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 methods of therapy does not have the proper 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 disease-free, healthy sections of the saphenous veins.
- 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 sections of the vein is carried out using a narrow probe, which is inserted through a small incision. After the affected area is removed, the risk of recurrence of the disease is low.
After surgery to remove a varicose vein, the chance of a recurrence of the disease is low.
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 the listed procedures can be used as an independent operation. In some cases, as an alternative to some stages of the classical combined phlebectomy, minimally invasive methods of treatment in the form of sclerotherapy or laser obliteration can be offered.
Operation types
The general name for the operation to remove the affected veins is phlebectomy. Modern types of this procedure:
- The implementation of 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.
- The implementation of 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 the vein along with a small diameter catheter, then 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 inserted into the vein area, and the doctor can personally analyze its condition and degree of damage. In the future, the surgeon has the opportunity to cut off the affected area.
The so-called seamless technologies are very popular, when the affected area of the vein is excised through small pinpoint incisions. Already 4-6 hours after the manipulation, the patient can walk independently. In the event that the development of trophic disorders is observed, 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 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 much time from the patient. Scars, bruises are not formed at the puncture site, pain is disturbed in isolated cases.
Miniphlebectomy 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 bruising and bruising, the operation can be performed using tumescent anesthesia, which, in addition to the 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 carried out 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 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 incisions and scars.
Among the disadvantages, one can note a higher probability of recurrence of the disease and a rather high cost of these procedures.
Training
The operation for varicose veins of the lower extremities is carried out after a preliminary examination of the patient and the implementation of an internal examination.
The following types of examinations can be assigned:
- Ultrasound of the leg veins.
- General blood analysis.
In the future, the doctor will conduct an oral survey in order to identify possible contraindications for surgical intervention. A preliminary examination allows you to choose the optimal type of surgical procedure or, if necessary, combine several well-known methods at once.
It is very important that the patient understands how to behave correctly before and after the procedure. Before surgery, it is recommended to refrain from taking medications, which include acetylsalicylic acid, because of the risk of bleeding. On the day of the operation, it is not necessary to prepare for the procedure especially carefully - you only need to get rid of the hair in the area of the operated limb.
When is an operation needed?
Patients who are wondering if surgery is needed 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.
- Feeling of intense heat and burning in the region of the veins.
- The spread of varicose veins above the kneecaps.
- 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 proper therapeutic effect.
Contraindications and possible consequences
It is mandatory to take into account possible contraindications and consequences of surgical intervention.
Surgical intervention 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 in the legs.
The operation can not be done in late pregnancy, as well as in elderly patients with weakened immunity.
Patients should take into account the possible complications, as well as the consequences of surgical intervention:
- Violation of the sensitivity of the operated limb as a result of damage to the nerve endings.
- Intermittent or persistent numbness in the ankle area.
- The formation of suppuration.
- The development of bleeding of varying intensity.
- Re-education of bulging veins in a place above or below postoperative scars.
- The pain syndrome does not bother all patients and occurs if the nerve endings have been affected. Normalization of sensitivity in most cases occurs independently, without the use of any drugs.
- Hematomas and bruises at the surgical site may be disturbing. In this case, drugs from the group of anticoagulants for topical use can be prescribed. If the patient has very delicate and sensitive skin, then traces of bruises can persist for 1-1. 5 months.
- The development of edema may indicate that the patient does not follow the instructions of the doctor, 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 doing surgery for varicose veins, you should take into account all possible risk factors: thoroughly weigh the pros and cons. The operation should be done 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 with experienced and qualified doctors who perform such operations: phlebologists, angiosurgeons.
Recovery period
After the operation, the patient is recommended 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 usual lifestyle. During the first 48 hours, patients are strictly prohibited from:
- The use of alcoholic beverages.
- Motor transport management.
- Bathing in a 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 involved, physiotherapy is prescribed. The patient should not always be in a horizontal position. You should walk a little daily to restore blood flow.
In the future, the implementation of the following recommendations also minimizes the risk of developing these postoperative complications.
- Hydroprocedures, massage, 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 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.
- In the event that sutures have been applied, they can be removed 7 days after the procedure.
- If the patient is overweight, then it should be brought back to normal in order to reduce the load on the veins.
- It is recommended 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 using rollers or pillows.
The rehabilitation period can take up to several weeks, during which time the patient will be issued a 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 so that the doctor evaluates the effectiveness of the treatment.
Operation cost
Phlebectomy is performed both in public clinics and in plastic surgery centers, the purpose of which is 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 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 given to the city and region in which the patient intends to carry out the procedure.
A number of clinics include a preoperative examination, as well as a rehabilitation period, on account of the cost.
Forecasts from experts
The implementation of the combined phlebectomy procedure does not exclude the possibility of a recurrence of the disease. After the use of radical methods of treatment, a recurrence 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 performing the procedure (if the doctor could not normalize the patency of the affected vein). The risk of re-exacerbation of the disease is observed in approximately 15-20% of cases. In the event that the patient notes manifestations of a repeated relapse of the disease, one 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 a timely manner, the consequences can be the most deplorable and irreversible.