Removal of the superficial vein in the lower leg, or phlebectomy - an operation performed on severe varicose veins. If at an early stage it is still possible to cure with compression and conservative methods, then when moving to the final stage of development, it is no longer possible to stop the development of pathology with drugs.
Although surgical intervention on blood vessels is not easy, sometimes only radical therapy can save the patient not only health, but also life.
This operation for varicose veins has several types. For each patient, the type of procedure was chosen purely individually.
All types of phlebectomy are listed below:
- Classic surgery (combination of phlebectomy)- a type of surgical treatment for varicose veins, which consists in removing the altered vein through a small incision of the skin. This intervention involves a combination of various techniques and is done with the help of instruments that allow you to remove vessels of large and small caliber from under the skin: phlebextractor probes, clamps, hooks. This type of varicose vein removal is the most common. It is used in all cases when other methods are ineffective. This method aims to restore normal blood flow in the veins in the lower leg. This completely eliminates the risk of developing irreversible pathological processes in the future.
- Laser phlebectomy- an innovative method of treating varicose veins, which has become increasingly popular in recent times. The point lies in the "burning" of varicose veins with a laser beam. This is a unique treatment without pain, scars and hematomas.
- Radiofrequency Vein Removalis the most modern method. With the help of radio waves, the affected veins heat up, collapse and then dissolve.
- Echosclerotherapy- filling vessels altered with sclerosant material, which damages the walls and causes them to stick together. Thus, the veins are knotted and transformed into scar tissue.
Indications and contraindications for phlebectomy
Varicose vein removal is a serious and risk-free procedure, so it is performed only if there are specific indications:
- inflammation of the affected venous tract;
- appearance of "bruises" on lower limbs;
- large vein lesions;
- venous thrombosis;
- fatigue and constant pain in the legs;
- swelling of the lower limbs and other affected limbs;
- formation of trophic ulcers that cause severe pain and discomfort;
- A burning sensation is felt along the length of the ship.
Contraindications to combined phlebectomy are:
- Ischemic heart disease (ischemic heart disease) in the acute stage;
- constant increase in blood pressure;
- presence of current infectious disease in any form;
- eritipelas or eczema eruption in the limbs;
- pathological rash of various natures.
Phlebectomy is strictly prohibited during pregnancy and is relatively contraindicated for elderly patients. This procedure can also have serious consequences for people with diabetes mellitus, previous stroke or myocardial infarction.
Only a phlebologist can determine if you have contraindications for phlebectomy.
Before performing a phlebectomy on a large saphenous vein (GSV), it is necessary to undergo a thorough body examination:
- runs an electrocardiogram;
- for general clinical analysis of blood and urine;
- donates blood for coagulation, biochemistry, for syphilis, HIV and hepatitis.
- underwent an ultrasound scan for varicose veins.
Also need to shave the hair on the affected limb.
If the patient is to be injected with general anesthesia, surgery should be performed on an empty stomach or gastric lavage should be performed immediately before that.
Usually, preparation for a classic phlebectomy lasts 1-2 days.
All phlebectomy methods must be performed under anesthesia, which prevents the development of pain syndrome. Depending on the circumstances and methods of intervention, pain relief may be local or general.
How long the procedure for removing varicose veins depends on several factors:
- surgical methods;
- individual characteristics of the organism;
- vein wounds.
On average, superficial vein removal on the lower leg takes 1-2 hours. Time can be extended if unforeseen circumstances arise during operation.
Combined phlebectomy is a radical method of surgical removal of a vessel affected by varicose veins, with the help of which it is possible to remove both the variable and only those from which the seals are localized. To prevent the development of pain, patients are given general anesthesia or spinal anesthesia.
The course of operation consists of the following 4 stages.
Stage 1 - crossectomy
In the first stage, an incision is made in the skin of the thigh, a large saphenous vein is isolated and bound at the location of the anastomosis with the deep vein.
Level 2 - stripping
This step consists of removing the damaged vein.
A special probe is used to extract vessels outward.
This stage of phlebectomy is divided into 4 types:
- The first type of stripping using a Babcock probe. This is a tool with a metal strap, on one side there is a handle, on the other - a head with a cutting edge. During surgery, other incisions are made in the shin area or on the inside of the ankle. After the introduction of the probe with the help of the head, the doctor corrects the sore vein and, by scrolling the handle, gradually pulls it out. Stripping like this is traumatic and painful.
- Inverted stripping method, the essence is the same as the previous one. However, the investigation in this case is not fully equipped. Attraction is the essence of such a procedure.
- PIN Stripping. During this procedure, an additional puncture is made, in which a special surgical thread is inserted, affixed to the probe. The thread is tied to the vein. Therefore, the surgeon's efforts were transferred to the venous vessel, it was overturned and removed.
