What is important to know about phlebectomy

For many patients with varicose veins, surgery to remove veins is scary: if the veins are removed or ligated, how will blood circulate in the vessels of the legs? In fact, only a tenth of the blood circulates through the veins located under the skin - the same ones that form unaesthetic varicose veins. Removing superficial veins does not create noticeable additional stress on the deep veins.

Recovery after surgery to remove varicose veins on the legs should be comprehensive, its goal is to prevent complications of the disease, relapses, and return the patient to work and usual activities as soon as possible. The measures that form the recovery program after surgery depend on the degree of neglect of the disease, the nature of the operation, as well as the general condition of the patient and the characteristics of his body.

How relevant, in your opinion, is surgical treatment of varicose veins today?

Phlebectomy, of course, is relevant, if only because we often encounter advanced forms of varicose veins: people do not always see a doctor on time. This is the first point. Second, surgery is necessary if the patient has certain characteristics of the veins, for example, they are very wide or very tortuous. Then it will not be possible to cure varicose veins using any other methods: neither sclerotherapy nor laser will guarantee that the lumen of the vein is completely closed.

The third important point when we can recommend surgery is a large number of lateral tributaries near the main vein. They can be removed using minimally invasive methods, but this takes a lot of time, which is difficult for the patient. It is in his interests to agree to the operation.

Why does the number of operations performed on leg veins increase every year?

How is phlebectomy performed?

Each operation has several stages. Crossectomy is a step where the target vein that we remove is ligated and thereby cut off from the deep venous system. Next comes the removal of the trunk - stripping. This can be a Babcock stripping, when the vein is cut out using a special probe. Cryostripping can be performed - an operation in which a cryoprobe is inserted into a vein, the vessel is “frozen” to it using nitrous oxide, and the doctor pulls it out. A distinctive feature of cryostripping is that the patient makes only one incision in the groin area. PIN stripping can also be performed, when the vein is “screwed” inward. The last two methods cause less tissue damage.

At the third stage, a miniphlebectomy is performed - the tributaries of the main vein are removed through punctures.

Very cosmetic

In most Russian hospitals, varicose veins on the legs are removed, both through a large incision in the groin (crossectomy) and through large incisions on the legs according to Narat or Linton. The consequences of such a combined phlebectomy are not satisfactory for most patients. Our technology involves minimal intervention through skin punctures that leave virtually no scars. The dilated vein is “evaporated” with a laser without incisions. Varicose veins and nodes are eliminated with microphlebetomy and Foam-Form sclerotherapy. The use of a minimally invasive technique involves significantly less tissue trauma than “classical” combined phlebectomy; patient reviews of the postoperative period are very good.

How long does the recovery period last?

Usually a week. We recommend that patients stay at home, but not in bed, but semi-active. The first three days you can spend about 40% of the time on your feet, and then you need to start “pacing.” On the seventh day, the stitches are removed and the sick leave is closed. For example, we had a patient who had surgery on both legs in turn. And once he completely went through the recovery period, and the second time he had to go to a work meeting after the operation. This leg recovered worse; there were bruises, although he tried to spare the leg and not put stress on it.

What activities are recommended during the rehabilitation period?

The rehabilitation period begins immediately after the end of the postoperative period, that is, 10 days after the operation. At this point, the sutures have already been removed, the postoperative punctures, if there are no complications, have healed. But the body’s recovery processes continue. In order for recovery to occur as quickly as possible, the doctor adjusts the patient’s lifestyle. During the rehabilitation period it is necessary:

taking medications prescribed by a phlebologist;
reasonable physical activity, exercise therapy;
limb compression;
work in gentle conditions, limiting heavy physical labor;
nutrition correction;
physiotherapy, massage.

Drug therapy in the postoperative period involves taking drugs that increase the tone of the venous walls, improve the rheological properties (fluidity) of blood, and have an anti-edematous effect. The drugs recommended during the rehabilitation period include products based on troxerutin, diosmin, drugs with vitamins C and PP, extracts of ginkgo biloba, and horse chestnut. Preparations of salicylic acid, hirudin, and heparin are used as anticoagulants.

