Removal of the veins of the lower extremities is indicated as a radical treatment method. The patient may be prescribed an operation to remove varicose veins on the legs in the event that the use of conservative and alternative methods of therapy does not have the correct therapeutic effect and the disease continues to progress.
With an advanced form of varicose veins, surgery is able to solve the following tasks:
- Eliminates pathological reflux (reverse flow) of blood.
- Saves healthy areas of the saphenous veins not affected by the disease.
- Eliminates affected vein areas.
Before the operation, the doctor makes a marking of the veins under the control of ultrasound, which allows you to determine the limits 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 varicose veins, the possibility of recurrence is not great.
In modern medicine, preference is given to the combined phlebectomy procedure, which involves the use of several techniques at the same time.
The main stages of combined radical treatment are: upper or lower crossectomy, short stripping, ligation of perforating veins, mini-phlebectomy.
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 steps of the classic combined phlebectomy.
Types of operations
The generic name of the operation to remove the affected veins is phlebectomy. Modern types of this procedure:
- Stripping(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.
- Laser phlebectomyis a modern treatment method 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 inserted into a vein together with a small diameter catheter, 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 disturbs 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 the degree of damage. In the future, the surgeon has the ability to cut the affected area.
The so-called seamless technologies are very popular, when the excision of the affected venous areas is done through small puncture cuts. 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.
Advantage of the miniflebectomy method
Miniflebectomy is one of the most painless and non-traumatic methods of surgical removal of affected veins. The procedure is performed in three stages: diagnosis, a small incision with a scalpel at the site of disturbed blood flow and extraction of the affected 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, painful sensations disturb in isolated cases.
Miniflebectomy is an almost painless way to get rid of varicose veins, the recovery period after surgery is minimal.
In order to minimize the risk of bruises and contusions, the operation can be performed using tumescent anesthesia, which, in addition to anesthetic, contains 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 refers to the ligation and subsequent resection of the minor or major saphenous vein. As an independent operation, such a procedure can be performed only in emergency cases when there is a risk of spreading an acute form of thrombosis.
Today, there are more benign alternative crossectomy procedures: endovascular laser obliteration and radiofrequency ablation.
The advantages of the techniques are: the ability to refuse general anesthesia, outpatient treatment, the absence of cosmetic defects in the form of scars from incisions and scars.
The disadvantages include a greater likelihood of disease recurrence and a rather high cost of these procedures.
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 exam types can be assigned:
- Performing an ultrasound of the leg veins.
- Complete blood count.
In the future, the doctor will conduct an oral survey to identify possible contraindications to surgery. A preliminary examination allows you to select the optimal type of surgical procedure or, if necessary, to combine several known techniques at the same time.
It is very important for the patient to understand how to behave correctly before and after the procedure. Before the operation, it is recommended to refrain from taking any medications that include aspirin due to the risk of bleeding. On the day of the operation, it is not necessary to prepare very carefully for the procedure - it is enough to remove the hair in the area of the operated limb.
When the operation is needed
Patients wondering whether surgery is needed for varicose veins of the lower limbs should understand that such a radical method of therapy is necessary in the following cases:
- Rapid progression of the disease, which is accompanied by a severe pain syndrome.
- Development of grade 1-4 varicose thrombophlebitis.
- Sensation of intense heat and burning in the veins.
- Spread of varicose veins over the kneecaps.
- Visible mass of a swollen, aesthetically unattractive vein.
The operation is also indicated for the formation of trophic disorders (ulcers) that have not healed for a long time, for which conservative therapy does not have the right therapeutic effect.
Contraindications and possible consequences
It is imperative to take into account the possible contraindications and consequences of the intervention.
Surgery cannot be performed if the patient has a history of diseases such as hypertension, abnormal heart rhythm, ischemic heart disease, presence of infectious diseases in the acute phase, dermatological inflammatory diseases of the legs.
The operation should not be performed in late pregnancy, as well as in elderly patients with weakened immunity.
Patients should be aware of the complications and consequences of the surgery:
- Sensory impairment of the operated limb due to damage to nerve endings.
- Periodic or persistent numbness in the ankle area.
- Formation of suppuration.
- Development of bleeding of various intensity.
- Reform of protruding veins above or below 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 of concern. In this case, drugs from the group of anticoagulants for topical use 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 respect the rest regimen 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 pass.
Therefore, before deciding whether to undergo surgery for varicose veins of the legs, it is necessary to take into account all possible risk factors: weigh the pros and cons. The operation should be performed in cases where the manifestations of the disease disturb patients for a long time and significantly impair the quality of life.
It is also necessary to consult only experienced and qualified doctors who perform such operations: phlebologists, angiosurgeons.
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 can quickly return to the usual way of life. During the first 48 hours, patients are strictly prohibited:
- Drinking alcoholic beverages.
- Engine transport management.
- Bathing in a whirlpool tub.
- Excessive physical activity.
In the first days after the operation, leg discomfort and an increase in body temperature may occur. In this case, drug therapy methods are used, physiotherapy is prescribed. The patient does not have to be constantly in a horizontal position. You should walk a little every day to restore blood flow.
In addition, the implementation of the following recommendations minimizes the risk of developing the listed postoperative complications.
- Hydrotherapy, massage, remedial gymnastics and other physiotherapy methods prescribed by the attending physician. Such procedures prevent the formation of blood clots and normalize the outflow of blood.
- For the first few months, both limbs will need to be rewound with a special stretch underwear or compression hosiery worn.
- Use medicines from the group of phlebotonics, angioprotectors. With the development of inflammatory processes, antibacterial drugs can be prescribed. Pain medications are used to relieve pain.
- In case the stitches are 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 recommended to give preference to loose clothing made from natural fabrics and comfortable shoes. Wearing high heels is contraindicated.
- At home, try to keep your legs elevated using pads 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 require a rehabilitation period of a few days, but are more expensive than usual.
In the future, the patient must report for a second examination and undergo an additional examination so that the doctor can evaluate the effectiveness of the treatment.
Cost of operation
Phlebectomy is performed both in state clinics and in plastic surgery centers, the purpose of which is to eliminate cosmetic imperfections.
Patients wonder how much an operation for varicose veins 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.
The combined phlebectomy procedure does not exclude the possibility of disease recurrence. 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 was notable to normalize the patency of the affected vein). The risk of a second exacerbation 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, a doctor should be consulted as soon as possible.
Only an experienced specialist will help you correctly suggest which surgery to remove varicose veins to choose and will also provide 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.