The development of varicose veins is facilitated by such "bad" habits of a modern man spoiled by civilization, for example:
- sedentary lifestyle (contraction of calf muscles helps blood to flow from the vessels of the lower extremities - this is called the "second heart");
- overweight (in the United States, where obesity has become a national problem, 25-30% of the adult population suffers from varicose veins);
- occupations related to staying on one's feet or in a sitting position for a long time (staying at the computer for a long time, especially if you have a bad habit of throwing your feet up, can also cause varicose veins).
The early stages of the disease are often completely asymptomatic, and conservative therapy cannot restore pathologically dilated vessels and deformed venous valves. Therefore, often on the first visit, doctors advise patients to remove the veins.
Tips for surgery
The indication for surgery to remove varicose veins can be any manifestation of the disease that reduces the patient's quality of life, including:
- Disruption of the valve apparatus, which is detected at the doctor's appointment with the elongation of the wall of the saphenous veins (this is the main criterion for the ineffectiveness of conservative therapy);
- Safen vein thrombosis (thrombophlebitis);
- symptoms of venous insufficiency (night cramps in calf muscles, pain and heaviness in the legs, swelling), which is difficult to conservative therapy;
- presence of trophic ulcers of venous etiology (when the ulcer is "fed" with an enlarged vein);
- aesthetic defect (dilated veins in the legs are an unattractive sight).
Surgery to remove varicose veins can be performed in different ways, which differ significantly in the amount of intervention and, consequently, in the results for the body.
When choosing a technique, surgeons mainly guide the stage of the process, so it is better to agree on the timely removal of the vessels, rather than waiting for the development of complications.
When surgery is not performed
The removal of varicose veins in the lower extremities does not apply to surgeries that are extremely dangerous for the body. However, in case of acute diseases (influenza, acute respiratory viral infections, etc. ), as well as exacerbation of any chronic pathology, vascular removal should be delayed.
In addition, the removal of varicose veins of the lower extremities may be delayed during pregnancy and childbirth. After childbirth, blood vessels often return to normal. This happens during the first 4-5 months after birth.
I must say that there are no contraindications to surgery to remove varicose veins. In cases where varicose veins pose a real threat to the patient's life and are difficult to treat, the operation is performed at any age and in any condition of the body (obesity, high blood pressure, etc. ).
Minimally invasive surgery for varicose veins of the lower extremities
Minimally invasive surgery for varicose veins does not involve mechanical removal of the venous vessels. The main mechanism of action of these procedures is the chemical (special solution) or physical (laser, high-frequency radiation) effect on the inner lining of the vessel. As a result, varicose veins collapse and grow.
Minimally invasive surgeries performed in accordance with the guidelines have the following advantages:
- high efficacy (relapses are very rare);
- no need for hospitalization;
- absence of severe traumatic effects on the body;
- good tolerance of the procedure by patients;
- minimum percentage of complications and unpleasant side effects;
- shortest recovery time;
- no need for general anesthesia (comparable to dental treatment in terms of pain).
Today, there are several methods of minimally invasive intervention that you can read below.
Advantages and disadvantages of vascular removal with sclerotherapy
The method of sclerotherapy is based on the chemical closure of the inner walls of blood vessels by applying a special substance - sclerosant. The advantages of the method include the relatively low cost of vascular removal.
However, with a significant spread of the process, several sessions of sclerotherapy may be needed - the treatment process can last up to 1 month.
In our clinic, we use sclerotherapy to remove superficial small blood vessels and spider veins (reticular varicose veins).
In addition, sclerotherapy can be used as a combined technique for extensive lesions in combination with laser ablation or RFA and miniflebectomy.
Sclerotherapy is also the best treatment for trophic ulcers in which the skin on the vein is altered and incisions cannot be made. In such cases, we use an intravenous injection of a sclerosant that nourishes the ulcer under ultrasound guidance.
In our clinic, foaming ethoxysclerol is used as a sclerosant, this method guarantees high efficiency, because the sclerosing agent spreads better through the affected vein.
Benefits of vascular removal with endovenous laser ablation
Endovenous laser ablation (EVLA) is a minimally invasive method to remove varicose veins of the lower extremities using a laser beam.
Compared to sclerotherapy, EVLO has the following advantages:
- absolute painlessness (the procedure is performed under local anesthesia);
- high accuracy (all surgeries are performed under ultrasound control);
- According to the indications, EVLO can be completed with a miniflebectomy procedure (removal of dilated canals), which significantly reduces the list of indications for mechanical removal of vessels;
- bruising is less common after the procedure;
- postoperative pain syndrome is less pronounced;
- absence of age spots at injection sites;
- shorter recovery time.
