Surgery to remove leg veins for varicose veins or laser removal? What better

18 November 2020

Varicose veins are a disease characterized by changes in the condition of the veins in the legs with disrupted blood flow. When its shape is ignored, the vessel swells, causing swelling and pain in the limbs (under load), as well as aesthetic discomfort. Damaged vein removal surgery is effective for this stage.

Instructions for varicose vein surgery

Surgery for varicose veins can be performed only if there is an indication for the removal of blood vessels:

varicose veins have affected most of the veins;
severe pain and swelling of the legs during physical activity, which interferes with the normal lifestyle;
formation of open wounds and boils against the background of the development of the disease. It is dangerous to attach a secondary infection;
violation of blood permeability through the ducts, often accompanied by seizures;
development of vascular necrosis;
pathological changes in the veins, accompanied by their expansion and protrusion. The change is dangerous due to trauma to the vessel, and also causes aesthetic discomfort;
blood clots in the veins.

Surgical intervention can only be performed with advanced forms of varicose veins and if there is no dynamics with conservative treatment.

Absolute and relative contraindications to surgical intervention

Surgery to remove leg veins for varicose veins is performed not only if there are indications, but also if there are no contraindications:

Absolute prohibition for operation	List of relative restrictions
Stable high blood pressure	Presence of infectious diseases
Increases blood pressure regularly	Dermatological pathology affecting the skin on the feet
Chronic heart disease	Inflammatory processes in the body, including blood vessels
Advanced age after 70	Recovery period after other surgical interventions
Presence of cancer	Chemotherapy
Diabetes mellitus and severe asthma	Severe soft tissue injury due to trauma
Thinning and fragility of blood vessels	Pathology of the liver and kidneys in the acute stage
Patients with limited leg movements (paralysis) or patients in bed	Blood clotting disorders or anemia
Varicose veins in the last stage	Take hormones, antibiotics or other hard drugs
Presence of complicated leg fractures (with damage to blood vessels and nerve endings)	Overweight
Allergic reactions to drugs used during surgery	Rejection of the patient from surgery

While carrying a child, there may also be a violation of the condition of the veins in the legs. More often, pathology is eliminated on its own after childbirth. If there are contraindications, surgical intervention is dangerous with the patient's deteriorating condition and even with fatal outcomes.

Phlebectomy

Phlebectomy is a surgical procedure to remove a damaged vein and restore normal blood flow to the deep vein.

Anatomical meaning, large vein removal surgery technique

The circulatory system in the legs consists of deep veins and many superficial branches of the veins, which affect varicose veins. Changes in vascular activity develop due to valve dysfunction. During normal functioning of the vessel, the valve is closed, which ensures blood flow in only one direction.

In those veins affected by varicose veins, the valves do not close, as a result, blood can move in both directions, causing blood flow to be disrupted, with blood congestion and venous protrusion.

To restore blood supply to the limbs, it is necessary to remove the affected veins (with reverse blood flow), that is, to perform a phlebectomy. Prior to surgery, the patient undergoes preparations (taking tests, scanning the condition of the veins, determining the general condition of the patient).

If there are no contraindications, the specialist performs a surgical intervention, which consists of the following stages:

Access to the affected vessel is provided through a small incision (in the groin or popliteal, depending on the location of the vein). Next, the damaged vessel is tied from a deep vein to restrict blood flow.
An incision is made near a varicose vein. With the use of probes, vessels are separated from muscle tissue, lymphatic system and small capillaries. Through a tube, or using a hook, the damaged vein is removed.
Capillaries are treated to prevent bleeding.
If there is a damaged capillary forming a spider vein, it will be removed.
Finally, cosmetic stitches, disinfectant garments and elastic bandages are used.

The operation is performed under general or local anesthesia. Depending on the size of the ship and its location.

Competency level

Surgical removal of a vein is used at different stages of varicose vein development. The procedure is very effective (more than 98%). Restoration of blood circulation occurs in a short time.

Recovery

The effectiveness of the procedure depends not only on the qualifications of the surgeon, but also on compliance with the rules in the postoperative period.

