Varicose veins or varicose veins, these formulations in phlebology mean pathology accompanied by modification, that is, deformation of veins.The vessels transporting blood to the heart expand, lengthen, their walls become thinner and the functioning of the venous valves is disturbed.
If the first stage of varicose veins is treated very effectively with conservative methods, then the progression of the disease to stages 2 and 3 can only be cured surgically;drugs and other methods can only stop the progression of the pathology.This article will discuss the main surgical methods for the treatment of varicose veins, the features of their application, etc.
Indications for surgery
Due to the fact that at the first stage of the development of varicose veins, surgical intervention is performed extremely rarely due to lack of necessity, indications for surgery are a very important factor.The decision is based on data obtained during detailed vascular diagnostics and is made by the patient together with the doctor.
The phlebologist is obliged to talk about the risks of the proposed operation, the duration and nuances of rehabilitation after the operation, which are subsequently carried out only with the consent of the patient.
As for the indications themselves, surgery for varicose veins is necessary in the following cases:
- Pathological expansion and subsequent deformation of purely saphenous veins of the second degree of severity and higher.
- In extensive forms of varicose veins, the disease affects not only the subcutaneous, but mainly the deep veins, or the deformation of the vessels spreads over too large an area of the lower limbs.
- There is a serious violation of blood circulation, accompanied by worsening blood stagnation.
- Severe forms of swelling, pain of high intensity, accompanied by pronounced external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to violation of the integrity of blood vessels;
- Progression of the pathological process to blockage of venous vessels and development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, i.e.when drugs and other methods to fight varicose veins are powerless.
Restrictions and contraindications for surgery
Unfortunately, even if severe forms of varicose veins develop, accompanied by complications and a severe clinical picture, the patient cannot always undergo surgery.
There are a number of contraindications that, even if they do not completely exclude the possibility of surgical intervention, still force you to postpone the operation for a certain period of time:
- Coronary heart disease - in this case it is necessary to conduct a more complete comprehensive examination.
- The same applies to hypertension grade 3.
- Active infectious and inflammatory processes in the body - before performing an operation for the treatment of varicose veins, you must deal with the infection or remove the inflammation.
- 2nd and 3rd trimester of pregnancy - it is better for pregnant women to postpone any surgical procedures until the woman gives birth.The only exception is when there is a serious danger to the life of the mother or the child and surgery can help.
- Skin disease in the field of varicose vein surgery.We are talking about eczema, various forms of dermatosis, etc.
- There are also certain age restrictions, of course regarding the older ones.In some cases, advanced age, as well as accompanying diseases of senility, increase the risk of developing postoperative complications or endanger the life of a person on the operating table.
Methods of surgical intervention in varicose veins
However, if the doctor, based on the diagnosis and after examining the patient, is convinced of the need for surgical intervention, it remains only to choose the most appropriate and effective method depending on the degree of progression of the varicose veins and a number of other factors.In order to understand what operations are available and in what cases they are performed, we will consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A full 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 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 if the operation is performed in the ankle area or up to 5 centimeters when operating on a larger area, for example in the groin.Often, these incisions are shallow because mostly superficial veins are removed.
The principle of the operation is to ligate the anastomosis of the vessel and then remove the part of the vein affected by varicose veins.Also, during surgery, the surgeon can adjust the venous valves to restore normal blood flow.
After the surgery is completed, cosmetic stitches are placed over the incisions, a bandage is made, and an elastic bandage is placed over the operated area to prevent bleeding.
Miniphlebectomy
During this procedure, the affected area of the vein is also cut out, but the scale of the operation is smaller and can rather be considered purely cosmetic.The idea is that the doctor makes a small puncture in the skin, through which he pulls the part of the vein that needs to be cut.This operation is mainly performed on small vessels, and its advantages include painlessness (due to local anesthesia) and a minimal recovery period.
Sclerotherapy
A relatively new technique, a minimally invasive method that is known for its effectiveness, as well as the absence of pain due to the same local anesthesia and practically non-existent rehabilitation period.
The procedure involves the introduction of a special substance into the lumen of the vein - a foaming sclerosant.This substance causes the walls of the vessel to collapse with their subsequent sticking.As a result, the vein ceases to participate in the blood circulation process, gradually dissolves and is replaced by connective tissue.
The sclerotherapy technique is mainly used to remove small superficial vessels, as well as to remove the so-called "spider veins".
Laser coagulation
The most modern and, according to many experts, effective way to fight varicose veins.Its essence is that a laser light guide is inserted into the venous lumen through an opening of only 2 millimeters.When the latter is activated, it starts emitting laser waves, the temperature inside the vessel rises and when the laser is removed, the vein walls shrink and stick together.Subsequently, the vessel disappears on its own and is replaced by connective tissue.
Of course, the main advantage of this procedure is the almost complete absence of visible damage to the skin, as well as the absence of the need for a rehabilitation period.
Possible consequences
Even the most gentle operation leaves certain traces and can lead to 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 combined phlebectomy, such consequences can be much more serious than a few bruises after laser coagulation.
Let's look at the most basic consequences that periodically arise after one or another type of surgical treatment:
- When eliminating varicose veins using minimally invasive methods that exclude the removal of the vessel, there is a risk of recurrence.This risk is minimal during laser coagulation, only 5%.
- Burns - occur after operations where heat effects were used.
- Bleeding - can start after any type of intervention, but is more likely after a phlebectomy.
- Cases of nerve damage are also known, but this factor is only related to the level of professionalism of the surgeon.
Rehabilitation process
In each of the described cases, rehabilitation is necessary, i.e.recovery after surgery, but if after coagulation this process takes only a few days, then after a combined phlebectomy it can last several weeks.To ensure that the recovery proceeds smoothly and quickly, it is important to follow simple recommendations:
- Follow all your doctor's advice strictly.
- Wear compression clothing or elastic bandages.
- If there were cuts, it is important to wait for them to heal.
- After the incisions have healed, it is important to resume physical activity;exercise therapy and regular walks will help with this.
- If your doctor prescribes any medications, take them as directed.
- It is also useful to see a massage therapist after surgery and to prevent varicose veins.
- At least 2-3 months you should not expose yourself to serious physical exertion.
If the operation went well and the patient fully followed all the doctor's instructions regarding recovery, the probability 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, prevention of varicose veins should always be carried out if there are cases of development of this pathology.