When faced with a problem such as varicose veins in the lower extremities, the patient should not hesitate to consult a doctor and start treatment. An experienced practitioner will conduct a thorough examination and draw conclusions as to which therapeutic tactic is best: conservative or surgical treatment. If, for some reason, the medications have not been able to have the desired effect on the patient’s blood vessel, doctors will prescribe surgical intervention, which can already help unconditionally.
Indications and whether surgery is required at all
Surgery to remove the varicose vein is a radical approach to treating abnormal blood vessels, so the indications will be appropriate.
The operation is justified in the following cases:
- lower varicose veins of the lower limbs visible to the naked eye;
- constant severe swelling of the legs, discomfort, pain, and feeling of heaviness in the legs or other places depend on the localization of the pathological process;
- an imminent risk that varicose veins in a certain part of the body will be complicated by a more dangerous disease (such as thrombophlebitis, trophic ulcer or pulmonary embolism).
By talking directly to your doctor, you can determine if surgery is worthwhile and also talk about what types of surgeries there are in general.
Contraindications to surgical treatment of varicose veins
Despite strong indications, in many cases, surgery to remove varicose veins may not be possible. For example, if a patient has the last stages of a varicose vein, surgical treatment will not always be possible. In such cases, doctors focus on medications, but they cannot help enough.
There are several other mandatory contraindications:
- the presence of skin diseases at the site of the affected vein, such as eczema, pyoderma, dermatitis, etc.
- severe diseases of the cardiovascular system - high blood pressure, coronary heart disease, heart failure;
- acute inflammatory process inside the vessel (phlebitis);
- previously transmitted thrombosis or pulmonary embolism;
- the active process of eradicating atherosclerosis;
- old age;
- period of pregnancy.
Patients should remember to tell their doctor if they are taking medicines for other conditions.
Sclerotherapy is a procedure based on injecting a special substance into the affected vessel, causing further contraction and overgrowth of the vessel. The main advantage of the method is that the procedure does not require incision or surgical access.
The essence of the procedure is as follows: using a syringe, the doctor injects a sclerosing agent into the abnormal vessel. At one stage of sclerotherapy, one skilled in the art will make two to ten such injections. The effect does not appear at the same time - usually 2-8 weeks and more of these treatments are needed. As a result of the sclerosant, the vein gradually narrows, then grows and disappears.
There are two types of manipulation:
- Microsclerosis. It is justified in the initial stage of the varicose vein, when the more superficial small vessels are involved in the process. In such cases, the amount of sclerosant required is minimal.
- Echosclerose. Deep veins are performed by duplex scanning to most accurately determine the localization of deep varicose veins.
Varicose vein laser surgery is by far the most popular. This is due to the fact that the procedure itself is performed under local anesthesia, does not require large incisions and tissue trauma, and has an immediate effect.
The vascular surgeon should tell you in detail how to perform the operation, but usually the point is to insert a special laser light guide into the patient vessel. A laser beam of its own wavelength passes through this device and acts on the wall of the varicose veins. Under its influence, the vessel coagulates and clogs.
This technique will be warranted if the patient has varicose veins in the leg or groin. In addition, laser coagulation is more effective on large blood vessels, so it is unreasonable to use this technique to damage veins.
Ligation of veins
Ligation of blood vessels requires more radical surgery on the varicose veins on the legs, large incision, and direct surgical access.
The operation is performed on the legs more often than on the blood vessels in the pelvic area. The technique of ligation of saphenous veins will be effective. The vascular surgeon reaches the indicated vessel at the point where the saphenous vein joins the femoral vein. The surgeon then performs a bandage with special threads.
In women, pelvic vein surgery can be performed. In this case, the ovarian vein is obtained and ligated.
Removal of expanded 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 varicose vein surgery is performed under general anesthesia or epidural anesthesia.
To remove the dilated vessel, the surgeon only needs an incision 0, 5-1 cm long, after opening access to the area with varicose veins, the surgeon ligates, crosses and removes the vessel.
One subtype of this intervention is miniflebectomy. It differs from traditional phlebectomy in that the surgeon needs punching rather than incisions to reach the vessel. This operation effectively affects small surface vessels. Its main plus is that it leaves no traces or cosmetic flaws.
Stripping is a subtype of phlebectomy that uses a special probe to remove a vein. As with simple varicose veins removal, the surgeon makes an incision in the saphenous vein and accesses the vessel. The doctor then performs another incision - in the region of the middle or lower leg.
Through upper access to the large saphenous vein, a special probe is introduced - an extractor probe. The surgeon bandages the mouth of adjacent veins in advance. The probe is guided along the entire length of the vessel to the lower incision and then used to remove the vein.
During stripping, several types of manipulation are distinguished:
- Short stripping. It is not the entire vessel that is emptied, but only a certain area that is exposed to the process of varicose veins.
- Complete. Such an operation of varicose veins of the lower extremities makes it possible to get rid of a large area of diseased vessels and to avoid further relapses.
Consequences of surgery and rehabilitation
Surgery for varicose veins can have the opposite effect and cause a variety of complications. These should be distinguished from the type of intervention performed:
- 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 general weakness is possible. Following the rules of the postoperative period, the symptoms disappear in a few days.
- After laser coagulation, the patient may experience a feeling of tension in the thigh area, minor bleeding and an increase in body temperature. With proper treatment, the symptoms will go away within a week.
- Vein ligation can be complicated by trauma and bleeding during the surgery itself.
- Phlebectomy and stripping can damage the nerves in the skin. This is accompanied by loss of sensitivity, numbness of the legs, pain at the incision site.
There is a common complication with all methods of surgical treatment - thrombosis. This is a dangerous process, but the chances of it occurring as a result of any operation are very low.
To avoid the above-mentioned complications and to shorten the rehabilitation period as much as possible, you should follow the recommendations for health and vascular care in the postoperative period.
Following the rules of the postoperative period, the symptoms disappear in a few days.
There are several advantages and disadvantages that experts recommend:
- Immediately after the operation and for the first week thereafter, you should wear special compression underwear - this can be in the form of stockings, tights, socks, and you can also use a standard elastic bandage for this purpose.
- Eliminate bad habits - alcohol, smoking, drug use.
- Avoid baths and saunas as well as overheating.
- You may not perform cosmetic procedures or apply various cosmetics at the site of the operation.
- Avoid strenuous physical activity. In case the patient has participated in any sport (especially hard) before the treatment, the heavy loads should be forgotten for at least 5-8 weeks after the operation. In the future, you should consult your doctor if it is at all possible to continue intense sports.
- Perform preventive exercises for up to 15-30 minutes a day.
- Follow the phlebologist's prescriptions - regularly take prophylactic anticoagulants, phlebotonics, NSAIDs, thrombolytics and other medications.
In general, these operations contain good evaluations among both physicians and patients. Which approach to treatment is appropriate for a particular patient should only be decided by the treating physician.