Varicose veins are abnormal broadening of the veins most often associated with insufficient venous valves. Varicose veins usually occur in the lower limbs and are especially visible on the feet, calves, under the knee and even on the thighs. Surgery to remove varicose veins improves the outflow of venous blood towards the heart and helps to prevent further complications associated with chronic venous disease. Surgery for varicose veins is the gold standard in the treatment of advanced stage venous insufficiency. The surgery to remove the veins is a minimally invasive procedure - the patient can walk and leave the hospital on the day of surgery or on the day after the surgery.
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How do varicose veins arise?
There are three groups of veins in the lower limb:
System of superficial veins - located on the fascia and under the skin
System of deep veins - located deep between the muscles or the bone,
Piercing veins - connecting the superficial veins with deep, perforating fascia.
- age,
- sex,
- standing work or work associated with prolonged sitting position,
- a history of venous thrombosis,
- a highly processed diet low in fiber
Varicose veins are often accompanied by other symptoms, such as a feeling of heaviness in the legs, swelling, pain and cramps in the calves, sensory disturbances and skin changes (discoloration, ulceration).
How to treat varicose veins of the lower extremities?
So far, no method has been developed that would repair the damaged veins in the lower extremities. Treatment of varicose veins is symptomatic treatment or treatment aimed at removing pathologically changed venous vessels from the bloodstream. One of the non-invasive methods of treating varicose veins of the lower limbs is wearing compression products (knee socks, stockings). The pressure exerted on the tissues is greatest around the ankle and gradually decreases towards the groin. Appropriate pressure distribution on the legs prevents blood from stagnating in the superficial veins, thanks to which the deep veins are also relieved. Sclerotherapy involves the injection of a special substance into the vein that closes its lumen. The blood then flows through other healthy venous vessels. Sclerotherapy can be effective in treating varicose veins of small and medium size. The veins can also be closed with special catheters that emit thermal energy or laser (obliteration). When varicose veins of the lower limbs become large, surgical removal of varicose veins (phlebectomy) remains the most effective treatment. The final decision regarding the choice of treatment of varicose veins is made by the angiologist or vascular surgeon.
Surgical treatment of varicose veins - phlebectomy
Before the operation, it is necessary to perform an ultrasound examination of the veins. This will allow the surgeon to locate pathologically changed vessels that remain invisible to the naked eye. The deep veins are also assessed. Proper blood flow in the deep veins is a prerequisite for the varicose veins removal procedure. The result of the operation of varicose veins in case of insufficient deep veins would be blood stagnation in the lower limb. That is why ultrasound diagnosis of veins performed by a vascular surgeon or an experienced radiologist is so important. The purpose of the operation of varicose veins is to eliminate the pathological backflow of blood in the superficial veins, i.e. venous reflux. Even at the groin level, blood can flow back from the deep femoral vein to the superficial saphenous vein. The result of this condition is overload of the deep vein system - part of the blood has to pass through the deep veins "twice". Removal of the saphenous vein eliminates venous reflux and facilitates the return of venous blood towards the abdominal veins. Many patients fear that due to the removal of the vein, the circulation in the limb will worsen. This is an unfounded concern. It is worth paying attention to the fact that the insufficient vein no longer fulfills its function, but only causes difficulties in the outflow of blood towards the heart.
The course of the procedure of removing varicose veins of the lower extremities
Operations of varicose veins are performed under local, epidural or, less frequently, general anesthesia. Due to the fact that the development of most varicose veins is related to the insufficiency of the saphenous vein, surgeons very often decide to remove this vein. The saphenous vein runs along the inside of the lower leg and thigh and then enters the deep femoral vein. Sometimes it is necessary to remove the small sagittal vein at the back of the calf. The procedure of vein removal is the so-called stripping. Stripping requires making a 3 cm incision in the groin area and above the ankle (removal of the saphenous vein) or in the popliteal fossa and above the ankle (removal of the saphenous vein). The surgeon cuts and ligates the superficial vein from the side of the deep vein. Then he introduces a special probe through the lower cut, which he places at the groin level. Pulling the probe down towards the ankle causes the vein to wind up and be stripped (stripping). Additionally, the ligation of ineffective piercing veins can be performed. Minor varicose veins are removed using the miniphlebectomy method - for this purpose, the surgeon makes small punctures in the skin through which he removes the varicose veins with the help of small hooks. The wounds are closed with stitches or secured with special plasters. The operated limb is bandaged from the foot to the thigh so that the pressure gradually increases towards the hip. You are discharged from hospital on the same day or the day after surgery.