Medicines are prescribed both in the form of general preparations (tablets, capsules for oral administration) and local preparations (gels, ointments for application directly to the skin of the lower extremities). Competent drug therapy during the rehabilitation period can accelerate the restoration of microcirculation and at the same time serves as an effective prevention of relapses of the disease.

Moderate physical activity is necessary to stimulate blood circulation in the lower extremities, prevent its stagnation, and the formation of blood clots. Walking at a moderate pace, swimming, and exercise therapy complexes are recommended as optimal measures to activate the patient. Running during the rehabilitation period is not recommended.

During the rehabilitation period, compression on the legs is mandatory. Compression of the lower extremities is necessary for all patients suffering from varicose veins - it helps prevent the progression of the disease and the development of complications. A phlebologist recommends a compression method and selects the size of elastic underwear.

Gentle working conditions are necessary to prevent relapse of the pathology and its transfer to the deep veins of the legs. Varicose veins are often a consequence of difficult working conditions and the characteristics of professional activity. If your job involves standing for a long time, it may be worth changing it or at least regularly performing therapeutic exercises during the working day aimed at improving blood circulation in the legs. Work in conditions of high temperatures associated with vibration and heavy lifting is contraindicated.

Correction of nutrition after leg vein removal surgery should be directed towards rationalization. Food needs to be complete, healthy, rich in protein, fiber, vitamins and microelements. If you are overweight, you should reduce your caloric intake, since obesity is one of the factors in the progression of varicose veins.

Physiotherapeutic techniques during the rehabilitation period accelerate recovery. A physiotherapeutic treatment program is recommended by a doctor; wraps, electrophoresis, UHF, and magnetic therapy may be useful. Massage during the rehabilitation period helps to effectively eliminate swelling.

Competent management of the postoperative period after removal of dilated veins in the legs, a responsible attitude to the doctor’s recommendations will help eliminate the natural discomfort that occurs after surgery as soon as possible, prevent possible complications and speed up the patient’s return to a full life.

And the last question - what happens if surgery is indicated, but the person does not do it?

I usually say this: “If you don’t deal with the disease, then the disease will deal with you.” If phlebectomy is not performed, varicose veins can lead to thrombophlebitis, and then the veins will have to be removed urgently. Therefore, I recommend that if there are indications for surgery, calmly collect all the tests, prepare and perform it.

Phlebectomy cost:

The main goal of the Phlebology Center clinic is to ensure maximum safety for the patient during surgical treatment. All operations are performed under local anesthesia by surgeons with at least 5 years of experience and only in the presence of an experienced anesthesiologist.

The cost of surgical treatment includes: hospital stay, anesthesia, postoperative dressings, suture removal. After completing the course of treatment, you will receive free six-month observation with ultrasound control.

What may be the consequences after vein removal?

Surgeries to remove varicose veins are quite traumatic interventions that seriously disrupt the internal balance of the body. Therefore, you need to be prepared for certain discomfort in the postoperative period: pain in the intervention area; hematomas at the site of the removed vein and at the sites of sutures on the skin; swelling of the leg at the site of the removed vein and sutures; moderate bleeding of the postoperative wound; general weakness, fever, nausea.

Why do such consequences occur? After removal of veins in the legs, an inflammatory process inevitably occurs in the tissues that previously surrounded the vessel - this is a natural, physiological reaction of the body to the intervention, aimed at healing the damage. Any inflammatory process is accompanied by local swelling and pain, and general symptoms of malaise are possible: nausea, fever, weakness. They disappear a few days after the intervention. Minor bleeding from a postoperative wound should not be a concern either: when a vein is removed, small vessels break off, which then collapse and the flow of blood stops. If you follow the surgeon’s recommendations, the unpleasant phenomena will quickly disappear.

