Varicose veins or varicose veins, these phlebology formulations signify a pathology accompanied by a modification, that is, deformation of the veins. The vessels that carry blood to the heart expand, lengthen, their walls become thinner and the function of the venous valves is interrupted.
If the first stage of varicose veins is treated very effectively with conservative methods, the progression of the disease to stages 2 and 3 can only be cured by surgery, drugs 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
Given that in 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 of the operation. The decision is based on data obtained during the detailed diagnosis of blood vessels, and is made by the patient in conjunction with the doctor.
The phlebologist is obliged to inform about the risks of the proposed operation, the duration and the nuances of rehabilitation after surgery, which are subsequently performed only with the patient's consent.
As for the indications themselves, surgery for varicose veins is necessary in such cases:
- Pathological dilation and subsequent deformation of the purely saphenous veins of second degree of severity and higher.
- 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 too much to the lower extremities.
- There is a serious circulatory disorder, accompanied by aggravated stagnant blood processes.
- Severe forms of edema, high-intensity painful syndrome, accompanied by external (aesthetic) signs other than varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to impaired vascular integrity;
- Progression of the pathological process to the blockage of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, that is, when medication and other methods of treating 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 be operated on.
There are several contraindications that, if they do not completely exclude the possibility of surgical intervention, are required to postpone the operation for a certain period of time:
- Ischemic heart disease - in this case, a more complete and comprehensive examination is necessary.
- The same applies to grade 3 hypertension.
- Infectious and inflammatory processes active in the body - before performing an operation to treat varicose veins, you need to deal with the infection or eliminate the inflammation.
- 2nd and 3rd trimesters of pregnancy - for pregnant women, it is better to postpone any surgical procedure until delivery. The only exceptions are those cases where 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 acne and so on.
- There are also certain age restrictions, of course, for the elderly. In some cases, old age, as well as concomitant senile diseases, increases the risk of postoperative complications or endangers a person's life on the operating table.
Surgical intervention methods for varicose veins
If, however, the doctor, based on the diagnosis and after examining the patient, is sure of the need for a surgical intervention, it remains to choose the most appropriate and effective method, depending on the degree of progression of the varicose veins and a seriesother factors. To understand what operations are and in which cases they are performed, we will consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A complete 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 progressed seriously.
During the operation, the surgeon makes an incision up to 2 cm long for the ankle or up to 5 cm for a wider area, such as the groin. Often, these incisions are superficial, because mainly the superficial veins are removed.
The principle of the operation is to connect the anastomosis of the vessel with the subsequent removal of the part of the vein affected by the varicose veins. In addition, during surgery, the surgeon can correct the venous valves to restore normal blood flow.
At the end of the operation, cosmetic sutures are applied to the incisions, a dressing is applied 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 be considered purely cosmetic. The fact is that the doctor makes a small puncture in the skin, where he pulls a part of the vein that needs to be cut. This operation is performed mainly in small vessels, and its advantages are the absence of pain (due to local anesthesia) and a minimum recovery period.
Sclerotherapy
A relatively young technique, a minimally invasive method, which stands out for its effectiveness, as well as the absence of painful sensations due to the same local anesthesia and a practically absent rehabilitation period.
The procedure involves introducing a special substance into the lumen of the vein - a foaming sclerosing agent. This substance leads to the collapse of the vessel walls with subsequent bonding. As a result, the vein stops participating in the blood circulation process, gradually dissolves and is replaced by connective tissue.
The sclerotherapy method 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 millimeters. When the latter is activated, it begins to emit laser waves, the temperature rises inside the vessel and, as the laser is removed, the walls of the veins 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 period of rehabilitation.
Possible consequences
Even the smoothest operation leaves traces and can have consequences. Firstly, this is due to the fact that the anatomical component of the body is removed - a full-fledged vessel. Obviously, with combined phlebectomy, these consequences can be much more serious than some bruising after laser coagulation.
Let's consider the most basic consequences that arise periodically after a specific type of surgical treatment:
- When eliminating varicose veins with minimally invasive methods, excluding the removal of the vessel, there is a risk of recurrence. This risk is minimal only during laser coagulation, only 5%.
- Burns - occur after operations during which thermal effects have been applied.
- Bleeding - may start after any type of intervention, but more likely after phlebectomy.
- There are also known cases of nerve damage, but this factor refers only to the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, that is, recovery after surgery, is necessary in each of the cases described, but if after coagulation this process takes only a few days, after combined phlebectomy it may take several weeks. For recovery to occur smoothly and quickly, it is important to follow simple recommendations:
- Carefully follow your doctor's advice.
- Wear compression clothing or elastic bandages.
- If there are incisions, it is important to wait for them to heal.
- After the incisions heal, it is important to restore physical activity, exercise therapy and regular walking help with this.
- If your doctor has prescribed a medication, take it according to these instructions.
- It is also useful to visit a massage therapist after surgery and for the prevention of varicose veins.
- Avoid severe physical exertion for at least 2-3 months.
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 healed, but that does not mean that the disease cannot affect other vessels. For this reason, the prevention of varicose veins must always be performed if there are cases of development of this pathology.