- Cryostripping is an expensive but very effective procedure. In this case, the cryoprobe is inserted through the incision, which freezes into the vein under the influence of low temperatures. As a result, the diseased vessel was carefully torn, and then pulled out.
If the incision is made on the patient during phlebectomy, then after removing the sore vein, cosmetic sutures are applied to this part of the limb, which is removed 8-9 days after surgery.
If the patient has a small puncture, the suture will not be used - such a hole will heal on its own.
Level 3 - communicative vein suppression
At this stage, the vessel connecting the removed superficial vein with the deep vein is tied.
Stage 4 - miniflebectomy
Manipulation not only has therapeutic effects but also cosmetics. After such an operation, the scar is almost never present, as it is done using a special hook.
A diseased vein is removed through a small puncture, which is then carefully removed. In some cases, this level may represent independent operation. Recovery after this type of phlebectomy does not last long.
This stage should be performed by the phlebologist surgeon carefully so that the affected vessel is not left intact during the operation, which must be removed.
Laser phlebectomy is a new method of treating varicose veins. After such manipulation, the patient does not experience sutures, scars and scars.
The essence of this procedure lies in the fact that under the influence of a strong laser beam, the damaged vein is "glued" and thus not included in the general bloodstream. Manipulation is performed outpatiently and for no more than 40 minutes.Laser phlebectomy is a modern and effective procedure for treating varicose veins. With its help, only varicose veins of large and small saphenous veins are processed. Their small tributaries were removed using the miniflebectomy method. Such a combination of interventions should be done most often, as it combines a good cosmetic effect with the radical removal of all varicose veins.
Removal of radio frequencies falls into the category of phlebectomy which causes little or no pain, while promoting complete reconstruction of the veins in the legs. That is, after performing one session of such a procedure, the patient can forget about varicose veins.
When manipulating, a special catheter is used, which is inserted through a puncture into the affected vein cavity and acts as a conductor. Through them these high frequency currents, controlled by ultrasound, flow. Due to heating, the vessel is soldered and then closed. The operation was performed under local anesthesia.
Recovery period after surgery
Recovery after phlebectomy is a purely individual problem, therefore the scheme is developed by a doctor separately for each patient. This takes into account his current state of health and the presence of chronic pathological processes in the body.
Suggested quick recovery in the postoperative period:
- Keep in mind that physiotherapy training is the key to early recovery. It is best to provide moderate physical activity on a sore leg after surgery. To begin with, you can simply bend and release your legs. Later, the doctor will prescribe exercise therapy, as physical therapy is to increase blood flow to the limbs being operated on.
- It is recommended to wear special elastic stockings 24 hours after surgery to make compression. Compression stockings should be used at least a month after varicose vein removal.
- In the postoperative period, limb massage should be performed to improve blood flow and prevent blood clots.
- During rest, the controlled leg should be in a high position.
- Vein tonic medication should be taken for several months after phlebectomy.
- Weightlifting is prohibited for one month after surgery.
Rehabilitation after phlebectomy involves moderate to moderate exercise to achieve good blood circulation in the limbs operated in the postoperative period. It is not acceptable to engage in sports.
Strict implementation of all physiotherapy exercises is the key to speedy recovery.
During the recovery period, you can not go to the sauna, swimming pool and body of water. Cycling should be abandoned until full recovery.
If you do not follow these recommendations, recovery from phlebectomy will take a long time and complications. Also, postoperative recovery lasts longer with thrombophlebitis in patients.
Possible operating complications
Complications of phlebectomy can appear immediately and shortly thereafter. They can be stated as follows:
- significant loss or decrease in controlled limb sensitivity;
- numbness in the lower part of the foot or ankle;
- suppuration where there is a puncture or incision;
- bruising or discoloration in the treated area (after laser freezing);
- edema and pain.
Complications after phlebectomy are often short-lived and disappear 1-2 months after surgery.
To reduce the risk of complications, you must adhere to all of your doctor's recommendations.
Advantages and disadvantages of varicose vein surgery
Although the procedure is not simple, it has several advantages:
- Phlebectomy surgery is one of the most effective methods of treating severe varicose veins;
- risk of recurrent disease;
- cosmetic effects;
- complete removal of diseased veins, as the remaining ducts can provide normal blood circulation in the limbs;
- surgery that is almost painless;
- relatively fast recovery;
- good patient tolerance to surgery;
- relatively short operating time.
Among the disadvantages of the procedure are:
- requirements for hospitalization of patients;
- scars (for certain types of surgery);
- the appearance of age spots on sore feet, which can last a long time.
Many patients often have questions, which is better - phlebectomy or sclerotherapy? Often, phlebectomy is performed in conjunction with sclerotherapy to maximize its effects. These treatments complement each other well and help the patient forget about varicose veins for many years.
But this question can be answered well by a phlebologist, based on specific patient data, and also by considering his material ability.