Varicose veins is a disease characterized by a change in the condition of the veins in the legs with impaired blood flow. When the shape is neglected, the vessels swell, which leads to swelling and soreness of the limbs (under load), as well as to aesthetic discomfort. Surgical removal of damaged veins is effective for this stage.
Indications for varicose vein surgery
Varicose vein surgery can only be performed if there are indications for removal of blood vessels:
- varicose veins have affected most of the vein;
- severe pain and swelling of the legs during exercise, which interfere with normal life;
- the formation of open wounds and ulcers against the background of the development of the disease. It is dangerous to attach a secondary infection;
- impaired blood permeability through the vessels, often accompanied by convulsions;
- pronounced development of vascular necrosis;
- pathological changes in the veins, accompanied by their dilation and protrusion. The change is dangerous from vascular trauma and also causes aesthetic discomfort;
- blood clots in the veins.
Surgery is permissible only in advanced forms of varicose veins and in the absence of dynamics in conservative treatment.
Absolute and relative contraindications for surgical intervention
Leg vein removal surgery for varicose veins is performed not only if there are indications, but also in the absence of contraindications:
| Absolute bans on surgery | List of relative prohibitions |
| Stable high blood pressure | Presence of infectious diseases |
| Regular blood pressure spikes | Dermatological pathologies affecting the skin of the feet |
| Chronic heart disease | Inflammatory processes in the body, including blood vessels |
| Elderly after 70 | Recovery period after other surgeries |
| Presence of cancer | Chemotherapy |
| Diabetes mellitus and severe asthma | Severe soft tissue injury from trauma |
| Thinning and fragility of blood vessels | Acute liver and kidney pathologies |
| Patients with limited mobility of the legs (paralysis) or bedridden patients | Blood clotting disorder or anemia |
| Varicose veins in the last stage | Taking hormones, antibiotics or other aggressive drugs |
| Presence of complex leg fractures (with damage to blood vessels and nerve endings) | Overweight |
| Allergic reaction to drugs used during surgery | Patient's refusal of surgery |
When you are carrying a child, there may be a violation of the condition of the veins in the legs. More often the pathology is eliminated on its own after birth. In the presence of contraindications, surgery is dangerous with deterioration of the patient's condition and even fatal.
Phlebectomy
Phlebectomy is a surgical procedure to remove damaged veins and restore normal blood flow to the deep veins.
Anatomical significance, technique of major vein removal surgery
The circulatory system in the legs consists of a deep vein and many branches of superficial veins that affect the varicose veins. Changes in vascular activity develop due to valve dysfunction. During the normal functioning of the vessels, the valves are closed, which ensures blood flow in only one direction.
In the veins of those affected by varicose veins, the valves do not close, as a result, the blood can move in both directions, leading to impaired blood flow, with blood congestion and bulging veins.
In order to restore the blood supply to the limb, it is necessary to eliminate the affected vein (with reverse blood flow), ie to perform a phlebectomy. Before the operation, the patient undergoes preparation (taking tests, scanning the condition of the veins, determining the general condition of the patient).
If there are no contraindications, specialists perform a surgical procedure, which consists of the following stages:
- Access to the affected vessel is provided through a small incision (in the groin or patella, depending on the location of the vein). The damaged vessel is then ligated from a deep vein to block blood flow.
- An incision is made near the varicose vein. With the use of a probe, a vessel separates from the muscle tissue, lymphatic system and small capillaries. The damaged vein is removed through a tube or with the help of a hook.
- Capillaries are treated to prevent bleeding.
- If there are damaged capillaries that form spider veins, they are removed.
- Cosmetic sutures, a disinfectant bandage and an elastic bandage are applied at the end.
The operation is performed under general or local anesthesia. It depends on the size of the vessel and its location.
Performance level
Surgical removal of veins is used at different stages of the development of varicose veins. The procedure is highly effective (over 98%). Restoration of blood circulation occurs in a short time.
Rehabilitation
The effectiveness of the procedure depends not only on the qualification of the surgeon, but also on compliance with the rules in the postoperative period.
