Surgical treatment of varicose veins of lower extremities

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

Thanks to modern technologies and improving functioning techniques, it is really effective in both terms and cosmetics, it is performed as easily and painlessly as possible, to be well tolerated by patients and does not cause prolonged disability.

Indications and Contraindications

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

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

Medical indications- a pronounced vein enlargement of 2-3 degrees, accompanied by complaints and signs of chronic venous failure:

• Persuasive, tense veins under the skin;
• Multiple varicose (joints) along changed vessels;
• swelling of the affected leg;
• severity and pain along the extended vein;
• convulsions in the beef muscles of the lower leg when “reduces the foot;
• Inflammatory changes in veins - thrombophlebitis;
• Disordishes trofilic skin-dark-dark, redness, sealing of the subcutaneous layer, a long-jazzwa wound.

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

• superficially located slightly enlarged and complex veins;
• "Stars" vascular, "spider" and small reddish capillaries on the skin of the feet.

It is important to remember that even if there are indications of surgery, you should refuse if its risk exceeds the benefit.

Key Contraindications for Surgical Treatment of Varicose veins:

• Serious general condition caused by any acute (heart attack, stroke, pneumonia) launched chronic illness (liver, heartfelt, pulmonary injustice) or the patient's old age.
• Anydo acute infectious disease.
• Conducting treatment for cancer.
• Pronounced anemia.
• A significant increase or decrease in blood clotting.
• Inflammatory and suppurative processes (results, rashes) on the skin of the lower extremities, where surgical intervention is planned.
• Pregnancy and early postnatal period.

All contraindications, except see, are considered relative.This means that under special circumstances (acute dangerous conditions caused by varicose veins, for example, thrombophlebitis should be performed in the thigh), one or another volume of surgical treatment should be performed.

When an urgent operation is needed

Surgical treatment of emergency veins with varicose legs can only be required in one case - with acute adhesive thrombophlebitis.This complication is an inflammation within 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 of stuck blood clots in a deep venous system.In case of dividing such a blood clot, it penetrates the lung vessels and blocks them, which causes a threatening life of a dangerous disease - pulmonary thromboembolism (pulmonary fiber).

The main manifestations of thigh thrombophlebitis growth:

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

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

• Junction - coating and intersection of a large subcutaneous vein at the site of union with bednaya;
• Removing a changed vein after the preliminary coating.

The goals of surgical intervention

Normally, about 30% of the blood from the lower extremities flow through small subcutaneous venous branches, which join in two central venous drawers - a large and small subcutaneous veins.These vessels are directly connected to the deep veins, through which 70% of the blood flows.In places of such compounds there are valves that pass blood only from surface to deep veins.

There are also tens of small veins, which are called perforants, also connecting the surface venous with deep.They also have valves that pass blood in just one direction.

The main cause of varicose veins is the failure of venous valves, which leads to improper discharge of blood: from deep veins to the surface, which increases the pressure on them and leads to the expansion of both small vessels and central venous trunks.

The main goals for which surgical treatment is aimed at varicose veins of the lower extremities:

• Elimination of blood stagnation in changed surface veins, which will prevent the progression of chronic venous insufficiency and trophic disorders in the skin.
• Removing deformed vessels and varieties that represent a cosmetic defect.
• Elimination of blood discharge from deep veins to superficial ones - bonding and intersection of perforant veins, as well as a large and small subcutaneous veins in their connecting places to deep ones.
• Preventing a repeated appearance of varicose veins.

Preparation for the operation

Complete associated preparation for surgical treatment for varicose veins includes:

1. A general pre -surgery examination that allows you to evaluate the patient's overall blood tests and urine tests, coagulogram, biochemical analysis, blood type and Rh factor, syphilis tests, blood sugar levels, lung radiography, ECG.
2. Special diagnostics that allow you to determine the characteristics of the disease - an ultrasound with the doppler color map of the surface, deep veins and the arteries of the lower extremities and the determination of the perforant veins of bankruptcy.
3. The surgery is performed on an empty stomach, so in the morning on the day of surgery you can't eat and drink.
4. In the morning before surgery, it is necessary to carefully shave all the hair on the injured leg from the groin.

Treatment of female varicose veins

A special place in the surgical treatment of female varicose veins of the lower extremities belongs to cosmetic surgery.After such interventions, not only pathologically altered veins, but also after surgery wounds on the skin of the legs, or they are unclear.

To achieve the maximum cosmetic effect, surgical surgery for varicose veins is performed according to the following methods:

• Laser ablation veins or radio frequency-Nan burning the central underwear of a large and small subcutaneous vein under the control of ultrasound through a puncture of the skin on the thighs or foot.
• Stem Sclerobliteration and Sclerotherapy-Determine large and small subcutaneous veins, as well as all their branches, even the younger, with a special sclerocant drug.

With any of the prescribed methods of treatment, varicose veins are not removed but returned from blood vessels to a soft cicatric fabric.Both physical impacts (laser rays, radio frequency waves), and chemical compounds (sclerosants) destroy the inner layer of the vein.Thanks to this, it loses the lumen, the adhesions and completely desert from the blood, turning into an ordinary (cyclic) connective tissue.

