Varicose veins or varicose veins, these formulations in phlebology mean pathology accompanied by modification, that is, deformation of the veins.The vessels transporting blood to the heart dilate, lengthen, their walls become thinner, and the functioning of the venous valves is disrupted.
If the first stage of varicose veins is very effectively treated with conservative methods, then the progression of the disease to 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 treating varicose veins, the features of their implementation, and so on.
Indications for surgery
Due to the fact that at the first stage of development of varicose veins, surgical intervention is performed extremely rarely due to lack of need, the indications for surgery are a very important factor.The decision is based on 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 surgery, which are subsequently 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.
- 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 extremities.
- There is a serious circulatory disorder, accompanied by worsening stagnation of the blood.
- Severe forms of swelling, pain of high intensity, accompanied by distinct external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to disruption of the integrity of blood vessels;
- Progression of the pathological process up to blockage of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics during conservative treatment, that is, when medications and other methods of combating 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 one 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 grade 3 hypertension.
- Active infectious and inflammatory processes in the body - before performing surgery to treat varicose veins, you need to cope with the infection or eliminate inflammation.
- 2nd and 3rd trimesters of pregnancy - for pregnant women, it is better to postpone any surgical procedures until the woman gives birth.The only exceptions are those cases when there is a serious danger to the life of the mother or child, 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 certain age restrictions, of course concerning older people.In some cases, advanced age, as well as the 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 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 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, since mainly 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 correct the venous valves in order to restore normal blood flow.
Upon completion 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 excised, 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 pulls out the part of the vein that needs to be cut out.This operation is performed mainly 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, 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 foaming sclerosant.This substance causes the walls of the vessel to collapse with their subsequent gluing.As a result, the vein ceases to participate in the blood circulation process, gradually resolves and is replaced by connective tissue.
The sclerotherapy technique is used primarily 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 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 rises, and as the laser is removed, the walls of the vein collapse 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 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 vessel removal, there is a risk of relapse.This risk is minimal during laser coagulation, only 5%.
- Burns – occur after operations during which thermal effects were used.
- Bleeding - can begin after any type of intervention, but is more likely after phlebectomy.
- There are also known cases of nerve damage, but this factor relates solely 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 takes only a couple of days, then after combined phlebectomy it can last for several weeks.To ensure recovery goes smoothly and quickly, it is important to follow simple recommendations:
- Follow all your doctor's advice strictly.
- Wear compression garments 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; exercise therapy and regular walks will help with this.
- If your doctor prescribes any medications, take them 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 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 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, prevention of varicose veins should always be carried out if there have been cases of the development of this pathology.