After phlebectomy you need:
- thread care for 7-14 days in hospital;
- wearing compression stockings or elastic bandages for 30 days is done around the clock;
- after 30 days, for another 3 months, wearing specialized underwear during the day
- water procedures with foot washing (where the operation was performed) are possible only after removal of the sutures;
- saunas, baths and hot tubs are prohibited during the recovery period;
- Medicines for pain after surgery are prescribed by a doctor. Self-choice is forbidden;
- take additional medicines to prevent blood clots;
- taking drugs to strengthen the walls of blood vessels (vitamins E and C);
- it is forbidden to stay for a long time in an upright / sitting position, wearing high-heeled shoes and tight underwear;
- During the period of rest in a supine position, the legs should be above body level. Promotes the flow of excess blood and reduces swelling;
- timely and gradually introduce physical activity to normalize blood flow (discussed with your doctor);
- massages and physiotherapy are performed with the permission of the treating specialist;
- abstinence from alcohol and nicotine. Alcohol provokes vasodilation, and tobacco, on the contrary, leads to their narrowing. These effects reduce the effectiveness of the operation;
- If you are overweight, a low calorie diet is prescribed.
If the rules are followed, it is possible to fully restore limb function in 6 months.
Laser endovenous coagulation
Surgery to remove leg veins with varicose veins with the help of a laser is performed when direct vessels with a diameter of at least 0, 02 cm and a small number of capillaries are affected. The procedure consists in the action of light waves on the damaged vessels with their subsequent soldering and destruction.
Equipment
Laser coagulation of veins can be performed with any of 3 types of optical fibers:
| Fiber Optic Type | Action Summary |
| End (classic) | This light guide produces beam radiation from the end, ie the ship is sealed in front of it. The disadvantage is the formation of hematomas and a painful feeling of tightness in the veins. Maximum vein diameter 0. 1 cm. |
| Radial (with elves painless radial light guide) | The light waves from the fiber form a circle that envelops a vein in diameter. This allows the treatment of veins of any size. And also the risk of hematoma formation and development of puffiness is minimized. |
| Of 3 types of radial fibers | Two-ring lasers are used to eliminate varicose veins. The first prepares the vein for the procedure (removal of excess fluid), the second round solders the walls. Light guides for fine and short veins, as well as for large vessels, are produced for treatment. |
The choice of equipment is made not only by the patient, but also by the treating specialist for the condition of the vessels.
Which veins can be removed with the EVLK method
Before choosing an EVLK from a phlebologist (a specialist who examines veins and eliminates varicose veins), the characteristics of the damaged vessels are determined. They must be straight and at least 2 mm in diameter.
As a result, laser therapy can be applied to the following groups of vessels:
- small and large saphenous veins; saphenous accessory veins that are at least 5 mm from the surface of the epidermis;
- vessels connecting deep veins with superficial ones.
In other veins, therapy is only possible with phlebectomy.
Efficiency
EVLK vein removal is possible with 3 types of optical fibers. Depending on the type of equipment, the effectiveness of the treatment varies. When surgery is performed with the help of an extreme light guide, the effectiveness of the therapy is 94-96%. The operation with radial light guides allows to achieve a 100% result in eliminating varicose veins in the legs.
Stages of preparation and implementation
When choosing to remove varicose veins with EVLK, the patient must undergo the following training:
- Withdrawal of hormonal drugs (if taken). Because they can cause thrombosis;
- one day before the intervention it is necessary to take blood thinners;
- screening of damaged veins to determine the extent of their damage;
- taking tests to rule out the presence of a hidden infection or inflammatory processes in the body. Blood clotting is also determined;
- the site of the procedure is washed thoroughly and shaved (only antibacterial soap is allowed without the use of cosmetics).
Before the start of the operation, the boundaries of the damaged vessels, the place of laser / fibrous insertion and the place of branching of the capillaries are marked. These brands allow you to solder the beginning and end of the vein, as well as the outlets of the capillaries. The process is performed under the control of an ultrasonic machine.
EVLK is produced in stages:
- Catheter insertion by small puncture (catheter insertion site is anesthetized with local anesthesia) in the marked area. The light guide will move on it.
- Inserting the fiber into the catheter and then moving it to the affected area. It is performed under ultrasonic control on a monitor.
