Surgical treatment of varicose veins of lower limbs

For many decades, surgical treatment of varicose veins of legs remains the only radical method of eliminating this disease and its complications.

Thanks to modern technologies and the improvement of operating techniques, it is really effective both in therapeutic and cosmetic terms, it is carried out as easily and without pain as possible, well tolerated by patients and does not cause prolonged handicap.

Indications and contraindications

It is not advisable to exploit patients with varicose veins.There are clear indications for the operation and contraindications to its implementation.

Surgical treatment of varicose veins of the lower limbs is indicated in the following cases.

Medical indications- A pronounced expansion of the veins of 2 to 3 degrees, accompanied by complaints and signs of chronic venous failure:

• convincing veins and stretched under the skin;
• Several varics (knots) along the modified ships;
• swelling of the affected leg;
• severity and pain along the extended vein;
• Convulsions in the muscles of the calf of the lower leg, when "reduces the leg;
• Inflammatory changes in the veins - thrombophlebititis;
• Types of toophilic skin disorders, redness, sealing of the subcutaneous layer, a long jazva wound.

Cosmetic indications- Early stage (first) of varicose veins without signs of venous insufficiency, causing only a cosmetic defect and an aesthetic discomfort in the patient:

• veins superficially located slightly widened and convoluted;
• The vascular "stars", "spiders" and the little reddish blue capillaries in the skin of the legs.

It is important to remember that even if there are indications of the operation, it is necessary to refuse whether the risk of it exceeds the advantage.

The main contraindications for surgical treatment of varicose veins:

• The serious general condition caused by any acute (heart attack, stroke, pneumonia) has launched chronic diseases (liver, cordial, pulmonary insufficiency) or old age.
• All acute infectious diseases.
• Cancer driver's treatment.
• Pronounced anemia.
• A pronounced increase or decrease in blood coagulation.
• Inflammatory and suppurative processes (scores, rashes) on the skin of the lower limb, where surgery is planned.
• Pregnancy and early postpartum period.

All contraindications, with the exception of the first, are considered to be relative.This means that in particular circumstances (acute dangerous conditions caused by varicose veins, for example, thrombophlebitis on the thigh), one or the other volume of surgical treatment should be carried out.

When an emergency operation is necessary

Emergency surgical treatment of varicose veins of the legs may be necessary in a single case - with a sharp ascending thrombophlebitis.This complication is an inflammation inside the light 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 of tightening blood clots in a deep venous system.In the event of separation of such a blood clot, it enters the vessels of the lungs and obstructs them, which causes a threatening life of a dangerous disease - pulmonary thromboembolia (pulmonary fiber).

The main manifestations of the climb of the thigh of the thigh:

• pain along the vein along the inner surface of the thigh;
• redness and increase in skin temperature;
• The seal of the modified area and its acute pain on palpation.

With the ascending thrombophlebitis, the volume of surgical treatment can be represented:

• Cultectomy - clothing and intersection of a large subcutaneous vein instead of confluence with the Bednaya;
• Elimination of a vein changed after a preliminary dressing.

The objectives of the surgical intervention

Normally, around 30% of the blood of the lower limbs flows through small subcutaneous venous tributaries, which merge in two central venous trunks-a large and small subcutaneous vein.These ships are directly linked to the deep veins, through which 70% of the blood flows.In the places of such compounds, there are valves which pass blood only from the veins of deep surface.

There are also dozens of small veins, which are called perforants, also connecting the venous network of surface to Deep.They also have valves that do not transmit blood in one direction.

The main cause of varicose veins is the failure of venous valves, which leads to poor blood listening: deep veins on the surface, which increases the pressure and causes the expansion of the small venous venous venous trunks.

The main objectives for which surgical treatment is intended for varicose veins of the lower limbs:

• The elimination of the stagnation of blood in the altered surface veins of the legs, which will prevent the progression of chronic venous insufficiency and trophic disorders on the skin.
• Elimination of distorted vessels and varieties representing a cosmetic defect.
• The elimination of the flow of the blood of the deep veins in superficial veins - the ligation and the intersection of the perforating veins (clans), as well as large and small subcutaneous veins in the places of their connection with the deep.
• Prevention of a repeated occurrence of varicose veins.

Preparation of the operation

Complete preparation of surgical treatment for varicose veins includes:

1. A general preoperative examination which allows you to assess the patient's blood and health urinary tests, coagulogram, biochemical analysis, blood group and HR factor, syphilis tests, blood sugar levels, pulmonary radiography, ECG.
2. Special diagnostics that allow you to determine the characteristics of the disease - an ultrasound with doppler surface doppler map, deep veins and arteries of the lower limbs and designating the location of insolvent perforating veins.
3. The operation is done on an empty stomach, so in the morning on the day of the operation, you cannot eat and drink.
4. In the morning before the operation, it is necessary to carefully shave all the hair on the painful leg of the groin at the foot.

Treatment of feminine varicose veins

A separate place in the surgical treatment of female varicose veins of the lower limbs belongs to cosmetic surgery.After such interventions, not only the pathologically modified veins, but also the postoperative scars on the skin of the legs, or they are discreet.

To obtain the maximum aesthetic effect, surgery for varicose veins is carried out according to the following methods:

• Laser removal veins or radiofrequency-Hending the central trunks of a large and small subcutaneous vein under the control of ultrasound through a puncture of the skin on the thigh or on the foot.
• STEM sclerotimation and sclerotherapy-The large and small subcutaneous veins, as well as all their tributaries, even the smallest, with a special sclerotic drug.

With one of the treatment methods described, the varicose veins are not eliminated, but are transformed blood vessels into gentle scar fabric.The two physical influences (laser rays, radiofrequency waves) and chemical (sclerosing) compounds destroy the inner layer of the vein.Thanks to this, he loses the light, the coges and the desolate completely of the blood, turning into ordinary connective tissue (scar).

