Removal of the trunk of the great saphenous vein. Surgical (surgical) treatment of varicose veins: is it necessary to have an operation and what kind? How is the preparation going?

Varicose veins are a “middle-aged” disease; it affects both women and men of any age. During the initial development of varicose veins, patients do not attach much importance to the emerging signs. But as the disease progresses, symptoms become more severe.

Which treatment should you prefer?

Varicose veins of the venous vessels of the lower extremities pose a serious threat to the life of the patient.

It can cause dermatitis, the formation of trophic ulcers, and bleeding, which not only make it impossible to work, but also lead to disability. The advanced form is not amenable to conservative treatment.

Varicose veins in the leg give rise to blood clots, which can break off at any time and lead to death. Varicose veins can only be overcome by surgical treatment.

Indications for surgery

Surgical interventions are performed by experienced surgeons if:

Contraindications

There are certain moments when you cannot resort to surgery, including:

In these cases, conservative treatment is used to alleviate the patient's condition. If this is the initial stage, it is recommended to wear compression garments, which will keep the stretched walls of blood vessels in good shape.

Lotions applied to the affected areas have a positive effect. For this, the following are used: curdled milk, wormwood decoction, hop infusion, alcohol tincture of Kalanchoe, cabbage leaf with honey and others.

Hirudotherapy is successfully used, in which leeches thin the blood with their saliva and thereby help blood circulation through the veins of the legs. Pharmacy ointments, creams, medicinal patches, gels, and medications are prescribed.

But it is important not to miss the onset of the disease, since at a late stage of development, surgery for varicose veins is inevitable.

Protruding nodes on the veins are a consequence of varicose veins.

This happens because the valves on the saphenous vein lose the ability to close tightly, thereby preventing blood flow in the opposite direction.

Modern medicine is able to select a different method of surgical treatment for each patient.

Methods can be combined and the interests of the result respected.

There is only one principle - it is necessary to normalize the blood flow in the leg and prevent the risk of a pathological process.

Preparing for surgery

Phlebectomy requires careful preparation. It is necessary to undergo a full examination of tests and hardware tests.

Before surgery for varicose veins, the patient is given a cleansing enema and all hairs are shaved off the legs.

The patient must inform the doctor about any allergic reactions he has to medications.

Types of surgery

There are several ways of performing surgical intervention, among which there are classic types and innovative ones, using new techniques and equipment.

It was first performed by a Swiss surgeon. A sharp, narrow-tipped scalpel and a large needle are used to penetrate the affected area.

This mini-operation does not require sutures, and the penetration fields are covered with adhesive tape. This is a delicate job that requires a lot of experience and skill from the surgeon.

Excision is performed under local anesthesia. During the intervention, the surgeon makes two punctures through which the dilated venous areas are removed.

Advantages:

• after such an invasion, there are no scars left on the skin;
• gives a cosmetic effect.

The method can be used alone or as part of a larger intervention.

The recovery period is short, leaves no traces and is in demand from an aesthetic point of view. It is recommended to wear compression garments.

Before the operation, an ultrasound duplex scan of the venous tract is performed, and markings are made using phlebography (a contrast agent is injected). Additionally, the results of the biochemical composition of urine and blood are studied.

The essence of the operation consists of subcutaneous pulling out of blood vessels using a metal probe. Incisions are made and the varicose vein is ligated through them. This method is also used in modern medicine.

The varicose vessel is removed in parts using the tunneling method, using suturing of the affected segment of the vessel with catgut.

The aesthetic perception of the skin after such treatment leaves a not very pleasant impression.

Disadvantages of the method:

• spinal anesthesia is performed;
• traumatic and dangerous due to its postoperative period;
• leaves scars after excision.

Short creaking

This is a gentle treatment for varicose veins, which allows you to eliminate the affected segment. Before the operation, the coordinates of the affected vein and the length of the segment are accurately determined. After two small incisions, the affected varicose vein is removed.

The method has its advantages in terms of the recovery period and minimizing injuries.

The equipment allows for most accurate penetration into the walls of blood vessels.

Disposable catheters are used, heating and removal temperatures are controlled.

All pain is minimized.

Advantages of the method:

• allows you to solve problems on both legs at the same time;
• reconstruction can be carried out on veins;
• gives excellent aesthetic results.

Endoscopic vein dissection

The impact is carried out with a special device - an endoscope. It gives a complete picture of the internal damage to the vein.

The peculiarity of the treatment is the use of new technologies that make it possible to remotely introduce it into the veins. The endoscope “looks through” the affected segments and selects the desired one.

In addition, the device allows you to determine the edges of the tibia on the lower leg even in the most obese patients.

A low-traumatic method of treatment for venous pathology. During surgery, a light guide is used, inserted into the affected area using an ultrasound scanner.

The laser beam closes the varicose vein and stops its functioning. This is the latest method of combating the disease, recognized throughout the world.

Under the influence of a laser beam, “gluing” of the affected area occurs.

The procedure is performed on an outpatient basis, takes 30 to 45 minutes, and does not require incisions. After surgical treatment, blood does not enter the fused vein and chooses normal venous lines.

Indications for the method

If classical surgical methods are not suitable for the patient due to his health characteristics, laser coagulation is chosen. The method allows you to quickly and permanently get rid of varicose veins without disfiguring your legs with incisions or stitches.

