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Surgical treatment of vein varicose veins from the lower extremities

Varicose verse surgery

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

Thanks to modern technologies and the improvement of operation techniques, it is really effective, in both therapeutic and cosmetic terms, is performed as easily and painlessly as possible, well tolerated by patients and does not cause prolonged disability.

Indications and against -indications

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

The surgical treatment of varicose veins of the lower ends is indicated in the following cases.

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

  • convincing and tense veins under the skin;
  • multiple varics (nodes) along the altered vessels;
  • swelling of the affected leg;
  • gravity and pain along the expanded vein;
  • seizures in the muscles of the leg calf when “reduces the leg;
  • Inflammatory changes in the veins - thrombophlebitis;
  • Trophilic skin disorders, redness, sealing of the subcutaneous layer, a long leaf wound.

Cosmetic indications- Early stage (first) of varicose veins with no signs of venous insufficiency, causing only one cosmetic defect and aesthetic discomfort in the patient:

  • superficially located slightly expanded and complicated veins;
  • "Vascular" Stars, "Spider" and small reddish blue capillaries on the skin of the legs.

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

The main against -indications for the surgical treatment of varicose veins:

  • The severe general condition caused by any acute (heart attack, stroke, pneumonia) has launched chronic diseases (liver, cordial insufficiency, pulmonary) or the patient's age.
  • Any acute infectious diseases.
  • Cancer conductive treatment.
  • Pronounced anemia.
  • A pronounced increase or decrease in blood coagulation.
  • Inflammatory and suppurative processes (scores, rash) in the skin of the lower limb, where surgical intervention is planned.
  • Pregnancy and period after early part.

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

When an emergency operation is required

Surgical treatment of emergency leg varicose veins may be required in only one case - with acute ascending thrombophlebitis.This complication is an inflammation within the lumen of a large subcutaneous vein, accompanied by the formation of blood clots.

Surgical treatment of varicose veins

If this pathological process applies to the thigh, there is a risk of grabbing blood clots in a deep venous system.In case of separation of such a blood clot, it penetrates the vessels of the lungs and enters them, which causes a threatening life of a dangerous disease - pulmonary thromboembolism (pulmonary fiber).

The main manifestations of increased thromboflebitis thigh:

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

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

  • CROSSECTOMY - Dressing and intersection of a large subcutaneous vein at the confluence site with Bednaya;
  • Removal of a altered vein after preliminary dressing.

The objectives of surgical intervention

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

There are also dozens of small veins, which are called piercing, additionally connecting the surface venous network in depth.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 blood discharge: from deep veins to the surface, which increases pressure on them and leads to the expansion of small vessels and central venous trunks.

The main objectives for which surgical treatment aims to varicose veins of the lower ends:

  • The elimination of blood stagnation in altered superficial veins of the legs, which will prevent the progression of chronic venous insufficiency and trophic disorders on the skin.
  • Removing deformed vessels and varieties representing a cosmetic defect.
  • The elimination of deep vein blood discharge in the surfaces - the connection and intersection of the piercing veins (clans), as well as a large and small subcutaneous veins in the places of their connection to the deep.
  • Prevention of a repeated occurrence of varicose veins.

Preparation for the operation

The complete preparation of surgical treatment for varicose veins includes:

  1. A general preoperative examination that allows you to evaluate the patient's blood and urine urine tests, coagulogram, biochemical analysis, blood type and HR factor, syphilis tests, blood sugar level, pulmonary radiography, ECG.
  2. Special diagnoses that allow to determine the characteristics of the disease - an ultrasound with mapping of color surface doppler, deep veins and arteries of the lower extremities and designating the location of insolvent drilling veins.
  3. The operation is performed with an empty stomach;Therefore, in the morning, on the day of operation, you cannot eat and drink.
  4. In the morning before the operation, it is necessary to carefully shave all the hair in the earnest leg of the groin at foot.

Treatment of female varicose veins

Preparation for the surgical treatment of varicose veins

A separate place in the surgical treatment of the veins of the veins of the lower extremities belongs to cosmetic surgery.After these interventions, not only the pathologically altered veins, but also post -operative scars on the skin of the legs, or are discreet.

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

  • Laser ablation veins or radio frequency-By the central trunks of a large, small subcutaneous vein under the control of ultrasound through a skin puncture on the thigh or foot.
  • Scleroblitration and rod sclerotherapy-Encouraging large and small subcutaneous veins, as well as all their tributaries, even the smallest, with a special sclerocant drug.

