Removal of veins in the lower extremities is referred to as radical methods of treatment. An operation to remove varicose veins in the legs may be prescribed to the patient if the use of conservative and alternative methods of therapy does not have adequate therapeutic effect and the disease continues to progress.
With the advanced form of varicose veins, surgery can solve the following problems:
- Eliminate pathological backflow (reverse flow) of blood.
- Save healthy and disease-free sections of saphenous veins.
- Eliminate the affected areas of the veins.
Before the operation, the doctor marks the veins under ultrasound control, which makes it possible to determine the extent of the affected segment. Removal of affected vessels and sections of the vein is performed using a narrow probe, which is inserted through a small incision. After removing the affected area, the risk of recurrence of the disease is low.
After surgery to remove a varicose vein, the chance of recurrence of the disease is low.
In modern medicine, they prefer the combined phlebectomy procedure, which involves using several techniques at the same time.
The main steps of combined radical treatment are: superior or inferior crossectomy, short stripping, perforating vein ligation, miniphlebectomy.
In the early stages of the disease, any of the listed procedures can be used as an independent operation. In some cases, as an alternative to some steps of classic combined phlebectomy, minimally invasive treatment methods in the form of sclerotherapy or laser obliteration may be offered.
types of operation
The general name for the operation to remove the affected veins is phlebectomy. Modern types of this procedure:
- Performing the stripping procedure (long or short) is the gentlest technique, during which the doctor can remove only a certain part of the affected vein. The procedure is performed through a small incision along the vein.
- The implementation of laser phlebectomy is a modern method of treatment that involves the use of a laser. Thanks to this tool, the laser coagulation process takes place inside the affected vessels. The procedure is performed under local anesthesia and does not require the use of special surgical instruments. The laser is injected into the vein along with a small-diameter catheter, then under the influence of the pulse small bubbles of steam are formed, which affect the walls of the vessels. As a result, the affected vein becomes part of the tissue and no longer bothers the patient.
- Endoscopic excision of the affected vein. In this case, an endoscope is inserted into the area of the vein and the doctor can personally analyze its condition and degree of damage. In the future, the surgeon has the opportunity to cut the affected area.
So-called seamless technologies are very popular, when the affected area of the vein is excised through small, point incisions. Already 4-6 hours after manipulation, the patient can walk independently. In case the development of trophic disorders is observed, endoscopic equipment is used.
The advantage of the miniphlebectomy method
Miniphlebectomy is one of the most painless and non-traumatic methods of surgically removing affected veins. The procedure is carried out in three steps: diagnosis, a small incision with a scalpel at the site of impaired blood flow, extraction of the affected area of the vein.
The operation is performed under local anesthesia, the rehabilitation period does not take much time from the patient. Scars, bruises are not formed at the puncture site, pain is disturbed in isolated cases.
Miniphlebectomy is an almost painless way to get rid of varicose veins, the recovery period after the operation is minimal.
To minimize the risk of bruising and bruising, the operation can be performed with tumescent anesthesia, which, in addition to the anesthetic, includes a substance that has a vasoconstrictor effect. After the procedure, the patient is discharged after a few hours, while there is no intoxication characteristic of general anesthesia, as well as pain.
crossectomy
The concept of "crossectomy" means ligation and subsequent crossing of a small or large saphenous vein. As an independent operation, such a procedure can only be performed in emergency cases, when there is a risk of dissemination of an acute form of thrombosis.
To date, there are milder alternative procedures to crossectomy - performing endovasal laser ablation and radiofrequency ablation.
The advantages of the techniques are: the possibility of refusing general anesthesia, outpatient treatment, the absence of aesthetic defects in the form of incision scars and scars.
Among the disadvantages, it can be noted a greater probability of recurrence of the disease and a very high cost of these procedures.
Training
The operation for varicose veins of the lower extremities is carried out after a preliminary examination of the patient and the implementation of an internal examination.
The following types of exams can be assigned:
- Ultrasound of leg veins.
- General blood analysis.
In the future, the doctor will perform an oral survey in order to identify possible contraindications for the surgical intervention. A preliminary examination allows you to choose the ideal type of surgical procedure or, if necessary, combine several known methods at once.
It is very important that the patient understands how to behave correctly before and after the procedure. Before surgery, it is recommended to refrain from taking medications, which include acetylsalicylic acid, due to the risk of bleeding. On the day of the operation, it is not necessary to prepare for the procedure very carefully - you just need to get rid of the hairs in the area of the operated limb.
When is an operation necessary?
Patients who are wondering whether surgery is necessary for varicose veins of the lower extremities should understand that such a radical method of therapy is necessary in the following cases:
- The rapid progression of the disease, which is accompanied by severe pain.
- The development of varicose thrombophlebitis of 1-4 degrees.
- Sensation of intense heat and burning in the region of the veins.
- The spread of varicose veins above the kneecaps.
