Surgery to remove leg veins for varicose veins or laser removal? What's better

18 November 2020

Varicose veins is a disease characterized by a change in the state of the veins in the legs with impaired blood flow. When the form is neglected, the vessels bulge, which leads to swelling and soreness of the limbs (under load), as well as to aesthetic discomfort. Surgical removal of damaged veins is effective for this stage.

Indications for surgery for varicose veins

Surgery for varicose veins can be performed only if there are indications for the removal of blood vessels:

varicose changes have affected most of the vein;
severe soreness and swelling of the legs during physical exertion, which interfere with a normal lifestyle;
the formation of open wounds and ulcers against the background of the development of the disease. It is dangerous to attach a secondary infection;
violation of the permeability of blood through the vessels, often accompanied by convulsions;
marked development of vascular necrosis;
pathological changes in veins, accompanied by their expansion and protrusion. The change is dangerous by trauma to the vessels, and also causes aesthetic discomfort;
blood clots in the veins.

Surgical intervention is permissible only with advanced forms of varicose veins and in the absence of dynamics with conservative treatment.

Absolute and relative contraindications for surgical intervention

Surgery to remove leg veins for varicose veins is carried out not only if there are indications, but also in the absence of contraindications:

Absolute bans on the operation	List of relative bans
Stable high blood pressure	Presence of infectious diseases
Regular jumps in blood pressure	Dermatological pathologies affecting the skin on the legs
Chronic heart disease	Inflammatory processes in the body, including blood vessels
Advanced age after 70	The recovery period after other surgical interventions
Presence of cancers	Chemotherapy
Diabetes mellitus and severe asthma	Severe soft tissue injury from trauma
Thinning and fragility of blood vessels	Liver and kidney pathologies in the acute stage
Patients with limited leg mobility (paralysis) or bedridden patients	Blood clotting disorder or anemia
Varicose veins in the last stage	Taking hormones, antibiotics or other harsh medications
The presence of complicated leg fractures (with damage to blood vessels and nerve endings)	Being overweight
Allergic reaction to medications used during surgery	Patient refusal from surgery

When carrying a child, there may also be a violation of the condition of the veins in the legs. More often, the pathology is eliminated on its own after delivery. In the presence of contraindications, surgical intervention is dangerous with a worsening of the patient's condition and even with a fatal outcome.

Phlebectomy

Phlebectomy is a surgical procedure to remove damaged veins and restore normal blood flow to deep veins.

Anatomical meaning, technique of large surgery to remove veins

The circulatory system in the legs consists of a deep vein and many branches of superficial veins, which affect varicose veins. Changes in vascular activity develops due to dysfunction of the valves. During the normal functioning of the vessels, the valves are closed, which ensures blood flow in only one direction.

In the veins of those affected by varicose veins, the valves do not close, as a result, blood can move in both directions, which leads to impaired blood flow, with blood congestion and veins protrusion.

To restore blood supply to the limb, it is necessary to eliminate the affected vein (with reverse blood flow), that is, to carry out phlebectomy. Before the operation, the patient undergoes preparation (taking tests, scanning the state of the veins, determining the general condition of the patient).

If there are no contraindications, specialists perform a surgical procedure, which consists of the following stages:

Access to the affected vessel is provided through a small incision (in the groin or popliteal, depending on the location of the vein). Next, the damaged vessel is ligated from a deep vein to block the blood flow.
An incision is made near the varicose vein. With the use of a probe, a vessel is separated from muscle tissue, the lymphatic system and small capillaries. Through a tube, or using a hook, the damaged vein is removed.
The capillaries are treated to prevent bleeding.
If there are damaged capillaries forming spider veins, they are removed.
At the end, cosmetic stitches, a disinfecting dressing and an elastic bandage are applied.

The operation is performed under general or local anesthesia. Depends on the size of the vessel and its location.

Efficiency level

Surgical removal of veins is used at different stages of development of varicose veins. The procedure is highly effective (over 98%). The restoration of blood circulation occurs in a short time.

Rehabilitation

The effectiveness of the procedure depends not only on the qualifications of the surgeon, but also on adherence to the rules in the postoperative period.

