Despite medical advancements, surgical treatment is the only way to get rid of varicose veins. Therapeutic methods that are effective only at the beginning of the disease, but they are only a supporting character. Today minimally invasive surgery is performed ambulatory and does not require a long recovery. And even traditional phlebectomy is performed with the improved method.
Varicose veins do I need surgery?
Varicose veins accompanied by painful symptoms and psychological discomfort, due to cosmetic defects. And suffer for it in the first place women. Medicines will not help to restore the stretched inflamed veins of the lost functions, especially at the 3. and 4. stages of the disease. The only way to restore normal foot traffic activity, which is the varicose veins. If you do not remove the affected veins, would not avoid the complications of thrombosis and venous disease.
Indications for the removal of veins
The need for surgery for varicose veins on the legs, shall be determined on an individual basis. The choice of techniques depends on the extent of injury, patient age, presence of comorbidities. Matters even of the weight of the patient. If any of the symptoms, a surgical operation:
- in the pathological process involved several vessels, are widespread and form a venous node;
- legs swell and hurt, they are cramping;
- disrupted valve apparatus and vice versa venous blood flow;
- start trophic changes of the skin becomes purplish-blue color, become dry and appear non-healing ulcers.
The doctor may decide for surgery if the varicose veins complicated to more vascular disease or other underlying health conditions, e.g., acute thrombophlebitis.
Contra-indications for surgery
Despite the low traumatic surgery, which makes it completely safe. Before making a decision is a vascular surgeon who examines the patient history for contraindications. Surgical treatment is unacceptable for the following diseases:
- serious violations of cardiac activity;
- elevated blood pressure;
- of malignant neoplasms;
- dermatitis and eczema;
- thrombosis of the veins of the lower extremities;
- infectious diseases.
A contraindication for surgery is pregnancy and period of lactation, a high level of obesity, age older than 75 years. You can't operate on a patient bedridden or with limited mobility.
In current clinical practice, surgical treatment of varicose veins is carried out in several ways. The task of the doctor is to exclude the blood flow in the affected vessels with their removal through the use of special hardware microsurgery. Modern surgery for varicose veins is minimal intervention with a good cosmetic effect.
Sclerotherapy refers to the non-surgical methods of treatment of varicose veins. If it is made in the early stages of the disease, the result will be a complete healing. In later phases, in combination with other types of surgery.
As a new technique of sclerotherapy is used on small branched surface vessels. During the surgery the large veins remove small branches remote vein in the final stage. Types of sclerotherapy:
- Echo sclerotherapy has been used more as a cosmetic procedure. Its purpose is expressed to eliminate spider and small veins. The technique consists in introducing into the vein of a special composition, which devastates her and stick to walls. The introduction of the sclerosant is performed under ultrasonic control. Treatment consists of several procedures, the visible effect appears within 2 months. In some cases, is used for the treatment of deep and main veins.
- Micro sclerotherapy is used in small vascular asterisks.
- Micro foam sclerotherapy is an innovative method, where the sclerosant use a mixture of active substances and the air.
- Traditional hardening of the blood vessels over large distances with the help of the catheter.
This procedure leaves no traces on the skin, which is an obvious advantage. Disadvantages include the possibility of recurrence of the disease, because the lumen within the vein may not close completely.
Laser coagulation of blood vessels — another minimally invasive methods of treatment of varicose veins. Its advantage consists in the possibility of operating also in the presence of trophic ulcers. There are two ways to laser photocoagulation, percutaneous and Transcutaneous. the elimination of spider veins. This method is used only on vessels of not more than 3 mm in diameter. The laser beam, avoiding skin, which heats the capillary to 70°C. grow together, the blood flow stops. Limit for the implementation of the intravascular laser coagulation is the diameter of the vein — it should be not more than 1 cm, the Procedure is as follows:
- The doctor performs duplex scanning of the diseased veins and causes a marker of its shape on the skin.
- Intake of fiber is neutralized.
- Injected into a vein fiber, where the laser beam affects blood and vascular wall. The blood evaporated, and protein on the inner shell of the vessel is improved by bonding. The rest of the endothelial cells subsequently form connective tissue in place of "sealed" wrists.
The whole operation takes no more than 45 minutes. As the echo of sclerotherapy is done under ultrasound control. The period of rehabilitation (up to complete disappearance of tracks and blood vessels) is a month and a half. The first five days you will need to wear a compression garment, and follow all recommendations of the doctor.
The use of intravascular electrocoagulation achieve the same effect as if exposed to a laser. For the coagulation and obliteration of the vessel using electrodes connected to a generator of high frequency current. The technique exists since the mid of the last century, it is considered obsolete and is rarely used in modern clinical practice.
Removal of varicose veins with a low temperature is almost not implemented in our country. For cryosurgery requires expensive equipment and highly qualified experts. Only in this way can we ensure the complete safety of operation. The principle of operation is similar to laser coagulation, the vessel is removed from the heart and the circulatory system through the games at the end.
