leg vein surgery

surgery to remove varicose veins

Varicose veins are aided by the "bad" habits of modern man corrupted by civilization, such as:

  • sedentary lifestyle (contraction of the calf muscles contributes to the outflow of blood from the veins of the lower extremities - this is called the "second heart");
  • overweight (in the U. S. , where obesity has become a nationwide problem, 25-30% of the adult population suffers from varicose veins);
  • occupations that involve a long, standing or sitting position (a long stay in front of a computer, especially if you have a bad habit of throwing your feet on your feet, can also lead to varicose veins).

The initial stage of the disease is often completely asymptomatic, while conservative therapy is unable to restore abnormally dilated veins and deformed venous valves. Therefore, often on the first visit, doctors recommend that patients have their veins removed.

Indications for surgery

An indication for surgery to remove varicose veins may be any manifestation of a disease that reduces the patient's quality of life, including:

  • violation of the valve device detected at the appointment of the doctor combined with elongation of the saphenous vein wall (this is the main criterion that conservative therapy is no longer effective);
  • venous thrombosis of the saphenous vein (thrombophlebitis);
  • symptoms of venous insufficiency (nocturnal cramps in the calf muscle, pain and heaviness in the legs, swelling) that are difficult to treat with conservative therapy;
  • the presence of trophic ulcers of venous etiology (if the ulcer is "fed" with an enlarged vein);
  • aesthetic defect (dilated veins on the legs are not an attractive sight).

Surgery to remove varicose veins can be performed in a variety of ways that vary significantly in the extent of the intervention and, consequently, the consequences for the body.

When choosing a technique, the surgeon is primarily guided by the stage of the process, so it is better not to wait for complications to develop, but to agree to remove the veins in time.

When surgery is not required

The operation to remove the varicose veins in the lower extremities does not apply to surgical procedures that are extremely dangerous to the body. However, the removal of veins should be postponed in the event of acute illness (influenza, acute respiratory viral infections, etc. ) and exacerbation of any chronic pathology.

In addition, the removal of varicose veins in the lower extremities may be delayed during pregnancy and childbirth. After delivery, the veins often become normal. This occurs in the first 4-5 months after delivery.

I have to say that there is no absolute contraindication to surgery to remove varicose veins. In cases where the varicose vein is a real threat to the patient’s life and is difficult to treat, vein removal surgery is performed at any age and in any condition of the body (obesity, high blood pressure, etc. ).

Minimally invasive surgery to treat lower extremity varicose veins

Minimally invasive surgery of varicose veins does not involve mechanical removal of venous vessels. The main mechanism of action of these procedures is the chemical (special solution) or physical (laser, high-frequency radiation) effect on the inner mucosa of the vein. As a result, the varicose veins collapse and overgrow.

The minimally invasive surgeries performed according to the indication have the following advantages:

  • high efficiency (relapses are extremely rare);
  • no hospital treatment required;
  • absence of severe traumatic effects on the body;
  • the procedure is well tolerated by patients;
  • a minimum percentage of complications and unpleasant side effects;
  • the shortest recovery period;
  • no general anesthesia is required (comparable to dental treatment in terms of pain).

Today, there are several methods for minimally invasive intervention, which you can read about below.

Advantages and disadvantages of sclerotherapy venous removal

The method of sclerotherapy is based on the chemical bonding of the inner wall of the veins with the introduction of a special substance, a sclerosant. The advantages of this method include the relatively low cost of removing the vein.

However, if the process is significantly widespread, several sclerotherapy sessions may be required - the treatment process can take up to 1 month.

In our practice, we use sclerotherapy to remove superficial small veins and spider veins (reticular varicose veins).

In addition, sclerotherapy can be used as a combined technique for extensive lesions in combination with laser ablation or RFA and miniphlebectomy.

Sclerotherapy is also the best method of treating trophic ulcers when the skin above the vein changes and no incision can be made. In such cases, sclerosis is delivered to the ulcer-feeding vein under ultrasound guidance.

In our clinic, we use the ethoxyclerol foaming agent as a sclerosing agent, this method guarantees high efficiency, as the sclerosing agent spreads better in the affected vessel.

Advantages of venous removal by endovenous laser ablation

Endovenous laser ablation (EVLA) is a minimally invasive method of laser beam removal of the lower extremities.

Compared to sclerotherapy, EVLO has the following advantages:

  • absolute pain relief (the procedure is performed under local anesthesia);
  • high accuracy (all surgical procedures are performed under ultrasound examination);
  • indications that EVLO can be supplemented with a miniflebectomy procedure (removal of dilated pathways), this option significantly reduces the list of indications for mechanical removal of veins;
  • bruises after the procedure are less frequent;
  • postoperative pain syndrome is less pronounced;
  • absence of age spots at the injection site;
  • shorter recovery period.