After phlebectomy, you need:

suture care for 7-14 days in a hospital;
wearing compression stockings or elastic bandages for 30 days is performed around the clock;
after 30 days, for another 3 months, wearing specialized underwear during the daytime
water procedures with washing feet (where the operation was performed) are possible only after removing the stitches;
during the recovery period saunas, baths and hot baths are prohibited;
Pain medications after surgery are prescribed by a doctor. Self-selection is prohibited;
additional drugs are taken to prevent blood clots;
taking medications to strengthen the walls of blood vessels (vitamins E and C);
it is forbidden to stay in a standing / sitting position for a long time, wearing high-heeled shoes and tight underwear;
during the rest period in the supine position, the legs should be above the level of the body. Promotes the outflow of excess blood and reduces swelling;
timely and gradually introduce physical activity to normalize blood flow (discussed with your doctor);
massages and physiotherapy are performed with the permission of the attending specialist;
refusal from alcoholic beverages and nicotine. Alcohol provokes vasodilation, and tobacco, on the contrary, leads to their narrowing. These effects reduce the efficiency of the operation;
if you are overweight, a low-calorie diet is prescribed.

If the rules are followed, complete restoration of the functioning of the limb is possible in 6 months.

Endovenous coagulation using a laser

An operation to remove veins in the legs with varicose veins using a laser is performed when direct vessels with a diameter of at least 0. 02 cm are affected and with a small number of capillaries. The procedure consists in the action of light waves on the damaged vessels with their subsequent soldering and destruction.

Equipment

Laser coagulation of veins can be performed with any of 3 types of optical fibers:

Optical fiber type	Action Brief
End (classic)	This light guide produces beam radiation from the end, that is, the vessel is sealed in front of it. The downside is the formation of hematomas and a painful feeling of tightness of the veins. Maximum vein diameter 0. 1 cm.
Radial (with elves painless radial light guide)	Light waves from the fiber form a circle that wraps around a vein in diameter. This allows veins of any size to be treated. And also the risk of hematoma formation and the development of puffiness is minimized.
Of 3 types of radial fibers	Lasers with two light rings are used to eliminate varicose veins. The first one prepares the vein for the procedure (eliminating excess fluid), the second circle solders the walls. For treatment, light guides are produced for fine and short veins, and for large vessels.

The choice of equipment is made not only by the patient, but also by the attending specialist for the state of the vessels.

Which veins can be removed with the EVLK method

Before choosing EVLK by a phlebologist (a specialist who examines veins and eliminates varicose veins), the characteristics of damaged vessels are determined. They must be straight and at least 2 mm in diameter.

As a result, laser therapy can be applied to the following groups of vessels:

small and large saphenous veins;
saphenous accessory veins, which are at least 5 mm from the surface of the epidermis;
vessels connecting deep veins with superficial ones.

For other veins, therapy is only possible with phlebectomy.

Efficiency

Removal of veins by the EVLK method is possible with 3 types of optical fibers. Depending on the type of equipment, the effectiveness of treatment changes. When performing an operation using an end light guide, the effectiveness of therapy is 94-96%. Operation with radial light guides allows you to achieve 100% results in eliminating varicose veins on the legs.

Stages of preparation and implementation

When choosing to remove varicose veins using EVLK, the patient should undergo the following training:

Cancellation of hormonal medications (if taken). Since they can cause the development of thrombosis;
one day before the intervention, it is required to take blood thinners;
screening of damaged veins to determine the extent of their damage;
taking tests to exclude the presence of a hidden infection or inflammatory processes in the body. Blood coagulation is also determined;
the site of the procedure is thoroughly washed and shaved (without the use of cosmetics, only antibacterial soap is allowed).

Before the start of the operation, the boundaries of the damaged vessels, the site of the laser / fiber insertion and the site of branching capillaries are marked. These marks allow you to solder the beginning and end of the vein, as well as the outlets of the capillaries. The process is carried out under the control of an ultrasound machine.

EVLK is produced in stages:

Insertion of the catheter through a small puncture (the site of insertion of the catheter is anesthetized with local anesthesia) in the marked area. The light guide will move along it.
Insertion of the fiber into the catheter and its subsequent advance to the damaged area. It is performed under ultrasound control on a monitor.
Injection of anesthetic to numb the vein and adjacent tissues.
Advancement of the "active" light guide through the damaged vein, followed by a delay in the places where the capillaries branch off (to seal the outputs and prevent bleeding).
Removing the laser with antiseptic treatment of the puncture site and applying an elastic bandage (or using compression stockings).

After completing the procedure, the patient can leave the hospital immediately.

Features of rehabilitation

To restore the functioning of the injured limb and prevent the development of complications, you need to familiarize yourself with the nuances of rehabilitation after EVLK.

They are:

after the completion of the procedure, it is recommended to walk the operated leg in a medical facility for an hour;
for 2-3 days, ultrasound control of the treated vein is performed;
within 5 days it is required to wear specialized underwear around the clock (the type of stockings is discussed with the attending specialist before the operation). Then, within 45-60 days, clothes must be used during the daytime;
carry out daily kneading of the legs by walking every day from 60 minutes;
avoid overloading on the legs (prolonged sitting or standing position) and visiting saunas or taking hot baths.

