Removal of veins in the lower extremities is called radical methods of treatment. The patient may be prescribed surgery to remove varicose veins in the legs if the use of conservative and alternative methods of therapy does not have the appropriate therapeutic effect and the disease continues to progress.
With the advanced form of varicose veins, surgery can solve the following problems:
- Eliminate pathological reflux (reverse flow) of blood.
- Preserve healthy parts of the veins without disease.
- Remove the affected areas of the veins.
Before surgery, the doctor marks the veins under ultrasound control, which allows you to determine the extent of the affected segment. Removal of the affected veins and parts of the vein is done with a narrow probe that is inserted through a small incision. After removing the affected area, the risk of recurrence of the disease is low.
After surgery to remove varicose veins, the chance of the disease recurring is small.
In modern medicine, they prefer the procedure of combined phlebectomy, which involves the use of several techniques at once.
The main stages of combined radical treatment are: upper or lower crossectomy, short stripping, perforating vein ligation, mini-phlebectomy.
In the initial stages of the disease, any of these procedures can be used as a stand-alone operation. In some cases, as an alternative to some stages of classical combined phlebectomy, minimally invasive treatment methods such as sclerotherapy or laser obliteration may be offered.
Types of operations
The general name for surgery to remove the affected veins is phlebectomy. Modern types of this procedure:
- Performing the removal procedure (long or short) is the most gentle 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.
- Laser phlebectomy is a modern method of treatment that involves the use of lasers. Thanks to this tool, the process of laser coagulation 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 a vein together with a catheter of small diameter, and then, under the influence of the pulse, small bubbles of steam are formed, which affect the walls of blood 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 that case, the endoscope is inserted into the area of the vein, and the doctor can personally analyze its condition and the degree of damage. In the future, the surgeon has the opportunity to cut off the affected area.
So-called seamless technologies are very popular, when the affected area of the vein is cut through small precise incisions. As early as 4-6 hours after the manipulation, the patient can walk independently. In case the development of trophic disorders is noticed, then endoscopic equipment is used.
The advantage of the miniphlebectomy method
Miniphlebectomy is one of the most painless and non-traumatic methods of surgical removal of affected veins. The procedure is performed in three phases: diagnosis, 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 for the patient. Scars, bruises do not form at the site of the sting, pain is disturbed in isolated cases.
Miniphlebectomy is an almost painless way to get rid of varicose veins, the recovery period after surgery is minimal.
In order to minimize the risk of bruising and bruising, surgery can be performed with tumescent anesthesia, which in addition to anesthetics includes a substance that has a vasoconstrictive effect. After the procedure, the patient is discharged after a few hours, with no intoxication characteristic of general anesthesia, nor pain.
Crossectomy
The concept of "crossectomy" means the ligation and subsequent crossing of a small or large vein. As a stand-alone operation, such a procedure can be performed only in emergencies, when there is a risk of spreading an acute form of thrombosis.
To date, there are milder alternative procedures for 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 cosmetic defects in the form of scars from cuts and scars.
Among the disadvantages is the higher probability of recurrence of the disease and the rather high cost of these procedures.
Training
Surgery of varicose veins of the lower extremities is performed after a preliminary examination of the patient and an internal examination.
The following types of reviews can be assigned:
- Ultrasound of the leg veins.
- General blood test.
In the future, the doctor will conduct an oral survey to identify possible contraindications for surgery. Preliminary examination allows you to choose the optimal type of surgery or, if necessary, combine several known methods at once.
It is very important that the patient understands how to behave properly before and after the procedure. It is recommended to refrain from taking medications, which include acetylsalicylic acid, before the operation, due to the risk of bleeding. On the day of the operation, it is not necessary to prepare especially carefully for the procedure - you only need to get rid of the hair in the area of the operated limb.
When is surgery needed?
Patients who are wondering whether surgery for varicose veins of the lower extremities is necessary should understand that such a radical method of therapy is necessary in the following cases:
- Rapid progression of the disease, which is accompanied by intense pain.
- Development of grade 1-4 varicose thrombophlebitis.
- Feeling of intense heat and burning in the veins.
- Dilation of varicose veins above the knee.
- Visible formation of swollen, aesthetically unattractive veins.
Surgery is also indicated for the development of long-term trophic disorders that do not heal (ulcers), for which conservative therapy does not have an appropriate therapeutic effect.
Contraindications and possible consequences
It is obligatory to take into account the possible contraindications and consequences of the surgical intervention.