After phlebectomy, you will need:

suture care for 7-14 days in hospital;
wearing compression stockings or elastic bandages for 30 days is done all the time;
after 30 days, for another 3 months, wear special underwear during the day
water procedures by washing the feet (where the operation is performed) can only be performed after removing the sutures;
during the recovery period, saunas, baths and hot showers are prohibited;
Pain medication after surgery is prescribed by a doctor. Self-election is prohibited;
supplements are taken to prevent blood clots;
take medication to strengthen blood vessel walls (vitamins E and C);
it is forbidden to be in a standing / sitting position for long periods of time, wearing high heels and tight underwear;
while resting in a supine position, the legs should be above body level. Promotes excessive blood outflow and reduces swelling;
introduces timely physical activity and gradually to normalize blood flow (discussed with your doctor);
massage and physiotherapy are performed with the permission of the attending specialist;
rejection of alcoholic beverages and nicotine. Alcohol provokes vasodilation, and tobacco, in turn, causes its narrowing. This effect reduces operational efficiency;
if you are overweight, a low-calorie diet is prescribed.

If the rules are followed, full restoration of limb function can be done in 6 months.

Endovenous freezing using laser

Surgery to remove a vein in the leg with a varicose vein using a laser is performed when a direct vessel with a diameter of at least 0, 02 cm is affected and with a small number of capillaries. This procedure involves the action of a light wave on a damaged vessel with its subsequent soldering and destruction.

Tools

Laser vein freezing can be done with one of 3 types of optical fibers:

Optical fiber type	Summary of Actions
End (classic)	This light indicator produces a beam of radiation from its end, i. e. the vessel is attached in front of it. The disadvantages are the formation of hematomas and the painful feeling of tightness in the veins. Maximum vein diameter 0. 1 cm.
Radial (with radial light guide without elf pain)	Light waves from fibers form a circle that encloses the diameter of the vein. This allows veins of various sizes to be treated. And also the risk of hematoma formation and swelling expansion is minimized.
Of the 3 types of radial fibers	A laser with two light rings is used to remove varicose veins. The first prepares the veins for the procedure (removes excess fluid), the second spirals the wall seller. For treatment, light guides are produced for fine and short veins, and for large vessels.

The choice of equipment is made not only by the patient, but also by the specialist who treats the condition of the vessel.

Which vein can be removed by EVLK method

Before selecting EVLK by a phlebologist (specialist who examines the veins and removes varicose veins), the characteristics of the damaged vessel are determined. They must be straight and at least 2 mm in diameter.

As a result, laser therapy can be applied to the following groups of vessels:

small and large saphenous veins;
saphenous accessory vein, which is at least 5 mm apart from the surface of the epidermis;
vessels that connect deep veins with superficial ones.

For other veins, therapy can only be done with phlebectomy.

Efficiency

Vein removal by EVLK method is possible with 3 types of optical fibers. Depending on the type of equipment, the effectiveness of treatment varies. When performing surgery using the final light guide, the effectiveness of therapy is 94-96%. Operation with a radial light guide allows you to achieve 100% results in removing varicose veins on the legs.

Level of preparation and implementation

When choosing to get rid of varicose veins using EVLK, patients should undergo the following exercises:

Hormone medication cancellation (if taken). Because they can cause the development of thrombosis;
the day before the intervention, you should take a blood thinner;
examination of damaged veins to determine the extent of damage;
take tests to exclude the presence of hidden infections or inflammatory processes in the body. Blood clots are also determined;
The procedure site is thoroughly washed and shaved (without the use of cosmetics, only antibacterial soap is allowed).

Prior to operation, damaged vessel boundaries, laser / fiber insertion sites, and branched capillary sites are marked. These signs allow you to solder the beginning and end of the vein, as well as the capillary ducts. The process is carried out under the control of an ultrasound machine.

EVLK is generated in stages:

Insert the catheter through a small puncture (the site of the catheter insertion is localized with local anesthesia) in the marked area.
Insert the light guide into the catheter and then to the damaged area. It is performed under ultrasound control on a monitor.
Anesthetic injections to kill adjacent veins and tissues.
Progress of "active" light guides through damaged veins, followed by delays in places where capillaries branch (to close output and prevent bleeding).
Laser release with puncture treatment with antiseptic and using an elastic bandage (or using compression stockings).

After completing the procedure, the patient can leave the hospital immediately.

Recovery features

To restore the function of the injured limb and prevent the onset of complications, you need to familiarize yourself with the nuances of recovery after EVLK.

They:

upon completion of the procedure, it is recommended to walk for a walk in a medical facility for an hour;
on day 2-3, ultrasound control of the treated vein was performed;
for 5 days, you must wear underwear at all times (the type of socks is discussed with the specialist present before the operation). Then, in 45-60 days, clothing must be worn during the day;
do kneading feet daily with daily walking from 60 minutes;
avoid loads on the feet (sitting or standing for a long time) and visit the sauna or hot tub.