- Visible formation of a swollen and aesthetically unappealing vein.
The operation is also indicated for the formation of long-lasting non-healing trophic disorders (ulcers), for which conservative therapy does not have the appropriate therapeutic effect.
Contraindications and possible consequences
It is mandatory to take into account possible contraindications and consequences of surgical intervention.
Surgical intervention cannot be performed if the patient has a history of diseases such as hypertension, heart rhythm disorders, coronary heart disease, presence of acute-stage infectious diseases, dermatological inflammatory diseases of the legs.
The operation should not be performed late in pregnancy, as well as in elderly patients with weakened immunity.
Patients should take into account possible complications, as well as the consequences of the surgical intervention:
- Violation of the sensitivity of the operated limb as a result of damage to the nerve endings.
- Intermittent or persistent numbness in the ankle area.
- The formation of suppuration.
- The development of bleeding of varying intensity.
- Reeducation of protruding veins above or below the postoperative scars.
- Pain syndrome does not bother all patients and occurs if nerve endings are affected. Normalization of sensitivity in most cases occurs independently, without the use of any medication.
- Bruising and bruising at the surgical site can be worrisome. In this case, drugs from the anticoagulant group can be prescribed for topical use. If the patient has very delicate and sensitive skin, traces of bruising may persist for 1-1. 5 months.
- The development of edema may indicate that the patient does not follow the doctor's instructions, does not observe the rest regimen, and exposes the body, including the lower limbs, to excessive physical exertion.
Strictly follow the doctor's recommendations, it depends on how long the consequences of the operation will last.
Therefore, before deciding whether it is worth having surgery for varicose veins, you should consider all possible risk factors: weigh the pros and cons well. The operation should be performed in cases where the manifestations of the disease bother patients for a long time and significantly worsen their quality of life.
It is also necessary to consult only experienced and qualified doctors who perform such operations: phlebologists, angiosurgeons.
recovery period
After the operation, it is recommended that the patient follow all the instructions of the attending physician so that the recovery period takes as little time as possible and you can quickly return to your usual lifestyle. During the first 48 hours, patients are strictly prohibited from:
- The use of alcoholic beverages.
- Motorized transport management.
- Bathing in a whirlpool tub.
- Excessive physical activity.
In the first days after the operation, there may be complaints of pain in the legs, in addition to an increase in body temperature. In this case, medical methods of therapy are involved, physical therapy is prescribed. The patient should not always be in a horizontal position. You should walk a little daily to restore blood flow.
In the future, the implementation of the following recommendations will also minimize the risk of developing these postoperative complications.
- Hydroprocedures, massages, therapeutic exercises and other physiotherapy methods, which will be prescribed by the attending physician. Such procedures prevent the formation of blood clots, normalize the outflow of blood.
- During the first few months, both limbs will need to be rewound with special elastic underwear or compression stockings.
- Use drugs from the group of phlebotonics, angioprotectors. With the development of inflammatory processes, antibacterial drugs can be prescribed. Analgesics are used to relieve pain.
- If sutures were applied, they can be removed 7 days after the procedure.
- If the patient is overweight, he should return to normal to reduce the load on the veins.
- It is recommended to give preference to loose clothing made of natural fabrics and comfortable shoes. The use of high heels is contraindicated.
- At home, you should try to keep your legs elevated using rollers or pillows.
The rehabilitation period can take several weeks, during which the patient will receive special sick leave.
Modern methods of varicose vein removal involve a rehabilitation period of just a few days, but they are more expensive than usual.
In the future, the patient must come for a second examination and undergo a complementary examination for the doctor to assess the effectiveness of the treatment.
Cost of operation
Phlebectomy is performed both in public clinics and in plastic surgery centers, whose objective is to eliminate aesthetic imperfections.
Patients are interested in how much varicose vein surgery costs.
It all depends on the clinic and the qualifications of the doctor who performs the procedure, as well as the degree of development of the disease and the complexity of the proposed operation. Nor is the last place in pricing given to the city and region in which the patient intends to perform the procedure.
Many clinics include a pre-op exam as well as a period of rehabilitation, on account of the cost.
expert predictions
The implementation of the combined phlebectomy procedure does not exclude the possibility of recurrence of the disease. After using radical methods of treatment, recurrence of varicose veins is possible due to physiological characteristics of the body (the structure of blood vessels and veins) or a violation of the technique of performing the procedure (if the doctor cannot normalize the permeability of the vein affected). The risk of disease re-exacerbation is observed in approximately 15-20% of cases. In the event that the patient notices manifestations of a repeated relapse of the disease, a doctor should be consulted as soon as possible.
Only an experienced specialist will help you correctly suggest which operation to remove varicose veins to choose, as well as provide useful recommendations that will need to be followed during the recovery period. If you do not consult a doctor in a timely manner, the consequences can be the most deplorable and irreversible.