- Injection of anesthetic to tingle the vein and adjacent tissues.
- Movement of the "active" light guide through the damaged vein, followed by a delay in the places where the capillaries branch (to seal the outlets and prevent bleeding)
- Removal of the laser with antiseptic treatment at the puncture site and application of an elastic bandage (or with the help of compression stockings).
After the procedure, the patient can leave the hospital immediately.
Rehabilitation characteristics
To restore the function of the damaged limb and prevent the development of complications, you need to know the nuances of rehabilitation after EVLK.
They are:
- after the procedure it is recommended to walk the operated leg to a medical institution for one hour;
- for 2-3 days ultrasound control of the treated vein is performed;
- within 5 days it is necessary to wear specialized underwear around the clock (the type of socks is discussed with the treating specialist before the operation). In addition, within 45-60 days, clothes should be used during the day;
- perform daily foot kneading, walking every day for 60 minutes;
- Avoid overloading your legs (prolonged sitting or standing) and visiting saunas or taking hot baths.
If the removal of varicose veins is still required, the procedures are allowed to be performed no earlier than 7 days.
The benefits of each method
Varicose vein surgery, depending on the type of intervention, has the following advantages:
| Phlebectomy | EVLK |
| The incisions for the operation are about 5 mm, so there are almost no scars | No pain during the procedure (using local anesthesia). No general anesthesia is required |
| Painless as the operation is performed under local anesthesia. Local anesthesia is used for miniphlebectomy. | EVLK is performed under ultrasound control. The result is high accuracy and efficiency. |
| Low price | Hematomas and pain at the site of surgery are rare or mild. |
| Fast recovery of skin tone (absence of stars and purple-cyanotic shade of the epidermis) | The operation requires 1 drilling, so no stitches and scars are needed |
| Short recovery period of about 30 days | Recovery period up to 5 days |
| Effective in all forms of varicose veins | After the operation, the patient can leave the clinic within 1 hour. |
| Restoration of normal life is possible after 24 hours. | |
| EVLK can be performed when the integrity of the epidermis is compromised by ulcers. | |
| The duration of the surgery is no more than 40 minutes. | |
| EVLK can be done on both feet in one day. A second operation on one leg is allowed after 7 days. |
The risk of infection during the procedure is minimal as the incision / puncture is small.
Complications after surgery and laser vein surgery
There is a risk of complications after removal of the veins by surgery or laser. Adverse reactions may occur due to the low qualification of the specialist or due to violation of the rules during the rehabilitation period. Possible complications of phlebectomy and endovenous coagulation.
| Vein removal methods | Minor complications of procedures | Major Complications |
| Phlebectomy |
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| Endovenous laser coagulation |
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An allergic reaction to anesthetics may develop during both operations.
Measures to minimize complications
Surgery to remove leg veins with varicose veins is sometimes accompanied by the development of complications, to prevent their occurrence, it is necessary:
- testing for allergic reactions to the drugs used;
- exclusion of infectious diseases and inflammatory processes in the body before surgery;
- selection of proven clinics with highly qualified specialists and modern equipment;
- compliance with the rules during the recovery period. Especially wearing compression underwear;
- follow the diet during the recovery period (discussed by a specialist after the procedure). The amount of pure water in the diet increases, food intake is carried out in small portions, the diet is enriched with vitamins and minerals;
- legs to rest during working hours;
- to be examined after surgery to monitor the dynamics of limb recovery;
- for massages and visits to physiotherapy procedures to quickly restore blood flow.
If you find unacceptable abnormalities during this operation, you should contact the clinic immediately.
Comparison of forecasts
In both methods of removing leg veins, the probability of complete recovery is higher than 95%, but provided that the contraindications are eliminated, the rules are followed during the rehabilitation period and when choosing a proven clinic. In surgical treatment the blood flow and the external condition of the legs are restored after 3 months, and in laser therapy the recovery is noted after 30 days.
In advanced forms, the removal of blood vessels is performed by surgery. The method of treatment is determined not only by the patient's desire, but also by the presence of indications and contraindications for the procedure. The effectiveness of therapy depends on the qualifications of the doctor and the application of the rules of foot care after surgery.