Removal of veins in the lower extremities is referred to as radical methods of treatment. An operation to remove varicose veins in the legs can be prescribed to the patient if the use of conservative and alternative therapeutic methods does not have the correct 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.
- Save healthy, disease-free sections of saphenous veins.
- Eliminate 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 affected vessels and vein sections is done using a narrow probe, which is inserted through a small incision. After the affected area is removed, the risk of disease recurrence is low.
After surgery to remove a varicose vein, the chance of the disease returning is low.
In modern medicine, they prefer the combined phlebectomy procedure, which involves the use of several techniques at the same time.
The main stages of the combined radical treatment are: upper or lower crossectomy, short stripping, ligation of the perforating vein, miniflebectomy.
In the initial stages of the disease, any of the listed procedures can be used as an independent operation. In some cases, minimally invasive treatment methods in the form of sclerotherapy or laser obliteration may be offered as an alternative to some stages of classic combined phlebectomy.
Types of operations
The general name for the operation to remove affected veins is phlebectomy. Modern types of this procedure:
- The implementation of the stripping procedure (long or short) is the most delicate technique, during which the doctor can only remove a certain part of the affected vein. The procedure is done 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 tools. The laser is injected into the vein together with a catheter of small diameter, then under the influence of the pulse, small bubbles of vapor are formed, which hit 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.
The so-called seamless technologies are very popular, when the affected area of the vein is excised through small punctate incisions. Already 4-6 hours after the manipulation, the patient can walk independently. In the event that the development of trophic disorders is observed, endoscopic equipment is used.
The advantage of the miniflebectomy method
Miniflebectomy is one of the most painless and non-traumatic methods of surgical removal of the affected veins. The procedure is carried out in three stages: 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 a long time from the patient. Scars, bruises are not formed at the puncture site, pain is disturbed in isolated cases.
Miniflebectomy is an almost painless way to get rid of varicose veins, the recovery period after the operation is minimal.
In order to minimize the risk of bruises and bruises, the operation can be performed using tumescent anesthesia, which, in addition to anesthetic, includes a substance that has a vasoconstrictive 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 spreading an acute form of thrombosis.
To date, there are more gentle alternative procedures for crossectomy: performing endovascular 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 incisions and scars.
Of the disadvantages, an increased likelihood of disease recurrence and a rather high cost of these procedures can be noted.
Training
The operation for varicose veins of the lower limbs is performed after a preliminary examination of the patient and the performance of an internal examination.
The following types of exams can be assigned:
- Ultrasound of the leg veins.
- General blood test.
In the future, the doctor will conduct an oral investigation in order to identify possible contraindications to surgical intervention. A preliminary examination allows you to choose the optimal type of surgical procedure or, if necessary, to combine several known methods at the same time.
It is very important for the patient to understand how to behave correctly before and after the procedure. Before surgery, it is recommended to refrain from taking medications, including acetylsalicylic acid, due to the risk of bleeding. On the day of the operation, it is not necessary to prepare for the procedure with special attention - it is enough to get rid of the hair in the area of the operated limb.
When is an operation needed?
Patients who are wondering whether surgery is required 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 intense 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 over the kneecaps.
- Visible formation of a swollen, aesthetically unappealing 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 correct therapeutic effect.
Contraindications and possible consequences
It is mandatory to take into account possible contraindications and consequences of surgical intervention.
Surgery cannot be performed if the patient has a history of diseases such as hypertension, heart rhythm disturbances, coronary heart disease, the presence of infectious diseases in the acute stage, dermatological inflammatory diseases of the legs.
The operation should not be performed at the end of pregnancy, as well as in elderly patients with weakened immunity.
Patients should take into account possible complications, as well as the consequences of surgical intervention:
- Violation of the sensitivity of the operated limb due to damage to the nerve endings.
- Intermittent or persistent numbness in the ankle area.
- The formation of suppuration.
- The development of bleeding of various intensity.
- Re-education of the protruding veins in a point above or below the postoperative scars.
- Pain syndrome does not bother all patients and occurs if nerve endings have been affected. Normalization of sensitivity in most cases occurs independently, without the use of drugs.
- Hematomas and bruises at the surgical site can be bothersome. In this case, drugs from the group of topical anticoagulants can be prescribed. If the patient has very delicate and sensitive skin, the traces of bruises can persist for 1-1 to 5 months.
- The development of edema may indicate that the patient does not follow the doctor's instructions, does not observe the rest regime and exposes the body, including the lower limbs, to excessive physical exertion.
Strictly adhere to the recommendations of the doctor, it depends on how soon the consequences of the operation will pass.
Therefore, before deciding whether it is worth undergoing surgery for varicose veins, it is necessary to take into account all possible risk factors - carefully weigh the pros and cons. The operation 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 one can quickly return to the usual lifestyle. During the first 48 hours, patients are strictly prohibited from:
- The use of alcoholic beverages.
- Motorized transport management.
- Bathe in a whirlpool tub.
- Excessive physical activity.
In the first days after the operation, there may be complaints of pain in the legs and an increase in body temperature. In this case, medical methods of therapy are involved, physiotherapy is prescribed. The patient does not always have to be in a horizontal position. You should 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.
- Hydroprocedures, massages, therapeutic exercises and other methods of physiotherapy, 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 undergarments or compression stockings.
- Use drugs from the group of phlebotonics, angioprotectors. With the development of inflammatory processes, antibacterial drugs can be prescribed. Pain relievers are used to relieve pain.
- If sutures have been applied, they can be removed 7 days after the procedure.
- If the patient is overweight, he should be brought back to normal to reduce the load on the veins.
- It is advisable to give preference to loose clothing made from natural fabrics and comfortable shoes. Wearing high heels is contraindicated.
- At home, you should try to keep your legs elevated by 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 a few days, but they are more expensive than usual.
In the future, the patient must come for a second examination and undergo a further examination so that the doctor assesses the effectiveness of the treatment.
Cost of the operation
Phlebectomy is performed both in public clinics and in plastic surgery centers, the purpose of which is to eliminate imperfections.
Patients are interested in how much varicose vein surgery costs.
It all depends on the clinic and qualifications of the doctor performing the procedure, as well as on the degree of development of the disease and the complexity of the proposed operation. Not the last place in the formation of prices is assigned to the city and region where the patient intends to carry out the procedure.
A number of clinics provide for a preoperative examination, as well as a rehabilitation period, due to the cost.
Forecasts from experts
The implementation of the combined phlebectomy procedure does not exclude the possibility of a relapse of the disease. After the use of radical methods of treatment, a relapse of varicose veins is possible due to the physiological characteristics of the body (the structure of blood vessels and veins) or a violation of the technique of carrying out the procedure (if the doctor cannot normalize the patency of the affected vein). The risk of aggravation of the disease is observed in about 15-20% of cases. In the event that the patient notices manifestations of a repeated relapse of the disease, it is necessary to consult a doctor as soon as possible.
Only an experienced specialist will help you correctly suggest which operation to choose to remove varicose veins, as well as give useful advice 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.