If the removal of varicose veins is still required, the procedures are allowed to be carried out no earlier than in 7 days.

The advantages of each method

Surgery to remove leg veins for varicose veins, depending on the type of intervention, has the following advantages:

Phlebectomy	EVLK
The incisions for the operation are about 5 mm, so there are practically no scars	No pain during the procedure (using local anesthesia). General anesthesia is not required
Painlessness, as the operation is performed under local anesthesia. For miniflebectomy, local anesthesia is used.	EVLK is performed under ultrasound control. The result is high precision and efficiency.
Low cost	Hematomas and pain at the site of surgery are rare or mild.
Rapid restoration of skin tone (absence of stars and purple-cyanotic shade of the epidermis)	The operation requires 1 puncture, so no stitches and no scars are required
Short recovery period of about 30 days	Recovery period up to 5 days
Effective for all forms of varicose veins	After surgery, the patient can leave the clinic within 1 hour.
Return to normal life is possible in 24 hours.
EVLK can be performed when the integrity of the epidermis is compromised by ulcers.
The duration of the surgical intervention is no more than 40 minutes.
EVLK can be performed on both legs in one day. On one leg, a second operation is permissible after 7 days.

The risk of infection during the procedure is minimal, since the incision / puncture is small.

Complications after surgical and laser vein surgery

There is a risk of complications after vein removal by surgery or laser. Negative reactions can occur due to the low qualifications of a specialist or due to violation of the rules during the rehabilitation period. Possible complications of phlebectomy and endovenous coagulation.

Vein Removal Methods	Minor complications from procedures	Major complications
Phlebectomy	hematomas and minor bleeding; temperature rise; swelling of the limb due to temporary disruption of the lymphatic system, as well as in case of non-compliance with the rules of rehabilitation; pain, decreased sensitivity in the area of the operation; the formation of seals due to small hemorrhages under the skin from the capillaries of the removed vein; festering of seams due to improper processing; nausea after general anesthesia.	development of deep vein thrombosis (therefore, during the recovery period, it is required to take blood thinners, and follow the diet prescribed by the doctor); tissue numbness in the operated area. Perhaps if the nerve endings are damaged during the operation; inflammation of a deep vein as a result of infection during surgery or in violation of the rules of care.
Endovenous laser coagulation	hematomas when using an end light guide; swelling within 3 days; a feeling of muscle tension and soreness at the site of the removed vein, especially when the leg is moved; slight increase in temperature; the appearance of seals at the site of the removed vein due to the rush of blood to the "sealed zone"; with insufficient soldering of the walls of the damaged vessel, it is possible to restore blood flow in it and the progression of varicose veins. Repeated surgery is required; change in the tone of the epidermis during the period of "decomposition of the sealed" vein. Provided that the vessel is located close to the skin surface.	formation of blood clots in deep veins; laser burns to nearby tissues and nerve endings with subsequent disruption of the functioning of the limb; development of the inflammatory process when an infection is introduced into the puncture site; spalling and sticking of a piece of fiber in the vein to be operated. It happens extremely rarely when using low-quality equipment.

During both operations, an allergic reaction to anesthetic drugs may develop.

Measures to minimize complications

Surgery to remove leg veins with varicose veins is sometimes accompanied by the development of complications, to prevent their appearance it is required:

testing for allergic reactions to medications used;
exclusion of infectious diseases and inflammatory processes in the body before the operation;
selection of proven clinics with highly qualified specialists and modern equipment;
compliance with the rules during the recovery period. Especially wearing compression underwear;
observe dietary food during the recovery period (discussed by a specialist after the procedure). The amount of pure water in the diet increases, food intake is made in small portions, the diet is enriched with vitamins and minerals;
rest feet during working hours;
undergo an examination after surgery to track the dynamics of limb recovery;
to perform massages and physiotherapy to quickly restore blood flow.

If any deviations are found that are unacceptable for this operation, you must immediately contact the clinic.

Comparison of forecasts

With both methods of removing leg veins, the probability of complete recovery is higher than 95%, but subject to the elimination of contraindications, adherence to the rules during the rehabilitation period and when choosing a proven clinic. With surgical treatment, the blood flow and the external condition of the legs are restored after 3 months, and with laser therapy, recovery is noted after 30 days.

In advanced forms, the removal of blood vessels is carried out by surgical intervention. The method of treatment is determined not only by the patient's desire, but also by the presence of indications and contraindications for the procedure. The effectiveness of therapy depends on the qualifications of the doctor and the implementation of the rules of foot care after surgery.