Varicose veins on the legs surgical treatment

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.

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 flows.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, additionally connecting the superficial 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.

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 of veins-burning of 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 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).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;
• Flebectomy.

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.Domestic surgeons call classical phlebectomy the Operation Trojanov-Trendelenburg-Bubko-Narat, and foreign authors with complete stripping.The volume of intervention is presented:

1. 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.
2. 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.
3. 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.
4. 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.

Flebectomy

The innovative methodology for removing small varicose veins of a large subcutaneous vein is called phlebectomy.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 phleectomy.Such a combined operation combines radicalism and adhesive trauma with a good cosmetic effect.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 cattle-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 is affected by varicose veins, but also its tributaries, they are removed according to the phlebectomy method.

A disease such as varicose veins is a disease characterized by dysfunction of the vascular walls and the weakness of the valves in the veins, which causes stagnation in the blood vessels of the lower extremities and the appearance of venous nodes.Such a pathology is quite dangerous and fraught not only with trophic disorders and the presence of an inflammatory process, but also by the lack of tissue nutrition.As a rule, this contributes to the formation of blood clots, which can spread through blood flow through the entire body and the appearance of difficult to live trophic ulcers.In addition, the formation of thrombotic formations inside the vessels threatens the development of such a disease as thrombophlebitis.Therefore, if the patient has varicose veins of the lower extremities, surgical treatment is mandatory, especially if the ailment is launched.I would like to draw the attention of the readers of our site that surgery for varicose veins of the lower extremities is a radical measure and, as a rule, is prescribed if it can not do without it.Varicose disease of the lower extremities, surgical treatment involves several, most used in surgical practice options for surgical treatment.These options are directly in the approach to the removal of the affected vessels and veins of the lower extremities.

• The use of traditional phlebectomy in the surgical practice for the radical treatment of varicose veins.This option is performed in accordance with the Bebbok methodology.This implies the introduction of a probe specially designed for such a procedure in the lumen of the vessel and the subsequent extract of the vein through a pre -made incision on the skin.After the operation, its cord is performed with a cosmetic seam, subsequently making it almost invisible.
• Flebectomy - such an operation is required to remove small sections of blood vessels and veins, affected by varicose veins.Note that this operation does not provide for cuts on the skin, since part of the affected vessel or vein is removed by means of puncture on the skin, which does not require imposing seams.

Note that surgical intervention in the treatment of certain diseases is shown far.Nevertheless, varicose veins of the lower extremities, surgical treatment is extremely necessary if the removal of blood clots and potentially dangerous sources of the inflammatory process is required.This approach will improve the patient's condition and help to avoid severe and insecure for the health and life of the patient's complications.States requiring urgent surgery for varicose veins include:

• the presence of thrombophlebitis or the risks provoking its appearance;
• acute thrombophlebitis or frequent exacerbations of the disease;
• extensive defeat of blood vessels and veins;
• The constantly disturbing feeling of fatigue and severity in the legs, unpleasant pain, which indicates a clearly expressed varicose veins;
• The appearance of trophic ulcers.

There are also certain contraindications to the operation for varicose veins:

• second and third trimester of pregnancy;
• the presence of infectious ailments in an acute form;
• exacerbation of the pathologies existing in a patient (diabetes, asthma, peptic ulcer and others);
• myocardial infarction, stroke;
• Dermatological problems.

Stripping - as a rule, this method is used in the presence of a small section of the lesion, this is a technique that is more sparing, unlike traditional phlebectomy.The method consists in stretching, through a special hook, the most venous node.There is also a subspecies of this technique - cryostropping, which implies the sinking of the damaged vessel to the cryosonda and its subsequent removal.

Sclerosis - the technique provides for the introduction of a damaged sclerosant, a special substance for the “gluing” of the walls of the vessel among themselves.Nevertheless, after the procedure, the vein does not stretch, but remains in place, without fulfilling its purpose, although the blood flow through Vienna and stops, nevertheless, this function is performed by collateral vessels, which does not violate the outflow of venous blood.The operation is carried out under mandatory control of a specialist with ultrasound equipment.

Laser coagulation - this method is the most innovative in the treatment of varicose veins and is the introduction of special equipment with laser radiation (thin probe) into the lumen of the vein.The device has a cauterizing effect on the walls of the blood vessel.

Consequences after surgery to remove varicose veins:

• the appearance of characteristic postoperative hematomas on the surface of the body, which, as a rule, are resolved for several months;
• Also, after several months, seals under the skin located along the bed of the remote vessel disappear;
• Violations of the integrity of the lymphatic system (blood vessels) of blood vessels, which can lead to stagnant processes.Such postoperative consequences are treated conservatively, nevertheless, often the circulation of lymph is restored after a few months;
• Possible damage to the subcutaneous nerve endings, which is manifested by impaired sensitivity of the epidermis-this postoperative symptoms passes after 5-6 weeks.

Summing up

Varicose disease surgery

Traditionally, phlebectomy (crossectomy) is performed according to the Bebcock method and consists in introducing the probe into the lumen of the vein with the subsequent stretch of the vein completely over its length through the cut on the skin outside.The incision is sutured at the end of the operation with a cosmetic seam.Flebectomy is used to remove very short areas of the vein, during the operation, veins are not used.Cuts on the skin are not carried out, and a piece of vein is removed through a thin puncture on the skin that does not require imposing seams.With a small area of damage to varicose veins, it is possible to perform a more gentle technique - stripping.This is stretching out with a thin hook of only a varicose node.Experience is carried out by means of two cuts on the skin with their subsequent suturing.A variety of this technique is cryostropping - “sinking” of the vein to the cryosonda using low temperatures, the destructive node is also stretched out.

Vienna sclerosion is the introduction of a sclerosant into its lumen - a substance that “glues” the walls of the vein with each other, but the vein remains deep under the skin, not performing its functions.The blood flow through the vein stops and goes through collateral vessels, without violating the outflow of venous blood from the lower limb.Vienna sclerosis is carried out under the control of ultrasound.Laser coagulation of varicose veins is the latest method in phlebology and consists in introducing a thin probe into the lumen of the vein with laser radiation, which exerts a cauterizing effect on the walls of the vein.The method of radio frequency expounding of the veins also refers to a more modern treatment of varicose veins, but not all medical institutions are equipped with appropriate equipment.The technique consists in the “cauterizing” effect on the vascular wall of the radio waves of high frequency.