For many decades, the surgical treatment of varicose veins of the legs remains the only radical method of eliminating this disease and its complications.
Thanks to modern technologies and the improvement of operation techniques, it is really effective both in therapeutic and cosmetic terms, it is carried out as easily and painlessly as possible, well tolerated by patients and does not cause prolonged disability.
Indications and contraindications
It is not advisable to operate the patients with any varicose veins.There are clear indications for the operation and contraindications to its implementation.
Surgical treatment of varicose veins of the lower extremities is indicated in the following cases.
Medical indications- a pronounced expansion of veins of 2-3 degrees, accompanied by complaints and signs of chronic venous failure:
- convincing, tense veins under the skin;
- multiple varics (nodes) along the changed vessels;
- swelling of the affected leg;
- severity and pain along the expanded vein;
- convulsions in the calf muscles of the lower leg, when “reduces the leg;
- inflammatory changes in veins - thrombophlebitis;
- Trophilical skin disorders-dark spots, redness, sealing of the subcutaneous layer, a long-leafing wound-jazva.
Cosmetic indications- early (first) stage of varicose veins without signs of venous insufficiency, causing only a cosmetic defect and aesthetic discomfort in the patient:
- superficially located slightly expanded and convoluted veins;
- Vascular "stars", "spider" and reddish-blue small capillaries in the skin of the legs.
It is important to remember that even if there are indications from the operation, one has to refuse if the risk of it exceeds the benefit.
The main contraindications for the surgical treatment of varicose veins:
- The serious general condition caused by any acute (heart attack, stroke, pneumonia) launched chronic diseases (liver, cordial, pulmonary insufficiency) or old age of the patient.
- Any acute infectious diseases.
- Conductive treatment for cancer.
- Pronounced anemia.
- A pronounced increase or decrease in blood coagulation.
- Inflammatory and suppurative processes (scores, rashes) on the skin of the lower limb, where surgical intervention is planned.
- Pregnancy and early postpartum period.
All contraindications, except for the first, are considered relative.This means that under special circumstances (acute dangerous conditions caused by varicose veins, for example, thrombophlebitis on the thigh), one or another volume of surgical treatment must be performed.
When an emergency operation is needed
Emergency surgical treatment of varicose veins of the legs may be required in only one case - with acute ascending thrombophlebitis.This complication is an inflammation inside the lumen of a large subcutaneous vein, accompanied by the formation of blood clots.
If such a pathological process applies to the thigh, there is a risk of clutching blood clots into a deep venous system.In case of separation of such a blood clot, he penetrates the vessels of the lungs and clogs them, which causes a threatening life of a dangerous disease - pulmonary thromboembolism (pulmonary fiber).
The main manifestations of rising thigh thrombophlebitis:
- pain along the vein along the inner surface of the thigh;
- redness and increase in skin temperature;
- The seal of the changed area and its sharp pain on palpation.
With ascending thrombophlebitis, the volume of surgical treatment can be represented:
- Crossectomy - dressing and the intersection of a large subcutaneous vein at the place of confluence with the Bednaya;
- removal of a changed vein after preliminary dressing.
The goals of surgical intervention
Normally, about 30% of blood from the lower extremities flows through small subcutaneous venous tributaries, which merge in two central venous trunks - a large and small subcutaneous veins.These vessels are directly connected to deep veins, through which 70% of the blood flow out.In the places of such compounds there are valves that pass blood only from surface veins into deep ones.
There are also dozens of small veins, which are called perforant, additionally connecting the surface venous network with deep.They also have valves that pass blood in only one direction.
The main cause of varicose veins is the failure of the venous valves, which leads to improper blood discharge: from deep veins to surface, which increases pressure in them and leads to the expansion of both small vessels and central venous trunks.
The main goals for which surgical treatment is aimed at varicose veins of the lower extremities:
- The elimination of stagnation of blood in altered surface veins of the legs, which will prevent the progression of chronic venous insufficiency and trophic disorders on the skin.
