Surgery to remove varicose veins on the legs

Faced with such a problem as varicose veins of the lower extremities, the patient should not hesitate to visit a doctor and start treatment. An experienced specialist will conduct a thorough examination and draw conclusions about which therapy tactics are best to take: conservative or surgical treatment. If, for some reason, the drugs could not have the desired effect on the patient's blood vessels, then the doctors prescribe an operative intervention, which can already unconditionally help.

Indications and whether surgery is needed at all

Surgery to remove varicose veins is a radical approach to the treatment of pathological vessels, so the indications for it will be appropriate.

The operation will be justified in the following cases:

• total varicose veins of the lower extremities, which is noticeable with the naked eye;
• constant severe swelling of the legs, discomfort, pain and a feeling of heaviness in the legs or other places, depends on the localization of the pathological process;
• a direct threat that the already existing varicose veins in a certain part of the body will be complicated by a more dangerous disease (for example, thrombophlebitis, trophic ulcer or pulmonary embolism).

In a direct conversation with the doctor, he will be able to determine whether it is worth doing the operation, and also talk about what types of surgical interventions exist in general.

Contraindications to the surgical treatment of varicose veins

Despite the strong indications, there are many cases in which surgery to remove varicose veins on the legs cannot be performed. For example, if a patient has the last stages of varicose veins, then surgical treatment will not always be possible. In such cases, doctors focus on drugs, but they cannot help sufficiently.

A number of other mandatory contraindications:

• the presence of skin diseases at the site of the affected vein, for example, eczema, pyoderma, dermatitis, etc.
• severe diseases of the cardiovascular system - hypertension, coronary artery disease, heart failure;
• acute inflammatory process inside the vessel (phlebitis);
• previously transferred thrombosis or thromboembolism of the pulmonary artery;
• active process of obliterating atherosclerosis;
• elderly age;
• period of pregnancy.

Patients should remember that in the case of taking medications for other diseases, the attending physician must be notified.

Sclerotherapy technique

Sclerotherapy is a procedure, the principle of which is to inject a special substance into the affected vessel, causing further contraction and overgrowing of the vessel. The main advantage of this method is that the procedure does not require any incisions or surgical access.

The essence of the procedure is as follows: with the help of a syringe, the doctor injects a sclerosing substance into the pathological vessel. During one stage of sclerotherapy, a specialist makes from two to ten such injections. The effect does not appear at the same moment - it usually takes 2-8 weeks and several sessions of such a procedure. Under the action of sclerosant, the vein gradually narrows, and then overgrows and disappears.

There are two types of manipulation:

1. Microsclerosis. It is justified in the initial stages of varicose veins, when small vessels that lie more superficially are involved in the process. In such cases, the amount of sclerosant needed is minimal.
2. Echosclerosis. It is performed on deeper veins using duplex scanning in order to most accurately determine the localization of deep varicose veins.

Laser coagulation

Laser surgery for varicose veins is by far the most popular. This is due to the fact that the procedure itself is done under local anesthesia, does not require large incisions and tissue trauma, and has an immediate effect.

The vascular surgeon should tell in detail about how the operation is performed, but, in general, its essence lies in the introduction of a special laser light guide into the diseased vessel. A laser beam, which has its own wavelength, passes through this apparatus and acts on the walls of varicose vessels. Under its action, the vessel coagulates and clogs up.

This technique will be justified if the patient has varicose veins of the leg or groin area. Moreover, laser coagulation will act more effectively on large vessels, which is why the use of this technique in case of damage to small veins is unjustified.

Ligation of veins

Vascular ligation is a more radical surgery for varicose veins in the legs, requiring a large incision and direct surgical access.

The operation is performed on the legs more often than on the vessels in the pelvic area. The technique of saphenous vein ligation will be effective. The vascular surgeon accesses the indicated vessel at the point where the saphenous vein joins the femoral vein. Next, the surgeon performs bandaging with special threads.