Radiofrequency ablation is the most advanced way to treat minimally invasive varicose veins.

The advent of radiofrequency obliteration (RFO) has significantly reduced the number of cases where surgical (mechanical) removal of the varicose vein was the only way to solve the problem.

Large venous trunks with a diameter of 15 mm or more can be "welded" using a radiofrequency electrode inserted into the venous cavity under ultrasound control.

Radiofrequency obliteration has all the benefits of EVLA. In addition, RFO is better than endovascular laser ablation in terms of:

  • use of disposable electrodes;
  • full automation of the process, which avoids annoying errors (the device is equipped with a sensor and operates according to a feedback method, so more energy is automatically sent at higher vessel widths);
  • the procedure takes much less time;
  • a year later, the vein treated with RFA completely dissolves (remains in the form of a cord when EVLA is applied).

The only disadvantage of radiofrequency ablation is the high cost of the procedure.

Surgery to remove varicose veins in the lower extremities

Flebectomy or surgical removal of varicose veins is a more radical surgical procedure that involves the complete or partial removal of the affected venous strain (large or small vein) along with all the branches, as well as the ligation of the fistulas with the deep veins of the limb.

Phlebectomy is performed in more advanced cases and is therefore often supplemented using minimally invasive methods to remove remaining branches and varicose veins.

The postoperative period after phlebectomy is usually longer than with minimally invasive procedures. Postoperative wounds remain on the operated leg and require careful care.

After a phlebectomy, small bruises and extensive hematomas are much more common, and inflammatory infiltrates (seals) are common.

However, with proper care, all unpleasant side effects disappear completely. Tiny, inconspicuous scars remain at the incision site, which usually do not cause major complaints.

Preparing for surgery

Regardless of the surgical treatment chosen, standard laboratory tests (general blood and urine tests, coagulogram, blood sugar levels, etc. ) should also be performed before surgery to remove the veins.

In addition, ultrasound of the veins and examination for blood-borne infections (hepatitis, syphilis, HIV) will be required.

Be sure to tell your doctor about all the medicines you are taking (contraceptives, painkillers, etc. ) and any allergic reactions to the medicines.

Consequences of the operation to remove the veins. How to behave to avoid complications

To prevent the development of thrombotic complications, doctors use special devices - anticoagulants, which are selected depending on the indicators of the blood clotting system.

After EVLO and RFO, early loading of the legs (walking) is recommended. In cases where surgery has been performed with phlebectomy while walking, transient pain syndrome may occur.

After removing the varicose veins, it will take some time for the following instructions to be strictly followed:

  • wear compression stockings (stockings are more comfortable);
  • leave thermal procedures (high temperature bath, sunbathing on the beach, etc. ).

The duration of the restrictions is determined by your doctor, depending on the stage of the disease, the type of surgery, the volume of veins removed, the general condition of the body and the dynamics of the healing process.

How to avoid relapse

It should be borne in mind that varicose veins occur in people with a hereditary predisposition, so every effort should be made after surgery to ensure that the disease does not return, namely:

  • watch your own weight;
  • avoid prolonged static loads;
  • take venotonic treatment courses;
  • wear compression clothing as instructed.

Is it possible without surgery?

In cases where irreversible changes have occurred in the wall of the veins, surgery is unfortunately not essential. In the case of long-term development, varicose veins are threatened with complications such as:

  • massive bleeding from dilated veins;
  • thrombosis of venous strains;
  • thromboembolic complications (including cardiac arrest, pulmonary infarction, etc. );
  • trophic ulcers, etc.

There are no magic ointments that dissolve living tissues (dilated veins). Most of these products have a locally distracting effect, causing a "cold" feeling when applied. Prevention of thrombosis with ointments without the use of compression stockings is not effective. Treatment of thrombosis as monotherapy is also completely ineffective.

Can vein removal surgery be delayed?

Modern methods of removing veins allow you to get rid of the disease in a fairly convenient way and continue to live a life with virtually no restrictions.

If you do not have the option to have surgery at this time, the only way to delay the onset of complications is to wear compression stockings of Compression Class 2 or 3 permanently.

Constantly - even in summer, when the risk of thrombosis is particularly high. Postoperative compression stockings can be worn for 2-3 weeks, after which they can be forgotten in most cases.

It should also be borne in mind that the later the patient visits a doctor, the more expensive the treatment will be and the traumatic intervention will not be necessary in the final stages.

Do not postpone the operation indefinitely. Take care of yourself. To be healthy.