Varicose veins or varicose veins, these formulations in phlebology mean a pathology that is accompanied by a change, that is, a deformation of the veins.The vessels that carry blood to the heart expand, lengthen, their walls become thinner and the function 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;Medicines and other methods can only stop the progression of the pathology.This article will discuss the main surgical methods of treating varicose veins, the features of their implementation, etc.
Indications for surgery
Due to the fact that at the first stage of the development of varicose veins, surgical intervention is carried out extremely rarely due to the lack of necessity, the indications for surgery are a very important factor.The decision is based on the data from detailed vascular diagnostics and is made by the patient together with the doctor.
The phlebologist is obliged to talk about the risks of the planned operation, the duration and nuances of rehabilitation after the operation, which will subsequently be carried out only with the patient's consent.
As for the indications themselves, surgery for varicose veins is necessary in the following cases:
- Pathological expansion and subsequent deformation of pure saphenous veins from severity level 2.
- In extensive forms of varicose veins, the disease affects not only the subcutaneous veins, but primarily the deep veins, or the vascular deformation spreads over too large an area of the lower extremities.
- There is a severe circulatory disorder that is accompanied by increasing blood congestion.
- Severe forms of swelling, pain of high intensity, accompanied by clear external (aesthetic) signs of varicose veins.
- Formation of trophic ulcers on the skin or subcutaneous hematomas due to a violation of the integrity of blood vessels;
- Progression of the pathological process up to the closure of venous vessels and the development of an acute form of thrombophlebitis.
- Lack of positive dynamics with conservative treatment, that is, when drugs and other methods to combat varicose veins are powerless.
Limitations and contraindications to surgery
Unfortunately, even if severe forms of varicose veins occur, which are accompanied by complications and a serious clinical picture, the patient cannot always be operated on.
There are a number of contraindications that, although they do not completely exclude the possibility of surgical intervention, nevertheless force the operation to be postponed for a certain time:
- Coronary heart disease – in this case a more comprehensive examination is required.
- The same applies to grade 3 high blood pressure.
- Active infectious and inflammatory processes in the body – before performing an operation to treat varicose veins, you need to deal with the infection or eliminate inflammation.
- 2nd and 3rd trimesters of pregnancy – for pregnant women it is better to postpone all surgical procedures until the woman gives birth.The only exceptions are cases in which there is a serious risk to the life of the mother or child and an operation can provide relief.
- Skin diseases in the field of surgery to combat varicose veins.We are talking about eczema, various forms of dermatoses and so on.
- There are also certain age restrictions for older people.In some cases, advanced age and associated senility conditions increase the risk of postoperative complications or endanger a person's life on the operating table.
Methods of surgical intervention for varicose veins
However, if, based on the diagnosis and after examining the patient, the doctor is convinced that surgical intervention is necessary, all that remains is to choose the most appropriate and effective method, depending on the degree of progression of varicose veins and a number of other factors.To understand what operations exist and in what cases they are performed, let's consider the most effective methods of surgical treatment of varicose veins.
Combined phlebectomy
A full-fledged 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 already progressed seriously.
During the operation, the surgeon makes an incision up to 2 centimeters long if the operation is carried out in the ankle area, or up to 5 centimeters if the operation is carried out on a larger area, for example in the groin.These incisions are often shallow because primarily superficial veins are removed.
The principle of the operation is to interrupt the anastomosis of the vessel and then remove the part of the vein affected by varicose veins.Also, during surgery, the surgeon may correct the venous valves to restore normal blood flow.
After the operation is completed, the incisions are stitched with cosmetic stitches, a bandage is applied, 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, but the scope of the operation is smaller and can be viewed as a purely cosmetic procedure.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 mainly performed on small vessels.Advantages include painlessness (due to local anesthesia) and minimal recovery time.
Sclerotherapy
A relatively new technique, a minimally invasive method known for its effectiveness, as well as painlessness due to the same local anesthesia and a practically non-existent rehabilitation period.
The procedure involves introducing a special substance into the lumen of the vein - a foaming sclerosant.This substance causes the vessel walls to collapse and then stick together.As a result, the vein no longer takes part in the blood circulation, gradually dissolves and is replaced by connective tissue.
The sclerotherapy technique is used primarily to remove small superficial vessels and to eliminate so-called “spider veins”.
Laser coagulation
The most modern and, according to many experts, the most effective method of combating varicose veins.Its essence lies in the fact that a laser light guide is inserted into the vein lumen through a hole that is only 2 millimeters in size.When the latter is activated, it begins to emit laser waves, the temperature inside the vessel rises and when 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 absence of a rehabilitation period.
Possible consequences
Even the gentlest operation leaves marks and can have consequences.This is primarily due to the fact that the anatomical component of the body is removed - a full-fledged vessel.Of course, such consequences with a combined phlebectomy can be much more serious than a few bruises after laser coagulation.
Let's consider the most basic consequences that regularly arise after one or another surgical treatment:
- When eliminating varicose veins using minimally invasive methods that exclude vessel removal, there is a risk of relapse.This risk is minimal with laser coagulation and is only 5%.
- Burns – occur after operations in which thermal effects were used.
- Bleeding – can begin after any type of procedure but is more likely after a phlebectomy.
- There are also known cases of nerve damage, but this factor is solely related to the professionalism of the surgeon.
Rehabilitation process
In each of the cases described, rehabilitation, i.e.To ensure a smooth and quick recovery, it is important to follow simple recommendations:
- Follow all your doctor's advice carefully.
- Wear compression clothing or elastic bandages.
- If you have a cut, it is important to wait until it has healed.
- After the cuts have healed, it is important to restore physical activity;Exercise therapy and regular walks help with this.
- If your doctor prescribes medication, take it as prescribed.
- It also makes sense to see a masseur after an operation and to prevent varicose veins.
- You should not engage in serious physical activity for at least 2-3 months.
If the operation went well and the patient fully followed all the doctor's instructions for 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 also affect other vessels.For this reason, prevention of varicose veins should be carried out whenever cases of the development of this pathology have occurred.