After surgery for varicose veins
After surgery for varicose veins, you can walk normally - it is even advisable to prevent venous blood stagnation. While sitting, the operated limb should be placed on a platform so that the foot is at least at the level of the thigh. The patient can perform simple leg exercises, instructed by the physiotherapist before leaving the hospital. The patient should report for a control visit on the 10th day after the procedure. Then the seams are also pulled off. The wounds after the operation of varicose veins are small, heal quickly, and the remaining scars are hardly visible. Hematomas and slight ecchymosis may persist on the skin of the legs, which is a normal phenomenon resulting from partial extravasation of blood from the removed veins during surgery. Hematomas are self-absorbed several weeks after the procedure. For a period of 2-4 weeks after the surgery, excessive overloading of the operated limb (jogging, squatting with weight lifting, gym training) should be avoided. A sick leave may be indicated for a period of 2-4 weeks after the operation of varicose veins (depending on the nature of the work performed). For several months after the procedure, you should wear compression stockings or tights, which will accelerate the absorption of hematomas and improve circulation in the operated limb.
The effectiveness of surgery for varicose veins
Surgical removal of the veins by stripping is to reduce the risk associated with further complications of venous insufficiency (phlebitis, skin trophic changes, massive swelling of the feet and calves). The treatment may also improve the aesthetic appearance of the legs to some extent. On the other hand, it should be borne in mind that, like any surgical procedure, stripping is associated with the occurrence of complications (e.g. sensory disturbances in the calf skin, infection). These complications are very rare, but you should be aware of their occurrence. It is worth noting that venous insufficiency is chronic - the surgery performed does not protect 100% against recurrence of varicose veins in the future. The patient should continue treatment and remain under medical care. Regular evaluation of the venous vessels by ultrasound is advisable.
Sources:
Zbroński R, Matuszewska-Zbrońska H, Urbaniak A, Glinka M. Stripping of the saphenous vein under local anesthesia in own experiences. Polish Surgery 2005; 7 (4): 238-243.
Marona H, Kornobis A. Pathophysiology of varicose veins development and selected methods of their treatment - the current state of knowledge. Advances in pharmacotherapy. 2009 (65) 2.
Frequently asked questions about the removal of varicose veins:
Varicose veins are treated by a vascular surgeon and / or an angiologist. It is worth going to a doctor who will perform an ultrasound of the veins. Thanks to the ultrasound examination, it is possible to accurately assess the venous system - it facilitates the selection of the appropriate treatment method.
There are many methods of treating varicose veins in the lower extremities. Treatment should be directed by an angiologist or vascular surgeon. Compression products (knee socks, tights, anti-varicose stockings) are available in medical stores, which reduce leg swelling and facilitate the return of venous blood towards the heart. This prevents to some extent the build-up of varicose veins and the appearance of new foci of "spider veins" on the legs. Small and medium-sized varicose veins can be treated with sclerotherapy or by local varicose excision (miniphlebectomy). Varicose veins of larger diameter are eliminated by performing the so-called stripping of the saphenous or small saphenous vein. The surgery to remove insufficient superficial veins and varicose veins in their basin shows the greatest effectiveness in the treatment of varicose veins.
Operations of varicose veins are low-risk procedures. As with any surgery, complications are possible, but they are very rare. When deciding on the operation of varicose veins, it is worth choosing an experienced vascular surgeon who will select the most appropriate surgical techniques for the patient's condition.
You are discharged from the hospital on the day of surgery or on the next day after surgery.
Light leg pain after surgery may persist for 2-3 weeks. During this period, you should strictly follow the doctor's instructions, perform the exercises recommended by the physiotherapist and avoid excessive overloading of the operated limb. If necessary, your doctor may prescribe painkillers.
