For many decades, the surgical treatment of varicose veins of the legs remains the only radical method to eliminate this disease and its complications.
Thanks to modern technologies and the improvement of the operating techniques, it is very effective in both therapeutic and cosmetic terms, it is carried out as simple and painless as possible, well tolerated by patients and does not cause longer disability.
Indications and contraindications
It is not advisable to operate patients with varicose veins.There are clear indications of the company and the contraindications for implementation.
The surgical treatment of varicose veins of the lower extremities is given in the following cases.
Medical indications- A pronounced expansion of veins of 2-3 degrees, accompanied by symptoms and signs of a chronic venous failure:
- Convincing, tense veins under the skin;
- Several varices (nodes) along the changed vessels;
- Swelling of the affected leg;
- Severe and pain along the extended vein;
- Cramps in the calf muscles of the lower leg when “reduces the leg;
- Inflammatory changes in veins - thrombophlebitis;
- Trophilic skin disorders-dark stains, redness, sealing of the subcutaneous layer, a long-leaved wound-jazva.
Cosmetic indications- Early (first) stage of varicose veins without signs of venous insufficiency, which only leads to a cosmetic defect and aesthetic complaints in the patient:
- superficially located slightly expanded and confused veins;
- Vessels "stars", "spiders" and reddish-blue small capillaries in the skin of the legs.
It is important to note that you have to refuse if the risk of benefit exceeds, even if there are signs from the company.
The main contrasts for the surgical treatment of varicose veins:
- The serious general condition caused by acute (heart attack, stroke, pneumonia) started chronic diseases (liver, warm, lung insufficiency) or the age of the patient.
- All acute infectious diseases.
- Conductive treatment of cancer.
- Pronounced anemia.
- A pronounced increase or decrease in blood clotting.
- Inflammatory and supporting processes (values, rashes) on the skin of the lower limb, in which surgical intervention is planned.
- Pregnancy and early postpartum period.
All contraindications with the exception of the first are considered relative.This means that in special circumstances (acute dangerous conditions caused by varicose veins, such as thrombophlebitis on the thigh), one or another volume of surgical treatment must be carried out.
If an emergency operation is required
Surgical emergency treatment of varicose veins of the legs may be necessary in just one case - with acute rising thrombophlebitis.This complication is inflammation in the lumen of a large subcutaneous vein, accompanied by the formation of blood clots.
If such a pathological process applies to the thigh, there is a risk that blood clots will be clutched into a deep venous system.When separating such a blood clot, it penetrates the vessels of the lungs and clogs it, which causes a threatening life of a dangerous disease - lung thromboembolism (lung fiber).
The main manifestations of the rising thigh thrombophlebitis:
- Pain along the vein along the inner surface of the thigh;
- Reding and increasing the skin temperature;
- The seal of the changed area and its sharp pain when palpated.
With rising thrombophlebitis, the volume of surgical treatment can be shown:
- Crossectomy - dressing and the intersection of a large subcutaneous vein at the place of the confluence with the Bednaya;
- Removal of a changed vein after temporary dressing.
The goals of the surgical intervention
Usually, about 30% of the blood flow from the lower extremities through small subcutaneous venous tributaries that merge in two central venous tribes - a large and small subcutaneous vein.These vessels are directly connected to deep veins through which 70% of the blood flow out.In the places of such connections there are flaps that only fit blood from surface veins into deep veins.
There are also dozens of small veins, which are referred to as a perforant, which connects the surfaces of Venous network with a deep connection network.They also have valves that only pass in 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 the pressure in them and leads to the expansion of small vessels and central vein tribes.
The main goals for which surgical treatment aims at varicose veins of the lower extremities:
- The elimination of blood tag nation of blood in changed surface veins of the legs, which prevents the progress of chronic venous insufficiency and trophic disorders on the skin.
- Remove deformed vessels and varieties that represent a cosmetic defect.
- The elimination of the blood discharge from deep veins in superficial - the league and the intersection of the perforants (clans) veins as well as a large and small subcutaneous vein in the places of their connection with depths.
- Prevention of a repeated occurrence of varicose veins.
Preparation for the company
The complete preparation for the surgical treatment of varicose veins includes the following:
- A general preoperative examination with which you can evaluate the patient's general blood and urine tests, coagulogram, biochemical analysis, blood group and Rh-factor, syphilis tests, blood sugar levels, lung radiography, ECG.
- Special diagnostics with which you can determine the characteristics of the disease - an ultrasound with the color dopper mapping of surfaces, deep veins and arteries of the lower extremities and the determination of the location of insolvent perform.
- The operation is carried out on an empty stomach so that you cannot eat and drink in the morning of the operation.
- In the morning before the operation, it is necessary to carefully shave all hair on the painful leg from the bar to the foot.
Treatment of female varicose veins
A separate place in the surgical treatment of female varicose veins of the lower extremities is part of cosmetic surgery.After such interventions, not only changed veins changed pathologically, but also postoperative scars on the skin of the legs or they are inconspicuous.
In order to achieve the maximum cosmetic effect, the surgical operations for varicose veins are carried out in accordance with the following methods:
- Laser or radio frequency allocation veins-Burning the central tribes of a large and small subcutaneous vein under the ultrasound control through a puncture of the skin on the thigh or on the foot.
- Stammliteration and sclerotherapy-Large and small subcutaneous veins as well as all their tributaries, even the smallest, perform with a special sclerocant medication.