For women, pelvic vein surgery can be performed. In this case, the ovarian vein is accessed and ligated.

Removal of dilated vessels

The most common and proven method of surgery is phlebectomy. Doctors perform it almost every day, and it is more affordable than laser coagulation or sclerotherapy. Such an operation for varicose veins is performed under general anesthesia or with epidural anesthesia.

To remove the dilated vessel, the surgeon needs an incision only 0. 5-1 cm long. Having opened access to the area with varicose veins, the surgeon ligates the vessel, crosses it and removes it.

As a subspecies of this intervention, miniflebectomy is distinguished. It differs from conventional phlebectomy in that the surgeon needs punctures rather than incisions to access the vessel. This operation is effective for affecting small superficial vessels. Its main plus is that it does not leave behind any traces and cosmetic defects.

Stripping

Stripping is one of the subtypes of phlebectomy, during which a special probe is used to remove a vein. As with simple varicose vein removal, the surgeon makes an incision in the saphenous vein and accesses the vessel. Then the doctor makes another incision - in the middle or lower region of the lower leg.

Through the upper access, a special probe is inserted into the large saphenous vein - an extractor probe. The surgeon pre-bandages the mouth of the adjacent veins. The probe is passed along the entire length of the vessel to the lower incision, after which it is used to remove the vein.

In stripping, several types of manipulation are also distinguished:

1. Short stripping. Not the entire vessel is eliminated, but only a certain area that is subject to the varicose process.
2. Total. Such an operation for varicose veins of the lower extremities allows you to get rid of a large area of diseased vessels and avoid further relapses.

Consequences of surgery and rehabilitation

Having varicose veins, the operation can reverse the effect and cause various complications. They should be separated by the type of intervention performed:

1. After sclerotherapy, the patient may experience itching, burning, discoloration of the skin and the appearance of edema at the injection site. An increase in body temperature and the occurrence of general weakness are possible. Subject to the rules of the postoperative period, the symptoms disappear in a couple of days.
2. After undergoing laser coagulation, the patient may experience a feeling of tension in the thigh area, minor hemorrhages, and an increase in body temperature. With proper treatment, symptoms go away within a week.
3. Vein ligation can be complicated by trauma and bleeding during the operation itself.
4. Phlebectomy and stripping can damage the nerves in the skin. This can be accompanied by loss of sensitivity, numbness in the legs, pain at the incision sites.

For all methods of surgical treatment, there is one common complication - thrombosis. This is a dangerous process, but the chance of its occurrence as a result of any operation is very low.

In order to avoid the aforementioned complications and to shorten your rehabilitation period as much as possible, you must adhere to the recommendations for caring for your health and blood vessels in the postoperative period.

Subject to the rules of the postoperative period, the symptoms disappear in a couple of days.

There are a number of pros and cons that experts recommend adhering to:

• Immediately after the end of the operation and in the first week after it, it is necessary to wear special compression underwear - it can be in the form of stockings, tights, socks, and for this purpose you can also use a regular elastic bandage.
• Eliminate bad habits - alcohol consumption, smoking, drug use.
• Avoid baths and saunas, as well as taking too hot baths.
• In the place where the operation was performed, no cosmetic procedures and various cosmetic products should be applied.
• Avoid strenuous physical activity. In the event that before treatment the patient was involved in any kind of sports (especially hard), then after the operation, heavy loads should be forgotten for at least 5-8 weeks. In the future, you should consult with your doctor if it is possible to continue intensive sports at all.
• Do daily prophylactic exercises lasting no more than 15-30 minutes.
• To adhere to the phlebologist's prescriptions for taking medications - to do regular prophylactic anticoagulants, phlebotonics, non-steroidal anti-inflammatory drugs, thrombolytics and other drugs.

In general, all these operations have good reviews from both doctors and patients. Which approach to treatment is suitable for a particular patient should be decided only with the attending physician.