Choosing the optimal way to deal with varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of development of the pathology, predominantly conservative treatment methods are used, which allow the preservation of varicose veins. However, if this technique proves 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, as the remote areas of the damaged vessels simply cannot change the varicose veins again.
In this article, we will consider the types of operations to remove varicose veins that modern vascular surgery can offer: their characteristics, pros and cons, preparation and implementation resources, as well as rehabilitation and possible complications.
What can be achieved with leg vein surgery?
Surgical intervention for varicose veins aims to solve the following problems:
- Elimination of reflux - a pathological reflux caused by venous valve failure.
- Removal of varicose veins. Recommended if the vein has undergone a severe transformation and there is no hope of restoring normal blood flow to the vein. In this case, the section of the vessel that affected the varicose veins is removed and blood is redistributed to healthy veins.
- Fight against cosmetic defects. As CVI (chronic venous insufficiency) and the varicose veins it causes do not best alter the appearance of the lower extremities, the operation should aim, inter alia, to eliminate aesthetic defects.
Types of venous surgery
The types of surgical interventions that modern angiosurgery can offer to fight 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.
Choosing the most appropriate leg vein surgery depends on the stage of development of the pathology, the patient's age and general health status, as well as the goals 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 surgical practice for treating varicose veins.
This method aims to remove the dilated varicose veins.
The operation has several varieties, each named after its inventor: phlebectomy according to Bebkokk, according to Narat, according to Mueller, which are performed under local anesthesia (with extensive vascular lesions - general).
Despite the differences, all these leg vein removal operations have something in common: they involve making cuts or perforations in the skin from 1 mm to 5 to 6 cm in length, whereby the angiosurgeon pulls the affected vein to the surface by middle of specialty hooks. The veins are excised, tied and removed, after which sutures or a special cast are applied to the skin. This operation to remove varicose veins in the legs is highly effective and allows to obtain 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, compared to the classic surgical intervention, began to appear. With their help, it is possible to shorten the procedure time, minimize postoperative scarring and also reduce the likelihood of complications and side effects. One such method is laser surgery on the veins of the lower extremities (intravenous, endovasal, or endovascular laser coagulation).
A special laser light guide is inserted into the cavity of the affected vessel, heating the walls of the blood and veins. Under the influence of high temperatures of up to 120 degrees, the vessel walls come together, which causes blood to stop flowing to this part of the circulatory system.
Opinion of an 'expert
Depending on the area of the lesion and the number of veins to be removed, treating varicose veins in this way usually requires several procedures lasting 30-60 minutes.
The operation to remove veins with laser is not very traumatic, it gives a good cosmetic effect (afterwards there are no visible scars and scars on the skin), it does not require prolonged hospitalization. However, it should be borne in mind that this technique is not suitable for the treatment of late stages of varicose veins, when the diameter of the veins is significantly increased and there are varicose veins; to eliminate them, traditional surgical intervention will be necessary.
sclerotherapy
This is another modern vein removal operation that allows you to get noticeable results with minimal trauma. A sclerosant is injected into the lumen of the dilated vessel - a special fluid or foam substance that sticks to the walls of the affected area of the vein. Taking a course of sclerotherapy allows you to get a quick cosmetic effect without leaving scars, which makes it very popular. However, this procedure is only suitable for early stage varicose veins as well as telangiectasias.
Radiofrequency Vein Surgery
RFA (Radio Frequency Obliteration) is the effect on affected areas of blood vessels with radio signals of a certain frequency, leading to heating of the walls of the veins, destruction of the endothelium and subsequent sealing of the vascular lumen. The procedure is minimally invasive and does not require hospitalization.
Preparing for Venous Surgery
Before surgery, it is necessary to perform preparatory measures: ultrasound of the veins of the lower limbs, a clinical blood test and a coagulogram. The day before the procedure, you need to shave your leg without using creams, gels and other cosmetics.
Opinion of an 'expert
If general anesthesia is planned, you should abstain from food 8 hours before the procedure (although in some cases your doctor may allow a light snack). Also, a cleansing enema may be needed before 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, in the presence of infectious and inflammatory processes in the legs.
Recovery after venous surgery
The length of the recovery period depends on the number of veins removed, the patient's general health and 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 clotting and sclerotherapy you can get up and move immediately, after sclerotherapy you should walk for about an hour, whereas combined phlebectomy requires a certain period of mobility restriction.
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 must use meshes with an adequate compression level. Pants or socks after venous surgery are a prerequisite for the restoration of normal blood flow in the lower extremities.
- Correct load on legs. It's important to choose the "golden medium" here: don't allow complete immobility so much as standing, sitting, and running for a long time.
- 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 or sauna, avoid contact with the skin in the area of veins remote from direct sunlight for some time.
- Wear loose pants or skirts, give up tight and uncomfortable shoes (especially heels).
- Take medications prescribed by your doctor. Most of the time, the ingestion of venotonics, anticoagulants and antioxidants is prescribed.
Consequences and complications after venous 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:
- Recurrence of varicose veins. If the root cause of varicose veins is not eliminated, chances are high that the disease will return again. Therefore, in addition to surgery on the leg veins, it is necessary to carry out a comprehensive treatment of the pathology and eliminate the triggering factors.
- The rise in temperature. A slight increase in local temperature in the area of removed veins is normal postoperatively. In addition, for 1-2 days after the procedure is complete, total body temperature may remain at subfebrile levels.
- Bruises. Bruising after venous surgery is a common complication after vein removal. It is caused by the perforation of the vessel. Most of the time, small bruises disappear without further treatment within a few weeks. However, if you have a large, painful bruise that doesn't go away for about 2 weeks, tell your phlebologist.
- Pigmentation disorders. Skin discoloration at the surgical site usually persists for several weeks and then disappears. It should be borne in mind that hyperpigmentation is a very common complication after sclerotherapy.
To avoid these unpleasant phenomena, do not neglect medical advice, make sure you wear compression stockings, and take medication recommended by a phlebologist.