Thus, without the direct removal of the veins, all the goals set to the rapid treatment of the varicose veins of the lower extremities are achieved - the changed vessels are eliminated, and the dangerous consequences of venous insufficiency are eliminated in them.

The sole restriction of cosmetic operations in the treatment of varicose veins in women is only possible to expand slightly or limited to 1-2 degrees.During pregnancy and in the early postnatal period, surgical treatment is contraindicated with the exception of acute situations that require urgent intervention, for example, with contagious thrombophlebitis.The surgery is limited to the coating of a large subcutaneous vein at the site of its connection to the femor (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 surgery, or complete stripping or operation of Trojanov-Trendelenburg-Bubko-Narata;
• short strip;
• Miniflebectomy.

Flexolectomy

Removal, extraction of veins from under the skin is called phlebectomy.This is one of the first methods of surgical treatment of varicose veins of the lower extremities.But even today, phlebectomy is most often performed by phlebology and vascular surgeons.There are three modifications and methods of operation: full, short, miniflebectomy.

The volume of the intervention is presented:

1. As a bandage of the luggage of a large subcutaneous vein at the site of its union, 2-3 cm in the thigh under the inguinal folding, in the thigh, through a cut.
2. Removing it throughout the groin using a special probe through two skin cuttings 1-2 cm along the inner surface near the knee and ankle.
3. Removing all varicose veins and small veins through small special cuttings is about 1-2 cm (they can be from 5-6 to 10-20) with the wearing of the perforant bankruptcy vessels.
4. Sewing all wounds with cosmetic stitches.

Classic phlebectomy more radically allows you to remove varicose but more traumatic veins among all existing techniques.

Short -loving

With a short stripping, not all the large subcutaneous vein is removed, but only its fragments, affected by varicose veins, for example, only in the thigh or lower leg.Healthy segments are not removed.This reduces the trauma of the intervention, but the risk of relapse remains.Otherwise, operational operations of the surgery are similar to classical phlebectomy.

Miniflebectomy

Innovative methodology for removing small varicose veins of a large subcutaneous vein is called miniflebectomy.

For its implementation, special tools (pronounced scalpel, hooks, clamps, shoulder) are needed, with which veins are extracted through the skin of several millimeters.It is not necessary to sew such skin defects, the wounds are invisible.

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

Endoscopic dissection of veins

Finding all the veins of inferior performance during any phlebectomy is difficult.For these purposes, endoscopic devices (video cameras and manipulators) are used.Through small cuts to 1-2 cm, they are inserted under the skin in places of perforative vein clusters, which are detected by ultrasound.

Under the control of the camera, all inferior perforators find, bandage and pass them.During this operation, the subcutaneous veins are not removed.It can be performed both independently and in combination with any type of phlebectomy: stripping, miniflebectomy.

Laser

Laser ablation for varicose veins involves burning with a laser beam of a large subcutaneous vein along the entire side of its cleaning.To do this, through the skin of the skin on the thighs or in the area of the foot in the vein lumen, a catheter-vertical is presented throughout its length.Under the control of ultrasound, Svetovod is slowly extracted.

The laser beam, acting on the venous wall, destroys the inner layer.As a result, Vienna falls and ceases to function, which is clearly visible on the ultrasound monitor.If not only the main venous luggage but also its branches are removed from the varicose veins, they are removed according to the miniFlebectomy method.

RePRinT

Despite those operating methods of varicose vein treatment, the restoration of patients in the post -operative period occurs quickly.The conditions of complete rehabilitation depend on the methodology of surgery, the stage of the disease and the general condition of the patient.With laser treatment and miniflebectomy the initial vein of varicose veins, it is 2-3 weeks, with classic phlebectomy for advanced forms of disease-1-3 months.

Walking is recommended as soon as possible, provided the situation stabilizes after anesthesia - after 5-6 hours.If spinal anesthesia is performed, bed rest is recommended within 12 hours.With local anesthesia, the patient can leave the operating room on his feet and is not also hospitalized.The main condition before you walk is to bandage your feet with an elastic bandage or put on an individually chosen compressed knitwear.

Stay in the hospital for 1-2 to 5-8 days.If the stitches were superimposed, it is best to remove them in 7-8 days during a control inspection by a specialist.Within a month after surgery, it is recommended to wear compression knit clothing.It is necessary to put it daily before you get out of bed.At night, compression products are removed.After classic phlebectomy with heavy varicose veins, it is best to continue compression for up to 3 months.

Throughout the month, it is strictly forbidden:

• sauna and hot bath;
• severe physical activity in the lower extremities;
• A long stay in a position without moving on the foot or sitting.

Potential complications

The most common complications associated with varicose veins operations:

• Pain in the leg operated as a result of damage to the large nerves.
• Long ellinging of the leg and lower leg.
• Hematoma and bruises in the lower leg and thigh.
• Bleeding from wounds.
• Flebotrombosis - inflammation of the deep veins.
• Surveillance of wounds after surgery and necrosis (death) of the skin around them with the formation of trophic ulcers.
• Formation of gross wounds after surgery.

Thanks to modern methods and technologies, the surgical treatment of varicose veins is easy, painless and highly efficient.Compliance with all post -surgery period recommendations contributes to rapid restoration, minimizes the risk of complications and relapse of the disease.