Varicose veins in the legs Surgical treatment

For many decades, the surgical treatment of the varicose veins of the legs remains the only radical method to eliminate this disease and its complications.Thanks to modern technologies and the improvement of operating techniques, it is really effective both in therapeutic and cosmetic terms, it is carried out in the easiest and painless pain possible, well tolerated by patients and does not cause prolonged disability.

Normally, approximately 30% of the blood of the lower extremities flows through small subcutaneous venous tributaries, which are merged into two central venous trunks: a large and small subcutaneous veins.These vessels are directly connected to deep veins, through which 70% of the blood flows.In the places of such compounds there are valves that pass blood only from the superficial to the deep veins.There are also dozens of small veins, who also connect the superficial venous network with deep.They also have valves that pass blood in one direction.The main cause of the varicose veins is the failure of the venous valves, which leads to an inadequate blood discharge: from deep veins to the surface, which increases the pressure in them and leads to the expansion of small vessels and central venous trunks.The main objectives for which surgical treatment is aimed at the varicose veins of the lower extremities:

• The elimination of the stagnation of the blood in the altered surface veins of the legs, which will prevent the progression of chronic venous insufficiency and trophic disorders in the skin.
• Eliminate deformed vessels and varieties that represent a cosmetic defect.
• The elimination of the blood discharge from the deep veins to the superficial: the ligation and the intersection of the perforating veins (clans), as well as the large and small subcutaneous veins in the places of their connection with the deep ones.
• Prevention of a repeated occurrence of varicose veins.

A separate place in the surgical treatment of the female varicose veins of the lower extremities belongs to cosmetic surgery.After such interventions, not only the pathologically altered veins, but also postoperative scars on the skin of the legs, or are discreet.To achieve maximum cosmetic effect, surgical surgery for varicose veins is carried out according to the following methods:

• Laser or radiofrequency ablation of the veins of the central trunks of a large and small subcutaneous vein under ultrasound control through a puncture of the skin in the thigh or foot.
• Sclerobliteration and sclerotherapy of the stem: filling large and small subcutaneous veins, as well as all its tributaries, even the smallest, with a special medicine.

With any of the treatment methods described, the varicose veins are not eliminated, but become the blood vessels into a soft scar tissue.Both physical influences (laser rays, radiofrequency waves) and chemical compounds (sclerosantes) destroy the inner layer of the vein.Thanks to this, it loses the light, the sticks and is completely disolished from the blood, becoming an ordinary connective tissue (scar).Therefore, without the direct elimination of the veins, all the objectives assigned to the rapid treatment of the varicose veins of the lower extremities are achieved: the changed vessels are eliminated and the dangerous consequences of venous insufficiency in them are eliminated.The only restriction of cosmetic operations in the treatment of varicose veins in women is possible only expanded veins slightly or limited to 1-2 degrees.During pregnancy and in the early postpartum period, surgical treatment is contraindicated with the exception of acute situations that require emergency intervention, for example, with ascending thrombophlebitis.The operation is limited to the dressing of a large subcutaneous vein in the place of its connection with the femoral (Crossectomy).Consider the most common surgical interventions in the treatment of varicose veins of the lower extremities: laser ablation, endoscopic dissection of veins and phlebectomy.The latter is divided into the following types:

• Classical operation, or complete bankruptcy or Operation of Trojanov Trendelenburg-Bubko-Narata;
• short peeled;
• Flebectomy

Flebectomy

The extraction, the extraction of veins from under the skin is called phlebectomy.This is one of the first methods of surgical treatment of the varicose veins of the lower extremities.But even today, phlebectomy is performed more frequently by phlegology and vascular surgeons.There are three modifications and operating methods: complete, short dispossession, miniflebectomy.Domestic surgeons call for classical phlebectomy the Trojanov Trendelenburg-Bubko-Nratrat operation, and foreign authors with full stripping.The intervention volume is presented:

1. As a bandage of the trunk of a large subcutaneous vein at the place of its confluence, 2-3 cm in the thigh under the inguinal fold, in the thigh, through an incision.
2. Its elimination throughout the groin to the foot using a special probe through two cuts of the skin 1-2 cm along the internal surface near the knee and ankle.
3. The elimination of all varicose veins and small veins through small separate incisions is approximately 1-2 cm (they can be 5-6 to 10-20) with the dress of insolvent perforating vessels.
4. Sew all wounds with cosmetic seams.

Classical phlebectomy allows you to eliminate varicose veins, but the most traumatic among all existing techniques.

Shorting

With a short strip, the entire large subcutaneous vein is not eliminated, but only its fragments, affected by varicose veins, for example, only in the thigh or at the bottom of the leg.Healthy segments are not eliminated.This reduces the trauma of the intervention, but the risk of relapse of the disease remains.Otherwise, the operational operations of the operation are similar to classical phlebectomy.

Flebectomy

The innovative methodology to eliminate small varicose veins of a large subcutaneous vein is called phlebectomy.For its implementation, special tools are needed (scoring scalpel, hooks, clamps, spatula), with which the veins are extracted through the skin of the skin several millimeters.It is not necessary to sew such skin defects, the scars are invisible.Most of the time, surgeons combine a short or complete extraction of a large subcutaneous vein with phlectomy.Such combined operation combines radicalism and adhesive trauma with a good cosmetic effect.Laser ablation for varicose veins implies burning with a laser beam of a large subcutaneous vein from the side of its free space.To do this, through the puncture of the skin in the thigh or in the ankle area in the vein light, a cattle servist is introduced throughout its length.Under ultrasound control, the Svetovod is slowly extracted.The laser beam, which acts on the venous wall, destroys the inner layer.As a result, Vienna falls and stops working, which is clearly visible in the ultrasound monitor.If not only the main venous trunk is affected by the varicose veins, but also by its tributaries, they are eliminated according to the phlebectomy method.