In one of the treatment methods described, varicose veins are not removed, but are transformed into a soft zikatricial fabric by blood vessels.Both physical influences (laser rays, radio frequency waves) and chemical compounds (sclerosant) destroy the inner layer of the vein.Thanks to this, it loses the lumen, the adhesives and fully stolks out of the blood and turns into an ordinary bandage -(-cicatricial) tissue.
Therefore, all goals that are assigned to the fast treatment of varicose veins of the lower extremities are assigned without direct veins of the lower extremities - 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 only slightly or intensively expanded to 1-2 degrees.During pregnancy and in the early postpartum time, surgical treatment with the exception of acute situations is contraindicated, such as emergency interventions, for example with rising thromblophbititis.The operation is limited to the dressing of a large subcutaneous vein at the point of its connection to femur (crossectomy).
Types of surgical operations
Consider the most common surgical interventions in the treatment of varicose veins of the lower extremities: laser ablation, endoscopic dissection of 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;
- Mini -fleebectomy.
Fleet
The distance, extraction of veins under the skin is referred to as phlebectomy.This is one of the first methods for the surgical treatment of varicose veins of the lower extremities.To date, however, phlebectomy is most often carried out by phlebology and vascular surgeons.There are three modifications and operating methods: full, short string, mini -fleeing.
The intervention volume is presented:
- As the bandage of the tribe of a large subcutaneous vein at the scene of its confluence, 2-3 cm on the thigh under the groin fold in the thigh through a cut.
- The distance through the groin area to the foot using a special probe by two skin slices 1-2 cm along the inner surface near the knee and ankle.
- The removal of all varicose veins and small veins by separate small cuts is about 1-2 cm (you can be between 5 and 6 to 10 to 20) with the dressing of insolvent perforant vessels.
- Sew all wounds with cosmetic seams.
With the classic phlebectomy you will remove the most radical varicose veins, but the most traumatic under all existing techniques.
Short strip
With a short stripping, the entire large subcutaneous vena is not removed, but only its fragments that are influenced by varicose veins, for example only on the thigh or on the lower leg.Healthy segments are not removed.This reduces intervention trauma, but the risk of relapse in the disease remains.Otherwise, the operating operations of the operation of the classic phlebectomy are similar.
Mini -fleece
The innovative methodology for removing small varicose veins of a large subcutaneous vein is referred to as mini fleeing.
For its implementation, special tools (pointed scalpel, hook, clamps, clamps, spatula) are required, with which veins are extracted several millimeters through the skin of the skin.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 mini fleeing.Such a combined operation combines radicalism and minimal trauma with a good cosmetic effect.
Endoscopic dissection of veins
It is difficult to find all the inferior perforations veins during a phlebectomy.Endoscopic devices (video camera and manipulators) are used for these purposes.Through small cuts in 1-2 cm, they are inserted under the skin in places of perforated veins, which are detected with ultrasound.
Find under the control of the camera, all inferior perforators find, connect and cross.The subcutaneous veins are not removed during this operation.It can be carried out both independently and in combination with any kind of phlebectomy: stripping, mini fleeing.
Laser treatment
The laser ablation for varicose veins comprises burning with a laser beam of a large subcutaneous vein from the side of its approval.For this purpose, a catheter settlement is inserted into its entire length by puncture the skin on the thigh or in the ankle area into the lumen of the veins.Under the control of the ultrasound, the Svetovod is slowly extracted.
The laser beam that acts on the venous wall destroys the inner layer.As a result, Vienna falls and stops working, which is clearly visible on the ultrasound monitor.If not only the main defense case, but also its tributaries are removed by varicose veins, they are removed according to the mini -fleeing method.
rehabilitation
Regardless of the operating methods used to treat varicose veins, the restoration of patients in the postoperative period is quickly restored.The conditions of complete rehabilitation depend on the methodology of the operation, the stage of the disease and the general condition of the patient.With laser treatment and mini-fleeing the initial varicose veins, it is 2-3 weeks, with a classic phlebectomy for advanced forms of disease-1-3 months.
Walking is recommended as early as possible, provided that the condition is stabilized after anesthesia after 5-6 hours.If the spine anesthesia has been carried out, the bed rest is recommended within 12 hours.With local anesthesia, the patient can have the operating room on his feet and is not even admitted to the hospital in a hospital.The main condition before walking is to connect the legs to an elastic bandage or attract a individually selected compression knitting clothing.
Stay in the hospital from 1-2 to 5-8 days.If the seams were overlaid, it is better to remove them on 7-8 days during a specialist inspection of a specialist.Within a month after the operation, it is recommended to wear compression knitting clothes.It is necessary to put it on daily before getting out of bed.Compression products are removed at night.After the classic phlebectomy with severe varicose veins, it is better to continue compression for up to 3 months.
In the course of the month it is strictly prohibited:
- Sauna and hot bath;
- severe physical activity on the lower limbs;
- A long stay was in a motionless position or sits.
Possible complications
The most common complications in connection with operations for varicose veins:
- Pain in the operated leg due to damage to large nerves.
- Long -lasting swelling of the lower leg and the foot.
- Hematomas and bruises on the lower leg and thighs.
- Bleeding from wounds.
- Fleing stream - inflammation of deep veins.
- Monitoring of postoperative wounds and necrosis (deadliness) of the skin around them with the formation of trophic ulcers.
- The formation of coarse postoperative scars.
Thanks to modern methods and technologies, the surgical treatment of varicose veins is simple, painless and with high efficiency.Compliance with all recommendations of the postoperative period contributes to the rapid restoration, minimizes the risk of complications and relapses of the disease.