Radiofrequency ablation is the most modern method of minimally invasive treatment of varicose veins.
The advent of radiofrequency ablation (RFO) has significantly reduced the number of cases in which the only solution to the problem is surgical (mechanical) removal of varicose veins.
Large venous trunks with a diameter of 15 mm or more can be "welded" with the help of a radiofrequency electrode inserted into the vascular cavity under ultrasound control.
Radio frequency obliteration has all the advantages of EVLA. In addition, RFO is superior to endovasal laser ablation:
- use of disposable electrodes;
- full automation of the process, which prevents annoying errors (the device is equipped with a sensor and works according to the feedback method, so more energy is automatically sent with a larger ship width);
- the procedure takes less time;
- after a year, the vessel treated with RFA is completely dissolved (when using EVLA, it remains in the form of a cord).
The only disadvantage of radiofrequency ablation is the high cost of the procedure.
Surgery to remove varicose veins in the lower extremities
Phlebectomy or surgical removal of varicose veins is a more radical surgical procedure that involves complete or partial removal of the affected venous trunk (large or small vein) with all branches, as well as closure of fistulas with deep veins of the joint.
Phlebectomy is performed in more advanced cases, so it is often completed with the use of minimally invasive methods to remove the remaining branches and varicose veins.
The postoperative period after phlebectomy is usually longer than minimally invasive interventions. Postoperative wounds remain on the operated foot, which requires careful care.
After phlebectomy, small bruises and large hematomas are more common, and inflammatory infiltrates (seals) often occur.
However, with proper care, all the unpleasant side effects disappear completely. As a rule, small inconspicuous wounds remain in the incisions that do not cause major complaints.
Preparation for surgery
Regardless of the surgical treatment chosen, you must undergo a preoperative examination that includes standard laboratory tests (total blood and urine tests, coagulogram, blood glucose, etc. ) to remove the blood vessels.
In addition, vascular ultrasound and tests for blood-borne infections (hepatitis, syphilis, HIV) are needed.
Be sure to tell your doctor about any medications you are taking (contraceptives, painkillers, etc. ), as well as allergic reactions to the medications.
Results of vascular removal operation. How to behave to prevent complications
To prevent the development of thrombotic complications, doctors use special means - anticoagulants, which are selected depending on the parameters of the blood clotting system.
After EVLO and RFO, early loading (walking) on the legs is recommended. Transient pain syndrome may occur if the operation is performed by phlebectomy while walking.
Once the varicose veins have been removed, it will take some time to strictly follow the instructions below:
- wear compression stockings (socks are more comfortable);
- Avoid thermal procedures (high temperature bath, sunbathing on the beach, etc. ).
The duration of the restrictions is determined by the attending physician depending on the stage of development of the disease, the method of operation, the volume of the removed vessels, the general condition of the body and the dynamics of the recovery process.
How to prevent relapse
It should be borne in mind that varicose veins occur in people with a hereditary predisposition, so it is necessary to do everything possible to prevent recurrence of the disease after surgery, ie:
- control your weight;
- avoid prolonged static load;
- take courses of treatment with venotonics;
- Wear compression garments according to instructions.
Is it possible to do without surgery?
In cases of irreversible changes in the walls of blood vessels, unfortunately, it is impossible to do without surgery. With long-term development, varicose veins threaten the following complications:
- massive bleeding from dilated vessels;
- venous thrombosis;
- thromboembolic complications (including cardiac arrest, pulmonary infarction, etc. );
- trophic ulcers, etc.
There are no magic ointments that dissolve living tissues (dilated veins). Most of these products have only a locally distracting effect, creating a feeling of "coolness" when applied. Ointments are not effective in preventing thrombosis without wearing compression stockings. Treatment of thrombosis as monotherapy is also completely ineffective.
Can vascular removal be postponed?
Modern methods of vascular removal allow you to get rid of the disease quite comfortably and continue to live a full life with virtually no restrictions.
If you do not have the opportunity to operate at the moment, then the only way to delay the occurrence of complications is to wear compression stockings of compression class 2 or 3 regularly.
Often - this happens in the summer, when the risk of thrombosis is particularly high. Compression stockings are worn for 2-3 weeks after surgery, after which you can often forget about it.
It should also be borne in mind that the later the patient sees a doctor, the more expensive the treatment will be and the later it will not be possible without traumatic intervention.
Do not postpone the operation indefinitely. Took care of yourself. Bless you.