- Removing deformed vessels and varieties representing a cosmetic defect.
- The elimination of the discharge of blood from deep veins into superficial ones - the ligation and intersection of perforant (clans) veins, as well as a large and small subcutaneous veins in the places of their connection with deep ones.
- Prevention of a repeated occurrence of varicose veins.
Preparation for the operation
Full -fledged preparation for surgical treatment for varicose veins includes:
- A general preoperative examination that allows you to assess the patient’s health-general blood and urine tests, coagulogram, biochemical analysis, blood type and Rh factor, syphilis tests, blood sugar level, lung radiography, ECG.
- Special diagnostics that allow you to determine the characteristics of the disease - an ultrasound with color Doppler mapping of surface, deep veins and arteries of the lower extremities and designating the location of insolvent perforant veins.
- The operation is performed on an empty stomach, so in the morning on the day of the operation you can not eat and drink.
- In the morning before the operation, it is necessary to carefully shave all the hair on the sore leg from the groin to the foot.
Treatment of female varicose veins
A separate place in the surgical treatment of female varicose veins of the lower extremities belongs to cosmetic surgery.After such interventions, not only pathologically altered veins, but also postoperative scars on the skin of the legs, or they are inconspicuous.
To achieve the maximum cosmetic effect, surgical surgery for varicose veins are carried out according to the following methods:
- Laser or radio frequency ablation veins-burning the central trunks of a large and small subcutaneous vein under the ultrasound control through a puncture of the skin on the thigh or on the foot.
- Stem sclerobliteration and sclerotherapy-Filling out large and small subcutaneous veins, as well as all their tributaries, even the smallest, with a special sclerocant drug.
With any of the described methods of treatment, varicose veins are not removed, but are turned from blood vessels into a soft cicatricial fabric.Both physical influences (laser rays, radio frequency waves), and chemical compounds (sclerosants) destroy the inner layer of the vein.Thanks to this, it loses the lumen, glues and completely desolates from the blood, turning into an ordinary connective (cicatricial) tissue.
Thus, without direct removal of veins, all the goals that are assigned to the rapid treatment of varicose veins of the lower extremities are achieved - changed vessels are eliminated, and the dangerous consequences of venous insufficiency are eliminated in them.
The only restriction of cosmetic operations in the treatment of varicose veins in women is possible only slightly or limitedly expanded veins to 1-2 degrees.During pregnancy and in the early postpartum period, surgical treatment is contraindicated with the exception of acute situations requiring emergency intervention, for example, with ascending thrombophlebitis.The operation is limited to the dressing of a large subcutaneous vein at the place of its connection with the femoral (crossectomy).
Types of surgical operations
Consider the most common surgical interventions in the treatment of varicose veins of the lower extremities: laser ablation, endoscopic dissection of the veins and phlebectomy.
The latter is divided into the following types:
- classic operation, or complete stripping or operation of Trojanov-trendelenburg-bubko-narata;
- short stripping;
- Miniflebectomy.
Flebectomy
Removal, extraction of veins from under the skin is called phlebectomy.This is one of the first methods of surgical treatment of varicose veins of the lower extremities.But even today, phlebectomy is most often performed by phlebology and vascular surgeons.There are three modifications and methods of operation: full, short stripping, miniflebectomy.
The volume of intervention is presented:
- As a bandage of the trunk of a large subcutaneous vein at the place of its confluence, 2-3 cm on the thigh under the inguinal fold, in the thigh, through an incision.
- Its removal throughout the groin to the foot using a special probe through two cuts of the skin 1-2 cm along the inner surface near the knee and ankle.
- The removal of all varicose veins and small veins through separate small incisions is about 1-2 cm (they can be from 5-6 to 10–20) with the dressing of insolvent perforant vessels.
- Sewing all wounds with cosmetic seams.
Classical phlebectomy most radically allows you to remove varicose veins, but the most traumatic among all existing techniques.