Thus, without direct elimination of the veins, all the objectives which are assigned to the rapid treatment of the varicose veins of the lower limbs are achieved - the modified 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 possible veins slightly or limited to 1 to 2 degrees.During pregnancy and at the start of the postpartum period, surgical treatment is contraindicated with the exception of acute situations requiring emergency intervention, for example, with an ascending thrombophlebitis.The operation is limited to the dressing of a large subcutaneous vein instead of its connection with the femoral (crosscomy).

Types of surgical operations

Consider the most common surgical interventions in the treatment of varicose veins of the lower limbs: laser removal, endoscopic dissection of the veins and phleectomy.

The latter is divided into the following types:

• Classic operation, or complete stripping or operation of Trojanov-Trendelenburg-Bubko-Narata;
• short stripping;
• Miniflectomy.

Fubletomy

Elimination, the extraction of the veins under the skin is called phleectomy.This is one of the first methods of surgical treatment for varicose veins of the lower limbs.But even today, phleectomy is most often carried out by phlebology and vascular surgeons.There are three modifications and operating methods: complete and short stripping, miniflectomy.

The intervention volume is presented:

1. As a trunk bandage of a large subcutaneous vein in place of its confluence, 2-3 cm on the thigh under the inguinal fold, in the thigh, by an incision.
2. Its removal throughout the groin at the foot using a special probe through two sections of the skin 1 to 2 cm along the inner surface near the knee and ankle.
3. The elimination of all varicose veins and small veins by small separate incisions is approximately 1 to 2 cm (they can be 5-6 to 10-20) with the dressing of insolvent perforating vessels.
4. Couture all injuries with cosmetic seams.

Classic phleectomy allows you to delete varicose veins, but the most traumatic among all existing techniques.

Short stripping

With a short stripping, not the whole large subcutaneous vein is deleted, but only its fragments, affected by varicose veins, for example, only on the thigh or on the bottom of the leg.The healthy segments have not been deleted.This reduces the trauma of the intervention, but the risk of relapse of the disease remains.Otherwise, the operational operations of the operation are similar to classic phleectomy.

Miniflectomy

The innovative methodology to eliminate small varicose veins from a large subcutaneous vein is called miniflectomy.

For its implementation, special tools (pointed scalpel, hooks, pliers, spatula) are necessary, with which the veins are extracted through the skin of the skin of several millimeters.It is not necessary to sew these skin defects, the scars are invisible.

Most often, surgeons combine a short or complete stripping of a large subcutaneous vein with miniflectomy.Such a combined operation combines radicalism and minimal trauma with a good cosmetic effect.

Endoscopic dissection of the veins

It is difficult to find all the lower efficient veins during any phleectomy.For these purposes, endoscopic equipment (video camera and manipulators) is used.Thanks to small 1-2 cm cuts, they are inserted under the skin in places of picking vein clusters, which are detected with ultrasound.

Under the control of the camera, all the lower perforators find, the strips and cross them.During this operation, the subcutaneous veins are not deleted.It can be done both independently and in combination with any type of phleectomy: stripping, miniflectomy.

Laser treatment

Laser removal for varicose veins involves burning with a laser beam of a large subcutaneous vein everywhere on the side of its clearance.To do this, by puncture of the skin on the thigh or in the ankle area in the light of the vein, a catheter-Verility is presented over its entire length.Under the control of ultrasound, the Svetivod is slowly extracted.

The laser beam, acting on the venous wall, destroys the inner layer.As a result, Vienna falls and stops working, which is clearly visible on the ultrasonic instructor.If not only the main venous trunk, but also its tributaries, are deleted by veins of varicose veins, they are deleted according to the miniflectomy method.

Rehabilitation

Regardless of the operational methods of treatment of varicose veins were used, the restoration of patients during the postoperative period occurs quickly.The terms of the complete rehabilitation depend on the methodology of surgery, the stage of the disease and the general condition of the patient.With laser treatment and miniflectomy of initial varicose veins, it is 2 to 3 weeks, with a classic phleectomy for the advanced forms of the disease - 1 to 3 months.

Walking is recommended as soon as possible, provided that the condition is stabilized after anesthesia - after 5 to 6 hours.If vertebral anesthesia has been made, bed rest is recommended within 12 hours.With local anesthesia, the patient can leave the operating room on his feet and is not even hospitalized in a hospital.The main state before walking is to bandage your legs with an elastic bandage or to put compression knitting individually selected.

Stay at the hospital from 1-2 to 5-8 days.If the seams were superimposed, it is preferable to remove them over 7 to 8 days during an inspection of control of a specialist.In a month after surgery, it is recommended to wear compression knitting.It is necessary to put it daily before getting out of bed.At night, compression products are deleted.After a classic phleectomy with serious varicose veins, it is preferable to continue compression up to 3 months.

Throughout the month, it is strictly prohibited:

• Sauna and hot bath;
• heavy physical activity on the lower limbs;
• A long stay in a motionless or seated position.

Possible complications

The most common complications linked to operations for varicose veins:

• Pain in the leg operated as a result of significant nerves damage.
• Long -term bouette of the leg and the lower foot.
• Hematomas and bruises on the bottom of the leg and thigh.
• Bleeding of injuries.
• Flébotrombose - Inflammation of the deep veins.
• Supervision of postoperative wounds and necrosis (dead) of the skin around them with the formation of trophic ulcers.
• The formation of gross postoperative scars.

Thanks to modern methods and technologies, surgical treatment of varicose veins is easy, painless and high efficiency.Respecting all the recommendations of the postoperative period contributes to fast food, minimizes the risk of complications and relapse of the disease.