In some cases, after venectomy surgery on the legs, infection of the intervention area, suppuration, thromboembolism, or accumulation of blood in the ligated vein with the development of inflammation of the vessel is possible. But thanks to modern surgical capabilities and the perfection of surgical technology, such complications are extremely rare.

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Indications

The main indications for phlebectomy of the veins of the lower extremities include:

Varicose veins. This is the most common reason for phlebectomy. The pathology affects the subcutaneous and deep veins and contributes to circulatory disorders. In the initial stages, it is possible to use medications. In more severe stages of the disease, surgery is prescribed.
Thrombophlebitis of superficial veins. The operation is performed for acute or chronic forms of pathology. The disease leads to the lumen of the vessel being blocked by the resulting clot. As a result, an obstruction occurs in the path of blood flow with subsequent circulatory disorders. In cases where medications do not help resolve the clot, surgical intervention is performed.
Trophic ulcers. The disease can affect the skin and soft tissues. An indication for emergency vein removal surgery is the occurrence of heavy bleeding from the affected areas.
Venous insufficiency. Pathologically, the process affects the valves of blood vessels. As a result, there is a disruption in the outflow of blood, which leads to stagnation. Phlebectomy is the most appropriate surgical option for this condition.

Prevention of varicose veins

Varicose veins are a serious disease that requires the patient to pay utmost attention to their health and a competent treatment strategy, which will involve a set of measures not only to eliminate objective symptoms, but also to prevent chronic venous insufficiency. Prevention should include several recommendations:

Weight control and proper nutrition;
Physical exercises to maintain vascular tone;
Maintaining water balance;
Contrast showers and cold baths;
Regular intake of medications to restore the venous wall, improve microcirculation and prevent venous stagnation.

When working “sedentarily” or “standing”, it is necessary to take breaks for exercise. Avoid wearing tight-fitting clothes and high-heeled shoes.

Priorities in the treatment of leg veins

At the Moscow Vascular Center, operations on the veins of the legs are carried out so often that every movement of any doctor on the staff is brought to automaticity. There can be no mistakes. Each doctor bears not only legislative, but also his own responsibility for treating patients. And the patient’s trust is the most valuable thing you can get in return.

Often, ordinary fear and uncertainty act as a powerful argument before the decision to undergo surgery. Think about what is better for you: decide on an operation that takes 1 hour or delay the development of the disease?

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Classification and stages

Like any disease, VV has several stages, differing from each other in the degree of spread of the pathology and symptoms. Among them, the following stages are distinguished:

Initial (or compensation).
Second (or subcompensation).
Third (or decompensation).

A detailed description of each stage can be found here.

It is worth noting that complications can occur at any of the above stages, but their greatest likelihood is inherent in the last two. VV can serve as an impetus for the development of diseases such as:

Thrombophlebitis.
Erysipelas.
Deep vein thrombosis.
Trophic eczema.

A visit to a specialist, made at the first signs of the disease, will help reduce the risks of worsening the situation and begin removing varicose veins. You should not ignore even minor symptoms, because this can lead to undesirable and extremely negative consequences.

Contraindications

Despite the large number of advantages and indications for use, phlebectomy has some limitations. These include:

Acute viral or infectious diseases. Such conditions increase the possibility of developing postoperative complications in the form of sepsis.
Severe hypertension, uncontrolled by medications.
Chronic heart failure in the stage of decompensation.
Pregnancy period. An absolute contraindication is the second half of gestation. This is due to the fact that any intervention can provoke the development of spontaneous abortion.
The presence of inflammatory diseases in the lower extremities. These conditions can trigger the spread of inflammation to other organs and tissues.
Age over 65 years. With age, surgical interventions are more difficult to tolerate. This is due to the presence of a sufficient number of concomitant pathologies. Phlebectomy of veins can lead to exacerbation of chronic diseases, which will negatively affect the course of the recovery period.

Some of the listed contraindications are temporary. This means that after removing the restrictions, the surgical intervention can be carried out in full. Depending on the severity of the condition and the type of affected vessel, the doctor selects a phlebectomy technique that will be most effective in each specific case.