Removal of superficial veins from the lower limbs or phlebectomy - an operation that is performed on severe varicose veins. If in the early stages it is still possible to cure by compression and conservative methods, then, when moving to an advanced stage of development, it is no longer possible to stop the progression of the pathology with drugs.
Although surgical intervention on blood vessels is a very difficult business, sometimes only radical therapy can save the patient not only health, but also life.
This operation for varicose veins has several varieties. For each patient, the type of procedure is selected purely individually.
All types of phlebectomy are listed below:
- Classic surgery (combined phlebectomy)- modality of surgical treatment of varicose veins, which consists of removing the altered veins through small skin incisions. The intervention includes a combination of several techniques and is carried out with the help of instruments that allow the affected vessels of large and small caliber to be extracted under the skin: phlebextractor probe, tweezers, hooks. This type of elimination of varicose veins is the most common. It is used in all cases where any other methods are ineffective. The method aims to restore normal blood flow in the veins of the lower extremities. This completely eliminates the risk of developing irreversible pathological processes in the future.
- Laser phlebectomy- an innovative method for treating varicose veins, which has been gaining high popularity in recent years. Its essence lies in the "burning" of varicose veins with laser beams. It is a unique treatment, without pain, scarring and bruising.
- Radiofrequency vein ablationis the most modern method. With the help of radio waves, the affected vein heats up, collapses and then dissolves.
- Ecosclerotherapy- filling the altered vessels with a sclerosing substance that destroys the walls and causes them to stick together. Thus, the vein becomes deserted and becomes scar tissue.
Indications and contraindications for phlebectomy
The removal of varicose veins is a serious and far from harmless procedure, therefore, it is performed only if there are certain indications:
- inflammation of the affected venous vessels;
- the appearance of "bumps" in the lower limbs;
- large affected areas of veins; venous thrombosis;
- constant fatigue and pain in the legs;
- swelling of the leg and other parts of the affected limb;
- the formation of trophic ulcers, causing severe pain and discomfort;
- burning sensation along the entire length of the vessels.
The contraindications for combined phlebectomy are:
- Ischemic heart disease (ischemic heart disease) in the acute phase;
- persistent increase in blood pressure;
- the presence of current infectious diseases of any kind;
- erysipelas or eczematous rashes on the limbs;
- pathological rash of various natures.
Phlebectomy is strictly prohibited during pregnancy and is relatively contraindicated for elderly patients. The procedure can also have dangerous consequences for people with diabetes mellitus, previous stroke or myocardial infarction.
Only a phlebologist can determine whether you have contraindications for phlebectomy.
Before performing a great saphenous vein phlebectomy (VSM), it is necessary to make a complete examination of the body:
- conducting an electrocardiogram;
- to perform a general clinical analysis of blood and urine;
- donate blood for coagulation, biochemistry, syphilis, HIV and hepatitis.
- do an ultrasound of your varicose veins.
It is also necessary to shave the hair of the affected limb.
If the patient is injected with general anesthesia, the operation must be performed on an empty stomach or gastric lavage must be performed immediately before.
Often, preparation for a classic phlebectomy lasts 1–2 days.
All phlebectomy methods are necessarily performed under anesthesia, which prevents the development of the painful syndrome. Depending on the situation and the method of intervention, pain relief can be local or general.
The length of the procedure to remove a varicose vein depends on several factors:
- surgical method;
- individual characteristics of the organism;
- lesions in the veins.
On average, the removal of superficial veins from the lower extremities takes 1 to 2 hours. The time can be extended if unforeseen circumstances occur during the operation.
Combined phlebectomy is a radical method of surgical removal of vessels affected by varicose veins, with which it is possible to remove all altered veins and only those where the seals are located. To prevent the development of pain, the patient receives general anesthesia or spinal anesthesia.
The course of the operation consists of the following 4 steps.
Stage 1 - crossectomy
In the first stage, incisions are made in the skin of the thigh, the thick saphenous vein is isolated and ligated at the anastomosis site with a deep vein.
stage 2 - removal
This step consists of removing the trunk from the injured vein.
A special probe is used to extract the vessel to the outside.
This phlebectomy stage is divided into 4 types:
- The first type of removal uses the Babcock probe. This is a tool with a metal cord, on one side of which there is a handle, on the other - a head with a cutting blade. During the operation, another incision is made in the shin area or inside the ankle. After introducing the probe with the aid of the head, the doctor corrects the diseased vein and, turning the handle, gradually pulls it out. This type of stripping is traumatic and painful.
- The inversion pickling method, the essence of which is identical to the previous one. However, the probe, in this case, is not equipped with a cutting edge. Traction force is the essence of such a procedure.
- PIN removal. During this procedure, an additional puncture is made, through which a special surgical thread is attached, attached to the probe. The thread is tied in a vein. Thus, the surgeon's efforts are transferred to the venous vessel, it is inverted and removed.