Surgery cannot be reported if the patient has a history of diseases such as hypertension, heart rhythm disorders, coronary heart disease, the presence of infectious diseases in the acute phase, dermatological inflammatory diseases of the legs.
Surgery should not be performed in late pregnancy, nor in elderly patients with weakened immunity.
Patients should consider possible complications as well as the consequences of surgery:
- Injury to the sensitivity of the operated limb as a result of damage to nerve endings.
- Occasional or persistent numbness in the ankle area.
- Formation of suppuration.
- Development of bleeding of varying intensity.
- Re-formation of bulging veins at the site 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 on its own, without the use of any drugs.
- Hematomas and bruises at the site of surgery can be upsetting. In this case, topical anticoagulants may be prescribed. If the patient has very sensitive and sensitive skin, then the traces of bruises can remain for 1-1, 5 months.
- The development of edema may indicate that the patient does not follow the doctor's instructions, does not follow the rest regime and exposes the body, including the lower limbs, to excessive physical exertion.
Strictly follow the doctor's recommendations, it depends on how quickly the consequences of the operation will pass.
Therefore, before deciding whether to do varicose vein surgery, you need to consider all possible risk factors: thoroughly weigh the pros and cons. Surgery should be performed in cases when the manifestations of the disease bother patients for a long time and significantly worsen the quality of life.
It is also necessary to consult only with experienced and qualified doctors who perform such operations: phlebologists, angiosurgeons.
Recovery period
After the operation, the patient is recommended to follow all the doctor's instructions so that the recovery period lasts as little time as possible and in order to quickly return to a normal lifestyle. During the first 48 hours, patients are strictly prohibited from:
- Use of alcoholic beverages.
- Motor transport management.
- Bathing in the hot tub.
- Excessive physical activity.
In the first few days after the operation, there may be complaints of pain in the legs, as well as an increase in body temperature. In this case, medical methods of therapy are included, physiotherapy is prescribed. The patient should not always be in a horizontal position. You should walk a little every day to restore blood flow.
In the future, the application of the following recommendations also minimizes the risk of developing these postoperative complications.
- Hydro procedures, massages, therapeutic exercises and other methods of physiotherapy, which will be prescribed by a doctor. Such procedures prevent the formation of blood clots, normalize blood flow.
- During the first few months, both limbs will have to be wrapped in special elastic underwear or compression stockings.
- Use drugs from the group of phlebotonics, angioprotectors. With the development of inflammatory processes, antibacterial drugs may be prescribed. Painkillers are used to relieve pain.
- If sutures are applied, they can be removed 7 days after the procedure.
- If the patient is overweight, then he should be returned to normal in order to reduce the load on the veins.
- It is recommended to give preference to wide clothes made of natural fabrics and comfortable footwear. Wearing high heels is contraindicated.
- At home, try to keep your legs raised with rollers or pillows.
The rehabilitation period can last up to several weeks, during which time the patient will be issued special sick leave.
Modern methods of removing varicose veins involve a rehabilitation period of only a few days, but they are more expensive than usual.
In the future, the patient must come for a second examination and undergo an additional examination in order for the doctor to assess the effectiveness of the treatment.
Operating costs
Phlebectomy is performed both in public clinics and in plastic surgery centers, the purpose of which is to eliminate aesthetic defects.
Patients are interested in how much varicose vein surgery costs.
It all depends on the clinic and the qualifications of the doctor performing the procedure, as well as the degree of disease development and the complexity of the proposed operation. It is not the last place in the formation of prices for the city and the region in which the patient intends to perform the procedure.
Numerous clinics include preoperative examination, as well as the rehabilitation period, at the expense of costs.
Expert forecasts
The implementation of a combined phlebectomy procedure does not exclude the possibility of recurrence of the disease. After the application of radical treatment methods, recurrence of varicose veins is possible due to physiological characteristics of the organism (structure of blood vessels and veins), or violation of the technique of performing the procedure (if the doctor could not normalize the patency of the affected vein). The risk of recurrence of the disease was observed in approximately 15-20% of cases. In case the patient notices manifestations of recurrent relapse of the disease, a doctor should be consulted as soon as possible.
Only an experienced specialist will help you correctly suggest which varicose vein removal surgery to choose, as well as give useful recommendations that you will need to follow during the recovery period. If you do not consult a doctor in time, the consequences can be most unfortunate and irreversible.