Sometimes it is impossible to limit the removal of only the main saphenous veins, abolition of venous relief. This is required to stop the flow of blood through the veins connecting superficial vessels to the deep. Such an operation for varicose veins necessary when persistent trophic changes. The procedure is endoscopic surgery, which requires only a small incision in the upper part of the Tibia. The intersection of the vessel, which is performed with ultrasonic scissors. Today, the endoscopic procedure is also not popular as electrocoagulation. It is gradually replacing the current non-invasive techniques.
Stripping — sparing operation for varicose veins. The removal of the diseased vein is completely or only on the affected area is performed through small incisions using special tools — a special probe. Incisions are slightly below the groin and above the knee or above the ankle and in the popliteal fossa. Vienna cut from both ends and tied off, and the affected area is picked out. The surgery is performed under local anesthesia and takes about one hour and a half. This allows you to remove the diseased vessel, regardless of its length and diameter. In modern phlebology use a special type of operation, pulling out the veins, through the holes.
Radiofrequency ablation of veins
The method of radiofrequency ablation doctors have borrowed in cardiothoracic surgical practice. This game is at the end of the vessel under the influence of the high frequency current that creates a temperature up to 120°C. So as to not damage the surrounding tissue around the vessel with special anesthetic medicine formed a "water bed". Pulse, which gives the possibility to handle 7 cm vein. The device is equipped with an automatic regulation of the temperature in the tank and adjust the flow of energy.
The operation of the when running varicose veins
Surgery involves ligation of the veins in the Shins. This is carried out using a small thin cut with the endoscopic equipment. Indications for surgical intervention in the later stages of varicose veins:
- a lot of the damage the veins;
- valvular insufficiency;
- participate in the pathological process of perforating veins.
The operation of the Muller, or mini-phlebectomy, which is used in thrombosis and severe varicose veins. Through the small incisions acquired the troublesome vein. The incisions are sewn by the sun, and pulled together a band-aid so after the surgery, the skin does not remain traces. Surgery Muller is considered one of the best ways for surgical treatment of varicose veins, as it is, then when it is almost without relapse of disease.
One of the most effective and popular surgical removal of the varicose veins on the legs — combined phlebectomy. Its stages are in different stages of the disease are used as independent methods of treatment:
- the second is ligation of the great and small saphenous veins at their confluence into the deep vein;
- The scaling, when you remove the affected part of the venous trunk;
- the point of intersection (ligation) of incompetent perforating veins for the termination of horizontal venous reset;
- mini-phlebectomy — removal of nodes and varicose veins through small holes.
Preparation for the surgery
Before surgery to make sure that the survey is conducted. The objective of diagnostics is to determine the General condition of the patient. For this made in the laboratory. To determine the degree of dilatation and the localization of the area that you want to remove, help Doppler ultrasound scan. In some cases, it is assigned to your computer or magnetic resonance tomography.
Minimally invasive operations are carried out without special training. If you have a plan of combined operations, before a patient is recommended to eat a light dinner (no later than 6 PM) and make cleaning enema. Selection of compression hosiery in the next. Surgery for varicose veins of the lower extremities, performed on an empty stomach, with a preliminary ultrasound study of the veins to be removed.
As surgery varicose veins
Surgery to get rid of varicose veins on the legs to fix the reflux (backward reflux of venous blood). With the use of modern techniques, also in combination phlebectomy today carried out in the hospital one day, that is, the patient is discharged home the next day after the surgery. In this case, General anesthesia is not needed. If it is an extensive surgery, the patient is given General anesthesia or doing spinal anesthesia (anesthetized only the lower part of the body). Stay in hospital is 1-2 weeks.
In the first phase, the blood flow is displayed saphenous vein for ligation or gateway at the junction with the deep vein. Depending on the localization of the affected area, the incision is made in the groin or in the popliteal fossa.
After crossing the saphenous vein removed. Usually limited to the femoral site (short of Stripping), because it is the most often the ones who suffer. Removing a probe is considered to be the most reliable way. If you want to do this, in the region of the ankle or the upper part of the Tibia is done another cut. The probe with the cutting tool at the end of running through one of the holes in the sky through the other. At the end of the vein is attached to the tool and is extracted to the outside. A more gentle technique of PIN Stripping. At the end of the patient's veins is fastened with the screw threads on the walls of the vessel, and the surgeon pulls out of her, twisting inside.
In the next phase of the operation is the ligation of the perforating veins. If a few of them, who have access, the muscle fascia is not cut. This is to avoid any visible cosmetic defects. If damage is more, the doctor is the reduction of the muscles, which gives a more stable result. The use of endoscopic procedures, which allows you to make surgery less traumatic, but this is not all clinics, as this requires complex expensive equipment.
By the joint operation of the mini-phlebectomy, allows for removal of visible blood vessels strain. Following the signs on the skin, the surgeon through the small holes, removes small veins. The operation ends with stitching and elastic bandages.