Surgery treatment of varicose veins in the lower limbs

For decades, surgical treatment of varicose veins in the legs has remained the only fundamental way to eliminate the disease and its complications.

Thanks to improvements in modern technology and operational techniques, it is indeed effective in treatment and cosmetics, so it is performed as easily and painless as possible, with patients well tolerated without causing prolonged disability.

Adaptations and contraindications

Patients with any varicose veins are not recommended.There are clear signs of the operation and contraindications it has been implemented.

In the following cases, surgical treatment of varicose veins in the lower limbs is indicated.

Medical signs- Signs of vein significantly expanded 2-3 degrees and accompanied by complaints and signs of chronic venous failure:

• Convincing, tense veins are under the skin;
• multiple varicose veins along the changing container (node);
• Swelling of affected legs;
• severity and pain along the dilated veins;
• When “reduce legs,” convulses in the calf muscles of the lower leg;
• Inflammatory changes in veins - thrombophlebitis;
• Nutritious skin diseases dark spots, redness, subcutaneous seal, long leaf wound jazva.

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

• slightly expanded and complex veins on the surface;
• Blood vessels “stars”, “spiders” and small red and blue capillaries in the skin of the leg.

It is important to remember that even if the action shows signs, it is necessary to reject the risk outweighs the benefits.

The main contraindications for surgical treatment of varicose veins:

• Any acute (heart attack, stroke, pneumonia) causes chronic disease (liver, cordial, lung insufficiency) or the elderly of the patient.
• Any acute infectious disease.
• Conductive treatment of cancer.
• Pronounced as anemia.
• Significant increase or decrease in blood clotting.
• Plan surgical interventions on the skin of the lower extremities (scores, rash).
• Pregnancy and early postpartum.

All contraindications except the first one are considered relative.This means that in special cases (e.g., acute hazardous conditions caused by varicose veins, such as the mass of thrombus on the thigh), one volume or another batch of surgical treatment must be performed.

When emergency operations are required

In one case, emergency surgical treatment of varicose veins in the legs may be required - acute ascending thrombotic thrombotic thrombosis.This complication is inflammation in the cavity of large subcutaneous veins, accompanied by the formation of blood clots.

If such a pathological process applies to the thigh, there is a risk of grabbing the blood clots at the deep venous system.If this clot is separated, he penetrates the blood vessels in the lungs and blocks them, which can lead to life-threatening diseases of dangerous disease - pulmonary thromboembolic (pulmonary fiber).

The main manifestations of thigh thrombosis and swelling:

• Vein pain along the inner surface of the thigh;
• Redness and increased skin temperature;
• Sealing of the changing area and its severe pain during palpation.

In the case of rising thrombotic phlebitis, the volume of surgical treatment can be indicated:

• Transverse - dressing and intersecting of large subcutaneous veins at the confluence with Bednaya;
• Clear the changed veins after preliminary dressing.

The goal of surgical intervention

Typically, approximately 30% of the blood in the lower limb flows through small subcutaneous veins tributaries, which merge in two central veins trunks – a sized subcutaneous vein.These blood vessels are directly connected to the deep vein and 70% of the blood flows out.In places with such compounds, there are valves that only spread from the surface veins to the deep layer.

There are also dozens of small veins called perforations and connect the network of surface veins to deep.They still have only one direction to bleed.

The main cause of varicose veins is the failure of the venous valve, which leads to improper blood excretion: from deep veins to the surface, which increases their pressure and causes dilation of small blood vessels and central veins trunks.

The main targets of surgical treatment are varicose veins in the lower limbs:

• Eliminate blood stagnation in the veins of the legs, which will prevent the progression of chronic venous insufficiency and skin nutritional disease.
• Remove deformed blood vessels and varieties representing cosmetic defects.
• Eliminate blood from deep veins into superficial - connected and intersecting (clan) veins, as well as large and small subcutaneous veins associated with deep ties.
• Prevent recurrence of varicose veins.

Prepare for operation

Comprehensive preparations for intravenous surgical treatment include:

1. A general preoperative test that allows you to evaluate the patient's healthy total blood and urine test, coagulation map, biochemical analysis, blood type and RH factor, syphilis test, blood sugar levels, lung radiography, ECG.
2. A special diagnosis allows you to identify the characteristics of the disease - ultrasound, colored Doppler mapping on the surface of the lower limb, deep veins and arteries, and specifies the location of perforated veins that are unable to dissolve.
3. The surgery is performed on an empty stomach, so on the morning of the day of the surgery, you cannot eat and drink.
4. On the morning before the surgery, it is necessary to carefully scrape off all hair that has ache in the abdomen.

Treatment of female varicose oral

A single location in the surgical treatment of varicose veins in women on the lower limbs is plastic surgery.With such interventions, not only did the veins change pathologically, but also the postoperative scars on the skin of the legs, or they were inconspicuous.

To achieve maximum cosmetic effect, varicose veins are performed according to the following methods:

• Laser or radiofrequency ablation of veins- The central torso of the subcutaneous veins of the large and small subcutaneous veins under ultrasound control by the skin on the thigh or foot.
• Stem sclerosis and sclerosis therapy- Fill in the size of the subcutaneous veins and all their tributaries, even the smallest tributaries, and use a special sclerosis drug.