Short stripping
With a short stripping, not the entire large subcutaneous vein is removed, but only its fragments, affected by varicose veins, for example, only on the thigh or on the lower leg.Healthy segments are not removed.This reduces the trauma of the intervention, but the risk of relapse of the disease remains.Otherwise, operational operations of the operation are similar to classical phlebectomy.
Miniflebectomy
The innovative methodology for removing small varicose veins of a large subcutaneous vein is called miniflebectomy.
For its implementation, special tools (pointed scalpel, hooks, clamps, spatula) are needed, with which veins are extracted through the skin of the skin several millimeters.It is not necessary to sew such skin defects, scars are invisible.
Most often, surgeons combine a short or complete stripping of a large subcutaneous vein with miniflebectomy.Such a combined operation combines radicalism and minimal trauma with a good cosmetic effect.
Endoscopic dissection of veins
Finding all the inferior perforate veins during any phlebectomy is hard.For these purposes, endoscopic equipment (video camera and manipulators) is used.Through small cuts in 1-2 cm, they are inserted under the skin in places of clusters of perforant veins, which are detected with ultrasound.
Under the control of the camera, all inferior perforators find, bandage and cross them.During this operation, the subcutaneous veins are not removed.It can be performed both independently and in combination with any type of phlebectomy: stripping, miniflebectomy.
Laser treatment
Laser ablation for varicose veins involves burning with a laser beam of a large subcutaneous vein throughout from the side of its clearance.To do this, through the puncture of the skin on the thigh or in the ankle area into the lumen of the vein, a catheter-vertist is introduced to its entire length.Under the control of the ultrasound, the Svetovod is slowly extracted.
The laser beam, acting on the venous wall, destroys the inner layer.As a result, Vienna falls and ceases to function, which is clearly visible on the ultrasound monitor.If not only the main venous trunk, but also its tributaries, are removed by varicose veins, they are removed according to the miniflebectomy method.
Rehabilitation
Regardless of what operational methods of treating varicose veins were used, the restoration of patients in the postoperative period occurs quickly.The terms of full rehabilitation depend on the methodology of surgery, the stage of the disease and the general condition of the patient.With laser treatment and miniflebectomy of initial varicose veins, it is 2-3 weeks, with classic phlebectomy for advanced forms of the disease - 1-3 months.
Walking is recommended as early as possible, provided that the condition is stabilized after anesthesia - after 5-6 hours.If spinal anesthesia was performed, bed rest is recommended within 12 hours.With local anesthesia, the patient can leave the operating room on his feet and is not even hospitalized in a hospital.The main condition before walking is to bandage the legs with an elastic bandage or put on an individually selected compression knitwear.
Stay in the hospital from 1-2 to 5-8 days.If the seams were superimposed, it is better to remove them on 7-8 days during a control inspection from a specialist.Within a month after surgery, it is recommended to wear compression knitwear.It is necessary to put it on daily before getting out of bed.At night, compression products are removed.After classic phlebectomy with severe varicose veins, it is better to continue the compression for up to 3 months.
Throughout the month, it is strictly prohibited:
- sauna and hot bath;
- heavy physical activity on the lower limbs;
- A long stay in a motionless position standing or sitting.
Possible complications
The most common complications related to operations for varicose veins:
- Pain in the operated leg as a result of damage to large nerves.
- Long -lasting swelling of the lower leg and foot.
- Hematomas and bruises on the lower leg and thigh.
- Bleeding from wounds.
- Flebotrombosis - inflammation of deep veins.
- Supervision of postoperative wounds and necrosis (deadliness) of the skin around them with the formation of trophic ulcers.
- The formation of gross postoperative scars.
Thanks to modern methods and technologies, surgical treatment of varicose veins is easy, painless and with high efficiency.Compliance with all the recommendations of the postoperative period contributes to rapid restoration, minimizes the risk of complications and relapse of the disease.