A disease such as varicose veins is a disease characterized by the dysfunction of the vascular walls and the weakness of the valves in the veins, which causes stagnation in the blood vessels of the lower extremities and the appearance of the venous nodes.Such pathology is quite dangerous and is tense not only with trophic disorders and the presence of an inflammatory process, but also due to the lack of tissue nutrition.As a general rule, this contributes to the formation of blood clots, which can spread through blood flow throughout the body and the appearance of trophic ulcers difficult to live.In addition, the formation of thrombotic formations within the vessels threatens the development of a disease such as thrombophlebitis.Therefore, if the patient has varicose veins of the lower extremities, surgical treatment is mandatory, especially if the ailment is thrown.I would like to get the attention of the readers of our site that surgery for the varicose veins of the lower extremities is a radical measure and, as a rule, it is prescribed if it cannot do without it.Varicose disease of the lower extremities, the surgical treatment involves several, most of the surgical practice options for surgical treatment.These options are directly in the approach to the elimination of the affected veins and veins of the lower extremities.

• The use of traditional phlebectomy in surgical practice for the radical treatment of varicose veins.This option is done according to the baby methodology.This implies the introduction of a probe specially designed for this procedure in the light of the container and the posterior extract of the vein through a prefabricated incision in the skin.After the operation, its cord is done with a cosmetic seam, which later makes it almost invisible.
• Flebectomy: This operation is required to eliminate small sections of blood vessels and veins, affected by varicose veins.Keep in mind that this operation does not provide skin cuts, since part of the affected container or vein is removed by skin puncture, which does not require imposing seams.

Note that surgical intervention in the treatment of certain diseases is far away.However, the varicose veins of the lower extremities, the surgical treatment is extremely necessary if the elimination of blood clots and potentially dangerous sources of the inflammatory process is required.This approach will improve the patient's condition and help avoid severe and insecure for the health and life of the patient's complications.States that require urgent surgery for varicose veins include:

• the presence of thrombophlebitis or risks cause their appearance;
• acute thrombophlebitis or frequent exacerbations of the disease;
• extensive defeat of blood vessels and veins;
• The constantly disturbing feeling of fatigue and severity in the legs, unpleasant pain, indicating a clearly expressed veins;
• The appearance of trophic ulcers.

There are also certain contraindications in the operation of varicose veins:

• Second and third trimester of pregnancy;
• the presence of infectious ailments acute;
• exacerbation of existing pathologies in one patient (diabetes, asthma, peptic ulcer and others);
• Myocardial infarction, stroke;
• Dermatological problems.

Disassembly: As a rule, this method is used in the presence of a small section of the lesion, this is a technique that is more saving, unlike traditional phlebectomy.The method consists of stretching, through a special hook, the most venous node.There is also a subspecies of this technique: Crioestroping, which implies the sinking of the glass damaged to the crystone and its subsequent elimination.

Sclerosis: The technique provides the introduction of damaged sclerosantes, a special substance for the "stuck" of the walls of the container between them.However, after the procedure, the vein does not extend, but remains in place, without fulfilling its purpose, although the blood flow through Vienna and stops, however, this function is performed by collateral vessels, which does not violate the exit of venous blood.The operation is carried out under the mandatory control of a specialist with ultrasound equipment.

Laser coagulation: This method is the most innovative in the treatment of varicose veins and is the introduction of special equipment with laser radiation (thin probe) in the vein light.The device has a caulster effect on the walls of the blood vessel.

Consequences after surgery to eliminate varicose veins:

• the appearance of postoperative postoperative bruises on the surface of the body, which, as a rule, are resolved for several months;
• In addition, after several months, the stamps under the skin located along the bed of the remote container disappear;
• Violations of the integrity of the lymphatic system (blood vessels) of the blood vessels, which can lead to stagnant processes.Such postoperative consequences are treated conservatively, however, often the circulation of lymph is restored after a few months;
• Possible damage to subcutaneous nerve endings, which is manifested by the deteriorated sensitivity of the epidermis: these postoperative symptoms pass after 5-6 weeks.

Resume

Varicose disease surgery

Traditionally, phlebectomy (cross -tetomy) is performed according to the Bebcock method and consists of introducing the probe in the vein light with the posterior stretch of the vein completely on its length through the cut on the skin outside.The incision sutures at the end of the operation with a cosmetic seam.Flebectomy is used to eliminate very short areas of the vein, during the operation, the veins are not used.The cuts in the skin are not carried out, and a piece of vein is removed through a thin puncture in the skin that does not require imposing seams.With a small area of damage to varicose veins, it is possible to perform a softer technique: eliminate.This stretches with a thin hook of only a varicose node.The experience is carried out by means of two cuts in the skin with its subsequent suture.A variety of this technique is Crioestria: "Sinking" of the vein to the Criosonda using low temperatures, the destructive node also extends.

Vienna sclerosion is the introduction of sclerosing in its light, a substance that "hits" the walls of the vein with each other, but the vein remains deep under the skin, without performing its functions.The blood flow through the vein stops and passes through the collateral vessels, without violating venous blood exit from the lower limb.Vienna sclerosis is performed under ultrasound control.The laser coagulation of the varicose veins is the last method in phlebology and consists of introducing a thin probe in the vein light with laser radiation, which exerts a caulster effect on the walls of the vein.The radiofrequency exposure method of the veins also refers to a more modern treatment of varicose veins, but not all medical institutions are equipped with appropriate equipment.The technique consists of the "cauterizing" effect on the vascular wall of high frequency radio waves.