Using any of the described treatments, varicose veins do not remove but instead change from blood vessels to soft protein structures.Physical effects (laser rays, radio frequency waves) and chemical compounds (hardeners) destroy the inner layer of the vein.Thus, it loses lumens, glue and completely desolate from the blood, becoming a common connective tissue (glia) tissue.

Therefore, without the veins being removed directly, all goals of all the goals assigned to the lower limb varicose veins can be achieved - eliminating the changing blood vessels and eliminating the dangerous consequences of venous inadequacy.

In women treating varicose veins, the only possibility is that the vein is only slightly or limitedly extended to 1-2 degrees.During pregnancy and early postpartum, surgical treatment is still contraindicated in acute conditions requiring urgent intervention, for example, in elevated thrombotic cysts.The procedure is limited to dressings in large subcutaneous veins where they are connected to the femur (transverse ectostomy).

Types of surgical procedures

Consider the most common surgical interventions in varicose veins treatment in the lower limbs: laser ablation, venous endoscopic anatomy, and venectomy.

The latter is divided into the following types:

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

Ovalectomy

Removal, extracting the vein from below the skin is called venectomy.This is one of the first surgical treatments for varicose veins in the lower limbs.But even today, venectomy is usually performed by phlebotomy and vascular surgeons.There are three modifications and methods for the operation: complete, short stripping, and miniectomy.

The number of interventions was proposed:

1. As a bandage of a large subcutaneous vein at the confluence, the thigh is under the thigh, and the thigh is below the thigh, and 2-3 cm below the thigh through the incision.
2. It is incited 1-2 cm along the inner surface near the knee and ankle along the special probe throughout the groin.
3. All varicose veins and veins are removed through individual small incisions through dressings for incompensated and difficult perforated containers.
4. Sew all wounds with cosmetic seams.

Fundamentally, classic veins allow you to remove varicose veins, but the most painful of all the prior art.

Short stripping

In the case of short stripping, not the entire large subcutaneous vein is removed, but can only be affected by varicose veins, for example, only on the thigh or lower leg.Healthy segments have not been removed.This reduces the trauma of the intervention, but the risk of disease recurrence remains.Otherwise, the operation of the procedure is similar to a classic veinectomy.

Minifle case resection

An innovative approach to removing small varicose veins from large subcutaneous veins is called MinifleBctormans.

To achieve this, special tools (sharp scalpel, hook, clamp, scraper) are required and a few millimeters of the skin are extracted through the skin with veins.There is no need to sew this skin defect, the scars are invisible.

In most cases, surgeons combine short or complete stripping of large subcutaneous veins with Minifle anti-resection.This joint operation combines activism with minimal trauma and has good cosmetic results.

Intravenous endoscopic anatomy

It is difficult to find all lower perforated veins during any veinectomy.For these purposes, endoscopic devices (camera and manipulators) are used.Through small incisions of 1-2 cm, they are inserted into the skin, and the locations of these perforated vein clusters are detected by ultrasound.

Under the control of the camera, all lower perforators will find, bandage and cross them.During this procedure, the subcutaneous vein was not removed.It can be performed independently and with any type of venectomy: stripping, mini case resection.

Laser therapy

Laser ablation of varicose veins involves burning from the side with a laser beam of large subcutaneous veins.To do this, catheter perpendicularity is introduced into the entire length by puncture through the skin in the thigh or ankle area.Under the control of ultrasound control, the Svetovod is slowly extracted.

The laser beam acts on the vein wall, destroying the inner layer.As a result, Vienna fell and stopped operating, which was clearly seen on the ultrasound monitor.If not only the main vein trunk, but also their tributaries can be removed by varicose veins, they are removed according to the miniectomy method.

Rehabilitation

No matter which method of treating varicose veins is used, the recovery of the patient after surgery will occur quickly.The terms of complete recovery depend on the procedure, the stage of the disease and the general condition of the patient.By laser treatment and miniectomy of initial varicose veins, it is 2-3 weeks, classic veinectomy for advanced forms of the disease - 1-3 months.

It is recommended to walk as soon as possible, provided that the condition is stabilized after anesthesia - 5-6 hours later.If spinal anesthesia is performed, bed rest is recommended within 12 hours.With local anesthesia, patients can step on their feet in the operating room and are not even hospitalized in the hospital.The main condition before walking is to bandage the legs with elastic bandages or wear compressed knitted clothing of your choice.

Stay in the hospital from 1-2 to 5-8 days.If the seams are superimposed, it is best to delete them in the expert's control check for 7-8 days.Within one month after the operation, it is recommended to wear compressed knitted clothing.It is necessary to put it on it every day before getting up.At night, the compressed product was removed.After classic veins and severe varicose veins, it is best to compress for up to 3 months.

Throughout the month, it is strictly prohibited:

• Sauna and hot tub;
• Major physical exercise in the lower limbs;
• Stand or sit in a motionless position for a long time.

Possible complications

The most common complications associated with varicose veins’ handling:

• The pain in the surgical leg due to damage to the large nerves.
• Long legs and long swelling of feet.
• Hematoma and bruises on lower legs and thighs.
• The wound was bleeding.
• Flebotrombosis - Inflammation of the deep vein.
• Supervision of postoperative wounds and necrosis (fatal) of the surrounding skin forms nutritional ulcers.
• The formation of large scars after surgery.

Thanks to modern methods and techniques, surgical treatment of varicose veins is very easy, painless and efficient.Following all recommendations during the postoperative period can help to recover quickly and minimize the risk of complications and the risk of disease recurrence.