Varicose veins or varicose veins, these formulations in phlebology mean pathology accompanied by modification, that is, deformation of the veins.The vessels that transport blood to the heart dilate, stretch, their walls thin and the functioning of the venous valves is disrupted.
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 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 implementation and so on.
Indications for surgery
Since in the first stage of development of varicose veins surgery is performed very rarely due to lack of necessity, the indications for surgery are a very important factor.The decision is based on the data obtained during a detailed vascular diagnosis 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.
- Extended forms of varicose veins, the disease affects not only the subcutaneous, but especially the deep veins, or the deformation of the vessels extends over too large an area of the lower extremities.
- There is a serious circulatory disorder, accompanied by worsening blood stagnation.
- Severe forms of swelling, high intensity pain, accompanied by distinct 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 up to blockage of the venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, that is, when drugs and other methods of combating varicose veins are powerless.
Restrictions and contraindications to surgery
Unfortunately, even if serious forms of varicose veins develop, accompanied by complications and a serious clinical picture, the patient cannot always undergo surgery.
There are a series of contraindications which, even if they do not completely exclude the possibility of surgery, still force the surgery to be postponed for a certain period of time:
- Coronary heart disease: in this case it is necessary to conduct a more comprehensive comprehensive examination.
- The same goes for grade 3 hypertension.
- Active infectious and inflammatory processes in the body: Before performing surgery to treat varicose veins, it is necessary to deal with the infection or eliminate the inflammation.
- 2nd and 3rd trimester of pregnancy - for pregnant women it is better to postpone any surgical interventions until giving birth.The only exceptions are cases where there is a serious danger to the life of the mother or baby and surgery can help.
- Skin disease in the area of surgery to combat varicose veins.We are talking about eczema, various forms of dermatosis and so on.
- There are also some age restrictions, obviously regarding older people.In some cases, advanced age, as well as accompanying senile diseases, increase the risk of developing postoperative complications or endanger a person's life on the operating table.
Methods of surgical intervention for varicose veins
If, however, the doctor, based on the diagnosis and after examining the patient, is confident in the need for surgical intervention, all that remains is to choose the most suitable and effective method, depending on the degree of progression of varicose veins and a number of other factors.To understand what operations there are and in what cases they are performed, we will consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A full-fledged operation, which 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 severely 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 if operating on a larger area, such as the groin.Often these incisions are superficial, as mainly superficial veins are removed.
The principle of the operation is to tie the anastomosis of the vessel and then remove the part of the vein affected by varicose veins.Additionally, during surgery, the surgeon can correct venous valves to restore normal blood flow.
At the end of the operation, cosmetic stitches are placed on the incisions, a bandage is made and an elastic bandage is applied to the operated area to prevent bleeding.
Miniphlebectomy
During this procedure, the affected area of the vein is also removed, however, 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 extracts the part of the vein that needs to be cut.This operation is performed mainly on small vessels, and its advantages include the absence of pain (thanks to local anesthesia) and a minimal recovery period.
Sclerotherapy
A relatively new technique, a minimally invasive method, famous for its effectiveness, as well as for the absence of pain due to the local anesthesia itself and a 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 process of blood circulation, gradually resolves and is replaced by connective tissue.
The sclerotherapy technique is mainly used to eliminate small superficial vessels, as well as to eliminate the so-called "spider veins".
Laser coagulation
The most modern and, according to many experts, effective way to combat varicose veins.Its essence lies in the fact that a laser light guide is inserted into the venous lumen through a hole of only 2 millimeters.When the latter is activated, it begins to emit laser waves, the temperature inside the vessel increases, and when the laser is removed, the walls of the vein collapse and join 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 delicate operation leaves some traces and can lead to consequences.First of all, this is due to the fact that the anatomical component of the body, a full-fledged vessel, is removed.Of course, with combined phlebectomy, such consequences can be much more serious than a couple of bruises after laser coagulation.
Let's consider 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 removal of the vessels, there is a risk of recurrence.This risk is minimal during laser coagulation, only 5%.
- Burns: occur after operations during which thermal effects have been used.
- Bleeding: This can begin after any type of surgery, but is more likely after phlebectomy.
- Cases of nerve damage are also known, but this factor exclusively affects the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, that is, recovery after surgery, is necessary in each of the described cases, but if after coagulation this process takes only a couple of days, then after combined phlebectomy it can last several weeks.To ensure that the recovery occurs smoothly and quickly, it is important to follow simple recommendations:
- Strictly follow all advice from your doctor.
- Wear compression clothing or elastic bandages.
- If there have been incisions, it is important to wait for them to heal.
- After the incisions have healed, it is important to restore physical activity;physical therapy and regular walks will help with this.
- If your doctor prescribes medications, take them as directed.
- It is also helpful to see a massage therapist after surgery and to prevent varicose veins.
- For at least 2-3 months you should not expose yourself to serious physical activity.
If the operation went well and the patient fully complied with 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 have been cases of development of this pathology.