If varicose vein removal is still required, the procedure is allowed to be performed no earlier than 7 days.

Benefits of each technique

Surgery to remove leg veins for varicose veins, depending on the type of intervention, has the following advantages:

Phlebectomy	EVLK
The incision for surgery is about 5 mm, so there are no scars left	No pain during the procedure (using local anesthesia). General anesthesia is not required
Painless, as surgery is performed under local anesthesia. For miniflebectomy, local anesthesia is used.	EVLK is performed under ultrasound control. The result is high accuracy and efficiency.
Low cost	Hematoma and pain at the site of surgery are rare or mild.
Rapid recovery of skin color (absence of stars and purple-cyanotic color of the epidermis)	Operation requires 1 puncture, so no stitches and scars are required
A short recovery period of about 30 days	Recovery period up to 5 days
Effective for all forms of varicose veins	After surgery, patients can leave the clinic within 1 hour.
Return to normal life is possible within 24 hours.
EVLK can be performed when the integrity of the epidermis is disturbed by boils.
The duration of the surgical intervention is not more than 40 minutes.
EVLK can be done on both feet in one day. On one leg, a second operation is allowed after 7 days.

The risk of infection during the procedure is minimal, due to the small incision / puncture.

Postoperative complications and laser vein surgery

There is a risk of complications after venous removal with surgery or laser. Negative reactions can occur due to low qualification from a specialist or due to violation of rules during the recovery period. Possible complications of phlebectomy and endovenous coagulation.

Vein Removal Method	Minor complications of the procedure	Major complications
Phlebectomy	hematoma and minor bleeding; temperature rise; swelling of the limbs due to temporary disruption of the lymphatic system, and also if recovery rules are not followed; pain, decreased sensitivity in the operating area; formation of seals due to minor bleeding under the skin from the capillaries removed; sewing crowd due to improper processing; nausea after general anesthesia.	development of deep vein thrombosis (therefore, during the recovery period, it is necessary to take a blood thinner, and follow a diet prescribed by a doctor); numb tissue in the affected area. Probably if the nerve endings are damaged during surgery; varicose veins as a result of infection during surgery or violation of the rules of care.
Endovenous laser freezing	hematoma while using the final light guide; swelling within 3 days; feelings of muscle tension and pain in the part of the vein that is removed, especially when moving the legs; slight temperature rise; the appearance of seals at the site of veins removed due to blood flow to the "closed zone"; with insufficient soldering of the vessel wall, it is possible to restore blood flow in it and the development of varicose veins. Repeated surgery is required; changes in epidermal tone during the "closed vein decomposition" period. Provided the vessel is located close to the surface of the skin.	formation of blood clots in the deep veins; lasers burn to tissues and nerve endings adjacent to subsequent limb dysfunction; development of inflammatory processes when infection is introduced to the puncture site; attach and attach a piece of fiber to a vein to handle. It is rare when using low quality equipment.

During both surgeries, allergic reactions to anesthetics may occur.

Steps to reduce complications

Surgery to remove leg veins with varicose veins is sometimes accompanied by the development of complications, to prevent its appearance is necessary: 

tests for allergic reactions to drugs used;
exclusion of infectious diseases and inflammatory processes in the body before surgery;
proven clinics selection with qualified specialists and modern equipment;
compliance with the rules during the recovery period. Especially wearing compression pants;
observe nutritional intake during the recovery period (discussed by a specialist after the procedure). The amount of pure water in the diet increases, food intake is made in small portions, the diet is enriched with vitamins and minerals;
rest your feet during working hours;
undergo postoperative examination to detect limb recovery dynamics;
to perform a massage and attend a physiotherapy procedure to restore blood flow quickly.

If there are unacceptable deviations for this operation, you must contact the clinic immediately.

Predictive comparison

With both methods of removing leg veins, the probability of full recovery is higher than 95%, but subject to elimination of contraindications, adherence to rules during the recovery period and when choosing a proven clinic. With surgical treatment, blood flow and external condition of the foot recovered after 3 months, and with laser therapy, recovery was noted after 30 days.

In advanced form, blood vessel removal is performed with surgical intervention. The method of treatment is determined not only by the patient's wishes, but also by the indications and contraindications to the procedure. The effectiveness of therapy depends on the qualification of the doctor and the implementation of postoperative foot care rules.