- Cryostripping is an expensive but very effective procedure. In this case, a cryoprobe is inserted through the incision, which freezes in the vein under the effect of low temperatures. Because of this, the diseased vessel is carefully pulled out and removed.
If an incision was made on the patient during phlebectomy, then, after removing the diseased vein, cosmetic points are applied to these parts of the limb, which are removed 8-9 days after the operation.
If the patient makes a small puncture, the suture is not applied - these holes heal on their own.
Stage 3 - suppression of communicative veins
At this stage, the vessels that connect the removed superficial vein with the deep venous vessels are connected.
Stage 4 - miniflebectomy
Manipulation has not only a therapeutic effect, but also a cosmetic one. After this operation, scars are almost never left because it is performed with a special hook.
A diseased vein is pulled out through small holes, which are then carefully excised. In some cases, this stage may represent an independent operation. Rehabilitation after this type of phlebectomy does not last long.
This step must be performed by the phlebologist surgeon with special care so that the affected vessels are 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 has no stitches, scars and scars.
The essence of the procedure lies in the fact that, under the influence of a powerful laser beam, the damaged vein is "glued" and therefore excluded from the general blood flow. The handling is outpatient and does not last more than 40 minutes.
Laser phlebectomy is a modern and effective procedure for treating varicose veins. With your help, only the varicose veins of the great and small saphenous veins are processed. Its small tributaries are removed using the miniflebectomy method. These combined interventions should be performed most of the time, as they combine a good cosmetic effect with a radical removal of all varicose veins.
Radiofrequency obliteration belongs to the category of phlebectomy, which is practically painless, while contributing to the complete reconstruction of the leg veins. That is, after performing a session of such a procedure, the patient may forget the varicose veins.
When performing the manipulation, special catheters are used, which are inserted through punctures into the cavity of the affected vein and serve as conductors. It is through them that a high frequency current, controlled by ultrasound, flows. Due to heating, the vessel is welded and then sclerosed. The operation is performed under local anesthesia.
The rehabilitation period after surgery
Recovery after phlebectomy is a purely individual matter, so your schedule is developed by the doctor separately for each patient. This takes into account your current state of health and the presence of chronic pathological processes in the body.
Recommendations for quick recovery in the postoperative period:
- It is necessary to learn that physiotherapy exercises are the key to an early recovery. It is advisable to apply moderate physical activity to the sore leg immediately after the operation. To begin, you can simply bend and unfold your leg. Then, the doctor will prescribe a course of exercise therapy, since it is the physical therapy exercises that improve blood flow in the operated limb.
- Special elastic stockings are recommended 24 hours after surgery to create compression. Compression stockings must be worn for at least one month after removal of the varicose vein.
- During the postoperative period, it is necessary to massage the limb to improve blood flow and prevent blood clots.
- During rest, the operated leg must be elevated.
- Tonic drugs for veins should be taken for several months after phlebectomy.
- Lifting weights is prohibited for one month after the operation.
Rehabilitation after phlebectomy involves moderate light sports to obtain good blood circulation in the operated limbs in the postoperative period. It is unacceptable to play extreme sports.
Strict implementation of all physiotherapy exercises is the key to a quick recovery.
During the rehabilitation period, you should avoid going to saunas, swimming pools and open water courses. Cycling should be avoided until complete recovery.
If you do not follow these recommendations, recovery from phlebectomy will be time consuming and complicated. In addition, rehabilitation after surgery lasts longer with thrombophlebitis in a patient.
Possible complications of the operation
Complications from phlebectomy can appear immediately and some time later. They can be expressed as follows:
- loss or significant decrease in the sensitivity of the operated limb;
- feeling of numbness in the leg or ankle;
- suppuration where there was a puncture or incision; bleeding
- hematoma or discoloration in the treated area (after laser coagulation);
- edema and pain.
Complications after phlebectomy are short-lived and disappear 1–2 months after surgery.
To reduce the risk of complications, you should strictly follow all your doctor's recommendations.
Advantages and disadvantages of varicose vein surgery
Although the procedure is not simple, it has several advantages:
- Phlebectomy is one of the most effective methods of treating severe varicose veins;
- low risk of disease recurrence; cosmetic effect
- complete disposal of the diseased vein, due to which the remaining vessels can guarantee normal blood circulation in the limb;
- almost total absence of pain during surgery;
- relatively quick rehabilitation;
- good patient tolerance to the operation;
- relatively short operating time.
Among the disadvantages of the procedure are:
- the need for the patient's hospitalization;
- scars (for certain types of surgery);
- the appearance of age spots on the sore leg, which can remain for a long time.
Many patients often have a question, which is better - phlebectomy or sclerotherapy? Often, phlebectomy is performed together with sclerotherapy to maximize its effect. These treatments complement each other well and help the patient to forget varicose veins for many years.
But this question can be better answered by a phlebologist, based on the data of a certain patient, and also taking into account his material abilities.