Varicose veins or varicose veins, these formulations in phlebology mean pathology associated with modification, i.e. deformation of veins.The vessels that transport blood to the heart expand, lengthen, their walls become thinner and the functioning of the venous valves is disrupted.
If the first stage of varicose veins is treated very effectively with conservative methods, then the progression of the disease in stages 2 and 3 can only be cured surgically;medications 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, etc.
Indications for surgery
Due to the fact that in the first stage of development of varicose veins, surgical intervention is performed extremely rarely due to lack of need, indications for surgery are a very important factor.The decision is based on the data obtained during a detailed vascular diagnosis and is taken 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 then carried out only with the consent of the patient.
As for the indications themselves, surgery for varicose veins is needed in the following cases:
- Pathological expansion and subsequent deformation of purely saphenous veins of the second degree of severity and higher.
- Wide forms of varicose veins, the disease affects not only the subcutaneous veins, but mainly the deep veins, or the deformation of the vessels spreads over a very large area of the lower extremities.
- There is a severe blood circulation disorder, accompanied by worsening blood stagnation.
- Severe forms of swelling, pain of high intensity, accompanied by distinct external (aesthetic) signs of varicose veins.
- The formation of trophic ulcers on the skin or subcutaneous hematomas due to the breakdown of the integrity of blood vessels;
- The progression of the pathological process until the blockage of venous vessels and the development of an acute form of thrombophlebitis.
- The lack of positive dynamics during conservative treatment, that is, when medications and other methods of combating varicose veins are powerless.
Limitations 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 someone to postpone the operation for a certain period of time:
- Coronary heart disease - in this case, it is necessary to carry out a more complete comprehensive examination.
- The same goes for grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing the operation for the treatment of varicose veins, you must deal with the infection or eliminate the inflammation.
- Second and third trimester of pregnancy - for pregnant women, it is better to postpone any surgical procedure until the woman gives birth.The only exceptions are those cases where there is a serious risk to the life of the mother or the child and surgery can help.
- Skin diseases in the field of surgery to combat varicose veins.We are talking about eczema, various forms of dermatosis, etc.
- There are also certain age restrictions, of course for the elderly.In some cases, advanced age, as well as diseases associated with old age, increase the risk of developing postoperative complications or endanger the life of a person on the operating table.
Methods of surgical intervention for varicose veins
If, however, the doctor, based on the diagnosis and after examining the patient, believes in the need for surgical intervention, it remains only 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 which operations there 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, 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 progressed seriously.
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 in a larger area, for example, in the groin.Often these incisions are shallow, since mostly the superficial veins are removed.
The principle of the operation is to connect the anastomosis of the vessel and then remove the part of the vein affected by varicose veins.Also, during the operation, the surgeon can correct the venous valves in order to restore normal blood circulation.
After the surgery, cosmetic sutures are placed in the incision, a bandage is made, and an elastic bandage is placed in the operated area to prevent bleeding.
Miniphlebectomy
During this procedure, the affected area of the vein is also cut, but the degree of surgery is smaller and can be considered purely cosmetic.The idea is that the doctor makes a small incision in the skin, through which he pulls out the part of the vein that needs to be cut.This operation is mainly performed on small vessels, and its advantages include no pain (due to local anesthesia) and a minimal recovery period.
Sclerotherapy
A relatively new technique, a minimally invasive method, which is famous for its effectiveness, as well as the absence of pain due to the same local anesthesia and a practically non-existent rehabilitation period.
The procedure involves the introduction of a special substance into the lumen of the vein - a foam sclerosant.This substance causes the walls of the vessel to collapse with their subsequent adhesion.As a result, the vein ceases to participate in the process of blood circulation, gradually dissolves and is replaced by connective tissue.
The sclerotherapy technique is mainly used 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, effective way to fight 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 starts emitting laser waves, the temperature inside the vessel rises, and as the laser is removed, the walls of the vein collapse and stick together.The vessel then 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 skin damage, as well as the lack of need for a rehabilitation period.
Possible consequences
Even the mildest 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 complete vessel.Of course, with combined phlebectomy, such consequences can be much more serious than a few bruises after laser coagulation.
Let's consider the most basic consequences that arise periodically after one or another type of surgical treatment:
- When eliminating varicose veins using minimally invasive methods that exclude the removal of blood vessels, there is a risk of recurrence.This risk is minimal during laser coagulation, only 5%.
- Burns – occur after operations during which thermal effects were used.
- Bleeding – can start after any type of intervention, but is more likely after phlebectomy.
- Cases of nerve damage are also known, but this factor is only related to the level of professionalism of the surgeon.
Rehabilitation process
Rehabilitation, that is, recovery after surgery, is required in each of the described cases, but if after coagulation this process lasts only a few days, then after combined phlebectomy it can last for several weeks.To ensure that recovery goes smoothly and quickly, it is important to follow simple recommendations:
- Strictly follow all your doctor's advice.
- Wear compression garments or elastic bandages.
- If there were cuts, it is important to wait for them to heal.
- After the cuts have healed, it is important to restore physical activity;Exercise therapy and regular walks will help with this.
- If your doctor prescribes any medication, take it as directed.
- It is also useful to visit a massage therapist after surgery and to prevent varicose veins.
- For at least 2-3 months you should not be exposed to heavy physical activities.
If the operation went well and the patient fully complied with all the doctor's instructions regarding recovery, the likelihood 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, the prevention of varicose veins should always be done if there have been cases of the development of this pathology.