With any of the described treatment methods, varicose veins are not removed, but are transformed from blood vessels into a soft scar tissue.Both physical influences (laser rays, radio frequency waves) and chemical (sclerosing) compounds destroy the inner layer of the vein.Thanks to this, he loses the lumen, the glues and the desolate completely of the blood, becoming a common (scar) connective tissue.

Thus, without direct removal of the veins, all objectives that are attributed to rapid treatment of the lower extremity varicose veins are achieved - altered 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 possible only mild or limited enlarged veins to 1-2 degrees.During pregnancy and in the early postpartum period, surgical treatment is against -indicated, except for acute situations that require emergency intervention, for example, with upward thrombophlebitis.The operation is limited to the dressing of a large subcutaneous vein at the site of its connection to femoral (cruise).

Types of surgical operations

Consider the most common surgical interventions in the treatment of lower extremity varicose veins: laser ablation, endoscopic vein dissection and flexibility.

The latter is divided into the following types:

  • classic operation, or complete removal or Trojanov-Trendelenburg-Bubko-Narata operation;
  • Short withdrawal;
  • Miniflebectomy.

Phlegic

The removal, the extraction of veins from the skin is called Flebectomy.This is one of the first methods of surgical treatment of varicose veins of the lower ends.But even today, flexibility is most often performed by phlegology and vascular surgeons.There are three modifications and operating methods: full and short stripping, miniflebectomy.

The intervention volume is presented:

  1. As a bandage of the trunk of a large subcutaneous vein in the place of confluence, 2-3 cm in the thigh under the inguinal fold, thigh, through an incision.
  2. Its removal throughout the groin to the foot using a special probe through two 1-2 cm skin cuts along the inner surface, near the knee and ankle.
  3. Removal of all varicose veins and small veins through small separate incisions is about 1-2 cm (they can be from 5-6 to 10 to 20) with the insolvent drilling healing.
  4. Sewing all wounds with cosmetic seams.

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

Short withdrawal

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

Miniflebectomy

Flebectomy as a method of treatment of varicose veins

The innovative methodology to remove small varicose veins from a large subcutaneous vein is called miniflebectomy.

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

Most of the time, surgeons combine a short or complete removal of a large subcutaneous vein with miniflebectomy.This combined operation combines radicalism and minimal trauma with a good cosmetic effect.

Endoscopic vein dissection

Finding all the lower perforated veins during any flexes is difficult.For these purposes, endoscopic equipment is used (video camera and handlers).Through small cuts at 1-2 cm, they are inserted under the skin in places of piercing vein groups, which are detected with ultrasound.

Under the camera control, all the lower perforators find, dressing and cross them.During this operation, subcutaneous veins are not removed.It can be performed independently and in combination with any type of phlegic: removal, miniflebectomy.

Laser treatment

Laser ablation for varicose veins surrounds burning with a laser beam of a large subcutaneous vein throughout the side of its clearance.To do this, by puncturing the skin in the thigh or ankle area in the vein lumen, a catheter strand is introduced throughout its length.Under the control of the ultrasound, the svetovod 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 ultrasound monitor.If not only the main venous trunk, but also its tributaries, are removed by varicose veins, they are removed according to the miniflebectomy method.

Rehabilitation

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

Walking is recommended as soon as possible as long as the condition is stabilized after anesthesia - after 5-6 hours.If the anesthesia of the spine has been performed, bed rest will be recommended within 12 hours.With local anesthesia, the patient can leave the foot operations room and are not even hospitalized in a hospital.The main condition before walking is to bandage the legs with an elastic bandage or place an individually selected compression mesh.

Stay in the hospital from 1-2 to 5-8 days.If the seams have been overlapping, it is best to remove them in 7-8 days during an expert control inspection.Within a month after surgery, it is recommended to use compression meshes.It is necessary to put it daily before leaving the bed.At night, compression products are removed.After classic phlebectomy with severe varicose veins, it is better to continue compression for up to 3 months.

Throughout the month, it is strictly forbidden:

  • Sauna and hot bath;
  • Heavy physical activity in the lower limbs;
  • A long stay in a property standing or sitting.

Possible complications

The most common complications related to operations for varicose veins:

  • Pain in the operated leg as a result of damage to the great nerves.
  • Long swelling of the leg and foot.
  • Bruises and bruises on the bottom of the leg and thigh.
  • Wound bleeding.
  • Flexibotherbosis - inflammation of deep veins.
  • Supervision of post -operative wounds and (deadly) skin around them with the formation of trophic ulcers.
  • The formation of scars in the gross post -operative.

Thanks to modern methods and technologies, the surgical treatment of varicose veins is easy, painless and with high efficiency.Compliance with all post -operative recommendations contributes to rapid restoration, minimizes the risk of complications and relapses of the disease.