Surgical treatment of varicose veins of lower limbs

Surgery treatment of the varicose veins of the legs has been the only radical method for eliminating the disease and its complications for decades.

Thanks to modern technologies and the development of operational techniques, it is truly effective in both therapeutic and cosmetic terms, as easily and painless as possible, patients tolerate well and do not cause longer disabilities.

Signs and contraindications

It is not advisable to operate patients with varicos.There are clear signs for surgery and contraindication to implementation.

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

Medical indications- Outstanding extension of 2-3 degrees of veins, with complaints and signs of chronic venous failure:

• convincing, tense veins under the skin;
• Multiple variations (nodes) along the changed vessels;
• Swelling of the affected foot;
• severity and pain along the enlarged vein;
• cramps at the lower leg calf muscles when “reduces the leg;
• Inflammatory changes in veins - thromboflebitis;
• Trofil skin disease-dark spots, redness, subcutaneous layer, a long sheet wound.

Cosmetics- Early (first) stage of varicose vein without signs of venous insufficiency, only causing a cosmetic error and aesthetic discomfort in the patient:

• Superficial, slightly expanded and winding veins;
• Vascular "stars", "spider" and reddish-blue small capillaries in the skin of the feet.

It is important to note that even if there are signs of the operation, it must be denied if the risk of its risk exceeds the advantage.

The main contraindication of surgical treatment of varicosas:

• A severe general condition caused by any acute (heart attack, stroke, pneumonia) has been caused by chronic diseases (liver, cordial, lung insufficiency) or the patient's old age.
• Any acute infectious disease.
• Treatment of leading cancer.
• Pronounced anemia.
• Outstanding or decrease in blood coagulation.
• On the skin of the lower limb, where surgical intervention is planned.
• Pregnancy and postpartum period.

All contraindications, except for the first, are considered relative.This means that one or another surgical treatment should be performed under special conditions (acute dangerous conditions caused by varicos, such as thromboflebitis on the thigh).

When an emergency operation is required

Emergency surgical treatment of the feet of the legs may only be required in one case - in acute rising thromboflebitis.This complication is an inflammation in the lumen of a large subcutaneous vein accompanied by blood clots.

If such an abnormal process applies to the thigh, there is a risk that blood clots are pushed into a deep venous system.If such a blood clot is separated, it penetrates into the lung vessels and clogs what causes the dangerous life of the dangerous disease - lung thromboembolia (pulmonary fiber).

The main manifestation of growing thighs -thrombophlebitis:

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

In the case of increasing thromboflebitis, the amount of surgical treatment can be represented:

• Crosectomy - Dressing and a large subcutaneous vein intersection at the place of confluence with the bed;
• Removing the changed vein with the preliminary dressing.

The purpose of surgical intervention

Usually blood from the lower limbs is approx.30% flow through the small subcutaneous venous tributaries that combine in two central venous packages - a large and small subcutaneous.These ships are directly connected to the deep veins through which 70% of the blood flows.There are valves in the places of such compounds that transfer blood only from surface veins.

There are also dozens of tiny veins called perforants and the surface venous network is connected to the deep.They also have valves that move only one direction from the blood.

The main cause of the varicose veins is the failure of venous valves, which leads to inadequate blood emissions: from deep veins to the surface, which increases the pressure and leads to the expansion of both small blood vessels and central vein packs.

The main goal for which surgical treatment is directed to the varicose veins of the lower limbs:

• Eliminating blood stagnation in the altered surface veins of the legs, which prevent chronic venous insufficiency and tropical disorders on the skin.
• Removal of deformed vessels and varieties that represent a cosmetic error.
• Blood emptying from deep veins to superficial colors - ligaming and intersection of perforant (clans) veins, and a large and small subcutaneous veins at their depth.
• Preventing the repeated occurrence of the varicos.

Preparing for the operation

Full preparation of Varicoosa surgical treatment includes the following:

1. A general preoperative study that allows the patient's health to test blood and urine tests, coagulogograms, biochemical analysis, blood type and RH-factor, syphilis tests, blood glucose, lung radiography, ECG.
2. Special diagnostics that allows you to determine the characteristics of the disease - with ultrasound, colored doppler mapping, deep veins and arteries of the lower limbs, and the location of insolvent perforant veins.
3. The operation is done on an empty stomach, so you can't eat and drink on the day of surgery.
4. In the morning before surgery, you should carefully shave all the hair on the sore leg from the groin to the foot.

Treatment of female varicosas

A separate place for surgical treatment of female varicose veins of the lower limbs belongs to cosmetic surgery.After such interventions, not only pathologically changed veins, but also postoperative scars are on the skin of the feet or unnoticed.

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

• Laser or radio frequency ablation blood vessels-burning the central trunk of a large and small subcutaneous vein during ultrasound control by punching the skin on the thigh or foot.
• Stem Sclerotherapy and Sclerotherapy-Fill in large and small subcutaneous veins, as well as all the tributaries, even the smallest, a special sclerocant drug.

With any of the treatment methods described, the varicose veins are not removed, but converts the blood vessels into a soft cytry tissue.Both physical influences (laser rays, radio frequency waves) and chemical compounds (scanned) destroy the inner layer of the vein.As a result, it loses lumen, glue and completely destroyed and becomes a usual binding (cicatric) tissue.

