Choosing the optimal way to fight varicose veins is an urgent problem faced by patients and phlebologists. In the early stages of the pathology, conservative treatment methods are used, which allow to protect mainly varicose veins. However, if such a technique turns out to be ineffective, the only appropriate option that can change the situation for the better is the removal of the veins in the legs. Surgery is the most radical method of treating varicose veins because the distant areas of the damaged veins cannot replace the varicose veins again.
In this article, we will look at the types of surgery to remove varicose veins that modern vascular surgery can offer: their features, pros and cons, preparation and application features, as well as rehabilitation and possible complications.
What can be achieved with vascular surgery?
Surgery for varicose veins aims to solve the following problems:
- Elimination of reflux - pathological reflux caused by venous valve insufficiency.
- Removal of varicose veins. It is recommended if the vessel has undergone a serious transformation and there is no hope of restoring normal blood flow inside. In this case, the part of the vein that affects the varicose veins is removed and the blood from it is redistributed through healthy veins.
- Fight against cosmetic imperfections. Since CVI (chronic venous insufficiency) and the varicose veins it causes do not change the appearance of the lower extremities in the best way, surgery should be aimed at eliminating aesthetic defects, among others.
Types of vascular operations
The types of surgical interventions that modern angiosurgery can offer to combat varicose veins are divided into two groups:
- Operations for mechanical resection of varicose veins affected by subsequent closure of varicose veins.
- Operations related to thermal or chemical exposure to varicose veins.
The choice of the most appropriate vascular surgery depends on the stage of development of the pathology, the patient's age and general health, as well as the goals set during the operation.
Phlebectomy of the vessels of the lower extremities: the course of the operation
Phlebectomy (venectomy) combined with surgical practice in the treatment of varicose veins is the "gold standard".
This method aims to remove varicose veins.
There are several varieties of each of the operations, named after the inventor: local (with extensive vascular damage - under general) phlebectomy according to Bebcock, performed under general anesthesia, according to Narat according to Mueller.
Despite the differences, all these operations to remove the veins of the legs have one thing in common: they involve making incisions or holes in the skin from 1 mm to 5-6 cm in length, and from this angiosurgeon draws the effective vessel to the surface by special means. hooks. The veins are cut, closed and removed, after which a suture or special plaster is applied to the skin. This operation to remove varicose veins in the legs is very effective and allows to achieve positive results in the treatment of venous pathology.
Vascular laser surgery
With the development of medicine in the arsenal of vascular surgeons, more modern and less traumatic methods of vascular removal began to emerge compared to classical surgery. With their help, it is possible to reduce the duration of the procedure, minimize postoperative scars, as well as reduce the likelihood of complications and side effects. One of these methods is laser surgery on the vessels of the lower extremities (endovenous, endovasal or endovascular laser coagulation).
A special laser light guide is placed in the cavity of the affected vessel, which heats the blood and vessel walls. Under the influence of high temperatures up to 120 degrees, the walls of the vessel stick to each other, as a result of which the flow to this part of the circulatory system stops.
Expert opinion
Depending on the area of the lesion and the number of veins to be removed, several treatments, usually 30 to 60 minutes, are required to treat varicose veins in this way.
Laser vein removal is less traumatic, has a good cosmetic effect (no more sores and scars on the skin), and does not require long-term hospitalization. However, it should be borne in mind that this technique is not suitable for treatment in the final stages of varicose veins, when the diameter of the veins increases significantly and there are heirs; traditional surgical intervention will be required to remove them. .
Sclerotherapy
Another modern vascular removal operation that allows you to achieve noticeable results with minimal trauma. A special sclerosant is injected into the lumen of the dilated vessel - a special liquid or foam substance that sticks to the walls of the affected area of the vessel. A course of sclerotherapy allows you to quickly achieve a 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 for telangiectasia.
Radiofrequency vascular surgery
RFA (radiofrequency obliteration) is an effect on the affected areas of the arteries with radio signals of a certain frequency, which causes the vessel walls to heat up, the endothelium to collapse, and the vascular lumen to close. The procedure is minimally invasive and does not require hospitalization.
Preparing for vascular surgery
Preparatory measures should be performed before the operation: ultrasound of the vessels of the lower extremities, clinical blood test and coagulogram. Before the procedure, you should shave your feet without using creams, gels and other cosmetics.
Expert opinion
If general anesthesia is planned, you should avoid eating 8 hours before the procedure (although in some cases your doctor may allow light snacks). In addition, a cleansing enema may be required before general anesthesia.
Contraindications to vascular surgery
These surgeries are not recommended during pregnancy, in severe endocrine and cardiovascular pathologies, in the exacerbation of chronic diseases, in the presence of infectious and inflammatory processes in the legs.
Recovery after vascular surgery
The duration of recovery depends on the number of vessels removed, the general health of the patient and compliance with the recommendations of a phlebologist.
Typically, the recovery period lasts from 2 to six months.
Depending on the type of surgery, the patient may be advised to perform limited activities during the recovery period. For example, you can stand and move immediately after laser coagulation and sclerotherapy, you need to walk for about an hour after sclerotherapy, and combined phlebectomy requires a certain amount of mobility.
Recommendations for rehabilitation after vascular surgery
There are some restrictions and recommendations that should be followed to reduce the risk of recurrence and complications after surgery:
- You should wear a knitted dress with an appropriate level of compression. After vascular surgery, tights or socks are a prerequisite for the restoration of normal blood flow in the lower extremities.
- Adjust the load on the legs. Here it is important to choose the "golden mean": not to allow complete inactivity, but also to stand, sit and run for a long time.
- Do not lift weights (maximum weight allowed up to 5 kg during recovery).
- Do not take a hot bath, steam bath or sauna, avoid contact with the skin in the distant veins of direct sunlight for a while.
- Wear loose pants or skirts, and avoid tight, uncomfortable shoes (especially heels).
- Take the medication prescribed by your doctor. Often prescribed venotonics, anticoagulants, antioxidants.
Outcomes and complications after vascular surgery
Any surgical intervention can lead to undesirable consequences, and surgery on the vessels of the lower extremities is not excluded. Potential complications include:
- Relapses of varicose veins. If the root cause of varicose veins is not eliminated, the disease is more likely to return. Therefore, in addition to surgery on the veins of the legs, it is necessary to conduct a comprehensive treatment of the pathology and eliminate the triggers.
- Temperature rise. In the postoperative period, a slight increase in local temperature in the area of the removed vessels is normal. Also, total body temperature may remain at subfebrile levels for 1-2 days after the procedure.
- Hematomas. Bruising after vascular surgery is a common complication after vascular removal. It is caused by perforation of the vein. Minor bruises usually go away within a few weeks without additional treatment. However, if you have a large, painful rash that lasts less than 2 weeks, tell your phlebologist.
- Pigmentation disorders. Skin discoloration at the site of surgery usually lasts for several weeks and then disappears. It should be noted that hyperpigmentation after sclerotherapy is a very common complication.
To avoid these side effects, do not ignore medical advice, make sure you wear compression stockings and take the medication recommended by a phlebologist.