Removal of veins in the lower extremities is called radical treatment. Surgery to remove varicose veins of the legs may be prescribed to the patient if the use of conservative and alternative therapies does not have the appropriate therapeutic effect and the disease continues to progress.
In the advanced form of varicose veins, surgery can solve the following problems:
- Elimination of pathological reflux (reverse flow) of the blood.
- Keep healthy areas of subcutaneous veins free of disease.
- Eliminate the affected areas of the veins.
Before the operation, the doctor marks the veins under ultrasound control, which allows you to determine the extent of the affected segment. Removal of the affected vessels and areas of the vein is performed using a narrow probe, which is inserted through a small incision. After removal of the affected area, the risk of recurrence of the disease is low.
After surgery to remove varicose veins, the chance of recurrence of the disease 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, miniphlebectomy.
In the initial stages of the disease, each 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 treatments in the form of sclerotherapy or laser obliteration may be offered.
Types of operations
The common name for surgery to remove the affected veins is phlebectomy. Modern types of this procedure:
- Performing the stripping 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 a laser. 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 with a small diameter, after which, under the influence of the pulse, small vapor bubbles 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 placed in the area of the vein and the doctor can personally analyze the condition and the degree of damage. In the future, the surgeon has the opportunity to cut the affected area.
Very popular are the so-called seamless technologies, when the affected area of the vein is cut through small incisions. Already 4-6 hours after the manipulation the patient can walk alone. In case of development of trophic disorders, then endoscopic equipment is used.
The advantage of the miniphlebectomy method
Miniphlebectomy is one of the most painless and non-traumatic methods for surgical removal of the affected veins. The procedure is performed in three stages: 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 from the patient. No scars or bruises are formed at the puncture site, in some cases the pain is disturbed.
Miniphlebectomy is an almost painless way to get rid of varicose veins, the recovery period after surgery is minimal.
To minimize the risk of bruising and bruising, surgery can be performed with tumescent anesthesia, which in addition to anesthesia 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 and no pain.
Crestectomy
The concept of "crossectomy" means ligation and subsequent crossing of a small or large subcutaneous vein. As an independent 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 more gentle 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, lack of cosmetic defects in the form of scars from incisions and scars.
Disadvantages include a higher probability of recurrence of the disease and a fairly high cost of these procedures.
Training
Surgery for varicose veins of the lower extremities is performed after a preliminary examination of the patient and an internal examination.
The following types of examinations can be scheduled:
- Ultrasound of the veins of the legs.
- General blood test.
In the future, the doctor will conduct an oral examination to identify possible contraindications to surgery. The preview allows you to choose the optimal type of surgical procedure or, if necessary, to combine several well-known methods at once.
It is very important for the patient to understand how to behave properly before and after the procedure. Before surgery, it is recommended that you refrain from taking medicines that include acetylsalicylic acid, due to the risk of bleeding. On the day of the operation you do not need to prepare for the procedure very carefully - you just 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:
- The rapid progression of the disease, which is accompanied by intense pain.
- The development of varicose thrombophlebitis of 1-4 degrees.
- Feeling of intense heat and burning in the veins.
- The spread of varicose veins above the knee caps.
- Visible formation of a swollen, aesthetically unattractive vein.
The operation is also indicated for the formation of long-term non-healing trophic disorders (ulcers), for which conservative therapy does not have the necessary therapeutic effect.
Contraindications and possible consequences
It is mandatory to take into account the possible contraindications and consequences of surgery.
Surgery can not be performed 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 stage, dermatological inflammatory diseases of the legs.
Surgery should not be performed in late pregnancy, as well as in elderly patients with weakened immunity.
Patients should consider possible complications as well as the consequences of surgery:
- Impaired sensitivity of the operated limb as a result of damage to nerve endings.
- Periodic or persistent tingling in the ankle area.
- The formation of suppuration.
- The development of bleeding of varying intensity.
- Rehabilitation of bulging veins on the spot above or below the postoperative scars.
- The 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 disturbing. In this case, topical anticoagulants may be prescribed. If the patient has very delicate and sensitive skin, bruise marks 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 follow the rest regime and exposes the body, including the lower extremities, to excessive physical exertion.
Strictly follow the doctor's recommendations, it depends on how soon the consequences of the operation will pass.
Therefore, before deciding whether it is worth doing surgery for varicose veins, you need to consider all possible risk factors: carefully weigh the pros and cons. Surgery should be performed in cases where 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 experienced and qualified doctors who perform such operations: phlebologists, angiosurgeons.
Recovery period
After the operation, the patient is advised to 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 normal lifestyle. During the first 48 hours patients are strictly forbidden:
- The use of alcoholic beverages.
- Vehicle management.
- Bathing in a hot tub.
- Excessive physical activity.
In the first few days after surgery, there may be complaints of pain in the legs, as well as fever. In this case, medical methods of therapy are included, physiotherapy is prescribed. The patient should not always be in a horizontal position. You need to walk a little every day to restore blood flow.
In the future, the implementation of the following recommendations also minimizes the risk of developing these postoperative complications.
- Hydrotherapy, massage, therapeutic exercises and other physiotherapeutic methods that will be prescribed by the attending physician. Such procedures prevent the formation of blood clots, normalize blood flow.
- 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 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, he should return to normal to reduce the load on the veins.
- It is advisable to give preference to loose clothing made of natural fabrics and comfortable shoes. Wearing high heels is contraindicated.
- At home, you should try to keep your legs raised using rollers or pillows.
The rehabilitation period can take up to several weeks, during which time the patient will be granted 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 should come for a second examination and undergo an additional examination so that the doctor can assess the effectiveness of treatment.
Cost of the operation
Phlebectomy is performed both in public clinics and in plastic surgery centers, which aims 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. Not the last place in the formation of prices is the city and the region in which the patient intends to perform the procedure.
A number of clinics include a preoperative examination as well as a rehabilitation period at the expense of costs.
Forecasts by experts
The performance of the combined phlebectomy procedure does not exclude the possibility of recurrence of the disease. After the use of radical treatments, recurrence of varicose veins is possible due to the physiological characteristics of the body (structure of blood vessels and veins) or violation of the technique of performing the procedure (if the doctor can not normalize the patency of the affected vein). The risk of recurrence of the disease is observed in approximately 15-20% of cases. If the patient notices a recurrence of the disease, you should consult a doctor as soon as possible.
Only an experienced specialist will help you correctly suggest which operation to remove varicose veins to choose, as well as give useful recommendations that will need to be followed during the recovery period. If you do not consult a doctor in time, the consequences can be most deplorable and irreversible.