Thus, without direct removal of the veins, all the goals ordered the changed blood vessels for the quick treatment of the veins of the lower limbs, and the dangerous consequences of venous insufficiency eliminate them.

The only restriction of cosmetic operations in women's varicos treatment is only possible to slightly or limitedly expanded veins at 1-2 degrees.During pregnancy and early childbirth, surgical treatment is contraindicated except for acute situations that require emergency intervention, such as increasing thrombophlebitis.The operation is limited to the dressing site of a large subcutaneous vein at the point of connection to the femur.

Types of surgical operations

Take into account the most common surgical interventions for the treatment of the lower limbs: laser ablation, endoscopic autopsy of veins, and flebectomy.

The latter is divided into the following types:

• a classic operation or complete strip or function of the Trojanov-Trendelenburg-Bubko-Narata;
• Short striping;
• Miniflebectomy.

Flebe

Extract of removal, veins from the skin is called flebectomy.This is one of the first methods of surgical treatment of the lower limbs.But even today, phlebectomy is done by flebology and vascular surgeons.There are three modifications and methods of operation: complete short strike, minifliuntomy.

We present the amount of intervention:

1. As a bandage of the large subcutaneous vein, the confluence is 2-3 cm on the thigh on the thigh, the thigh, through an incision.
2. Removing the groin to the leg throughout the groin with a special probe through two cuts of the skin 1-2 cm along the inner surface near the knee and ankle.
3. The removal of all varicos and small veins through separate small incision is approximately 1-2 cm (these can be 5-6-10-20) with insolvent perforant blood vessels.
4. Sewing all the wounds with cosmetic seams.

Classical flebectomy is most radically allowed to remove varicos, but the most personal techniques are the most personal.

Striping

With a short strip, the whole large subcutaneous vein is removed, but only the fragments of the varicos, such as the thighs or the lower leg.Healthy segments are not removed.This reduces the trauma of the intervention, but the risk of decline in the disease remains.Otherwise, the operational operations of the operation are similar to classical flebectomy.

Cheering

The innovative methodology of removing the small subcutaneous vein is minifliebectomy.

Special tools (pointed scalpels, hooks, clamps, spatula) are required for implementation, with which the blood vessels are extracted several millimeters on the skin.No need to sew such skin defects, scars are invisible.

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

Endoscopic autopsy of veins

It is difficult to find all lower levels of perforating blood vessels during any flebectomy.Endoscopic equipment (video camera and manipulators) are used for these purposes.With small cuts of 1-2 cm, they are placed under the skin in the places of perforant veins, which are detected with ultrasound.

During the camera control, all lower perforators will find, connect and cross them.In this operation, the subcutaneous veins are not removed.After all, it can be done and can be done with any type of flebectomy: stripping, minifliebectomy.

Laser treatment

The laser ablation of the varicose veins involves burning with a large subcutaneous vein laser foot, on the side of the gap.To do this, a catheter-verb is introduced into the vein's lumen by punching the skin on the thigh or ankle.Under the control of ultrasound, Svetovod is slowly extracted.

The laser leg acting on the venous wall destroys the inner layer.As a result, Vienna falls and ceases to operate, which is clearly visible on the ultrasound monitor.If not only the main venous boot, but also its tributaries are removed with varicos, they are removed according to the Miniflebectomy method.

Rehabilitation

Regardless of the operational methods used to treat varicose veins, patients are restored rapidly during the postoperative period.The conditions for total rehabilitation depend on the methodology of surgery, the stage of the disease and the general condition of the patient.With the laser treatment and miniflectomy of the initial varicose veins, it is 2-3 weeks, with classic flebectomy for advanced forms of the disease 1-3 months.

The walk is recommended as early as possible, provided that the condition is stabilized after anesthesia after 5-6 hours.If spinal anesthesia are performed, it is recommended to rest within 12 hours.In case of local anesthesia, the patient may leave his operating room on his leg and will not be hospitalized even in the hospital.Before walking, the main condition is to connect the legs with a flexible bandage or place it on a separate -separately selected compression knitwear.

Stay in the hospital for 1-2-5-8 days.If the seams are placed on each other, it is better to remove them 7-8 days during a specialist check check.It is recommended to wear compression knitwear within one month after surgery.You have to put it daily before getting out of bed.At night, compression products are removed.After severe varicose veins, it is better to continue the compression for up to 3 months.

It is strictly forbidden during the month:

• sauna and hot bath;
• Heavy physical activity on the lower limbs;
• Long stay in a motionless position or sitting.

Potential complications

The most common complications associated with varicos operations:

• Pain in the working foot due to damage to large nerves.
• Long swelling of the lower leg and leg.
• Hematomas and bruises on the lower leg and thighs.
• Bleeding from wounds.
• Flebotrombosis - inflammation of the deep veins.
• Supervision of postoperative wounds and necrosis (fatal) with the formation of tropical ulcers around them.
• The formation of rough postoperative scars.

Thanks to modern methods and technologies, the surgical treatment of varicose veins is simple, painless and highly efficient.Compliance with all recommendations for the postoperative period contributes to rapid recovery, minimizes the risk of complications and the decline of the disease.