive vascular lesions - under general) anesthesia.
Despite the differences, all these operations to remove leg veins have one thing in common: they involve making cuts 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 hooks. The veins are excised, tied up 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 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 an operation to remove veins began to appear in comparison with classical surgical intervention. With their help, it is possible to reduce 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, endovasal, or endovascular laser coagulation).
A special laser light guide is introduced into the cavity of the affected vessel, heating the blood and vein walls. Under the influence of high temperatures up to 120 degrees, the walls of the vessel stick together, as a result of which the blood stops flowing into this part of the circulatory system.
Depending on the area of the lesion and the number of veins to be removed, treatment of varicose veins in this way usually requires several procedures lasting 30-60 minutes.
The operation to remove veins with a laser is low-traumatic, gives a good cosmetic effect (after it there are no visible scars and scars on the skin), does not require lengthy 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 is significantly increased and there are varices; in order to eliminate them, traditional surgical intervention will be required.
This is another modern vein removal operation that allows you to achieve noticeable results with minimal trauma. A sclerosant is injected into the lumen of the dilated vessel - a special liquid or foamy substance that sticks together the walls of the affected area of the vein. Carrying out a course of sclerotherapy allows you to achieve a quick cosmetic effect without scarring, which makes it very popular. However, this procedure is suitable only for the initial stage of varicose veins, as well as telangiectasias.
Radiofrequency vein surgery
RFA (radiofrequency obliteration) is the effect of radio signals of a certain frequency on the affected areas of the vessels, leading 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 vein 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 need to shave your leg without using creams, gels and other cosmetics.
If general anesthesia is planned, you should abstain from food 8 hours before the procedure (although in some cases the doctor may allow a light 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 pathologies, at the time of exacerbation of chronic diseases, in the presence of infectious and inflammatory processes on the legs.
Recovery after vein surgery
The duration of the recovery period depends on the number of removed veins, the general health of the patient, and his compliance with the phlebologist's recommendations.
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 must walk for about an hour, while combined phlebectomy requires a certain period of restriction of mobility.
Recommendations for rehabilitation after leg vein surgery
To reduce the risk of recurrence and complications after surgery, there are some restrictions and recommendations that should be followed:
- You should wear knitwear with a suitable compression level. Tights or stockings after vein surgery are a prerequisite for the normal restoration of blood flow in the lower extremities.
- Correct the load on the legs. It is important to choose the "golden mean" here: not to allow both 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 and a sauna, avoid contact with the skin in the area of the remote veins of direct sunlight for some time.
- Wear loose pants or skirts, give up tight, uncomfortable shoes (especially with heels).
- Take medications prescribed by your doctor. Most often, the intake of venotonics, anticoagulants, antioxidants is prescribed.
Consequences and complications after vein surgery
Any surgical intervention can have undesirable consequences, and surgery on the veins of the lower extremities is no exception. Potential complications include the following:
- Relapses of varicose veins. If the root cause of varicose veins is not eliminated, the chances are high that the disease will return again. 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 provoking factors.
- The rise in 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 end of the procedure, the total body temperature can remain at subfebrile levels.
- Hematomas. Bruising after vein surgery is a common complication after vein removal. It is caused by the perforation of the vessel. Small bruises most often resolve without additional treatment within a couple of weeks. However, if you have a large, painful bruise that does not go away for about 2 weeks, report it to your phlebologist.
- Pigmentation disorders. The discoloration of the skin at the site of surgery usually persists 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 hosiery and take medicines recommended by a phlebologist.