Advantages of laser coagulation:

Contraindications for this method:

How to avoid complications?

Almost any intervention causes certain consequences and complications. An ultrasound will highlight dilated tributaries and prescribe sedatives. Internal vascular treatment will avoid:

• damage to the lymphatic system and nerve ducts;
• injuries to nearby tissues;
• swelling;
• pain;
• loss of sensitivity in the area where the affected vein was removed.

Rules for life after such treatment

Varicose veins after surgery require special attention to prevent relapses or complications on the leg. It is necessary to increase the tone of the venous vessels, for this:

A sedentary lifestyle is contraindicated after surgery. Already in the first postoperative hours, you should sit down and do light exercises for your legs.

Today, surgery for varicose veins is a routine procedure, it takes place without complications and has only positive consequences for the body. Every year, as phlebologists note, more and more young people turn to specialists for help. The diagnosis of varicose veins is not a death sentence at all! But do not forget that such a massive spread of the disease is due to the incorrect lifestyle of people who, in a rush for a successful career and material well-being, completely forget about their health, exposing themselves to constant stress and strain.

Varicose veins can cause not only physical, but also moral discomfort to the patient, reducing his quality of life. That is why you should take care of your health and seek help at the first signs of venous pathology, especially for people with a hereditary predisposition to the disease and obesity, as they are at risk of developing serious vascular damage. And also listen to the doctor, if you need to have surgery for varicose veins, then there is no point in delaying solving the problem at all.

Despite many innovative techniques in the world of medicine, varicose veins are considered to be an incurable disease. Unfortunately, patients do not pay attention to the characteristic symptoms of the disease, attributing them to fatigue. By doing this, they contribute to the development of chronic varicose veins, which cannot be completely eliminated.

Varicose veins have several degrees, the first two are amenable to conservative treatment, but stages 3 and 4 cannot be done without surgical intervention. Whether surgery is necessary for stage 2 varicose veins or the disease can be treated with medications, the doctor decides based on the tests that will be performed. To diagnose varicose veins, ultrasound examination of veins with a contrast agent, blood tests, computed tomography and magnetic resonance imaging are used. As an addition, radiography of blood vessels can be performed.

Laser therapy does not leave scars or scars on the surface of the skin

Indications for surgery

The feasibility of an operation to remove varicose veins is determined by the doctor individually, depending on the stage of the pathology, the patient’s age, his weight, the presence of concomitant diseases and other characteristics of the body. Surgical treatment of varicose veins is carried out for the following symptoms:

• extensive vein lesions;
• severe swelling of the legs;
• abnormal expansion of veins under the skin;
• rapid fatigue of the legs, a person cannot stand for a long time;
• trophic ulcers;
• mechanical damage to the leg;
• disturbances of blood outflow in the lower extremities;
• acute thrombophlebitis.

In addition to the above indications for surgery for varicose veins, there are also contraindications. They can reduce the effectiveness of treatment to zero and even cause additional harm to the patient’s body. Surgery for varicose veins of the lower extremities is not prescribed for the following diagnoses:

• stage 3 hypertension;
• cardiac ischemia;
• inflammatory and purulent processes in the body;
• elderly age;
• pregnancy period;
• chronic skin diseases in the acute stage;
• oncological diseases and chemotherapy.

Before starting surgery, it is necessary to conduct a full examination of the patient; if there are contraindications, the doctor will individually develop a more gentle treatment regimen. It is important to follow the diet recommended by your doctor.

Surgery for varicose veins

Surgery for varicose veins on the legs can be performed in several ways, the most commonly used methods are:

• phlebectomy;
• laser correction;
• sclerotherapy.

Each operation to remove varicose veins has its own characteristics and methodology. For example, phlebectomy is done at an early stage of varicose veins on the legs, sometimes it gives good results even at stage 2 of the disease. Preparation for this type of intervention is minimal; the patient only needs to wash the skin of the extremities with soap and shave the hair in the groin and legs.

Surgery for varicose veins of this type involves removing the subcutaneous vessel in which the genetic disorder occurs. The whole process takes from 1 to 2 hours, depending on the complexity of the case. During surgery for varicose veins in the legs, an incision is made in the groin area and at the ankle. The length of the incisions is no more than 5 cm, as a rule, they are shallow, so the scars will be invisible. A special instrument is inserted into them, which is commonly called a venous extractor. With its help, the doctor will remove the diseased vein. After removing the vessel, the incisions are sutured, disinfected and wait until the anesthesia wears off. During the manipulation, extravasal correction of the valves can be performed to normalize blood outflow.

After completion of the operation, the patient is given a sterile bandage on the leg and given recommendations for further activities. After 72 hours the person can move independently. The postoperative period lasts 2 months. During this time, the patient must adjust his diet, wear compression stockings and use venotonics, which normalize blood circulation in the extremities.

Surgery today is rapidly developing, so for some patients, especially people with second-degree varicose veins, an alternative method of surgical intervention is recommended, which does not involve completely removing the vein, but only eliminating only the problematic part. For stage 2 varicose veins of the lower extremities, a miniphlebectomy can be performed under local anesthesia. As a rule, in the absence of concomitant diseases, the patient can be sent home after a couple of hours and undergo further treatment on an outpatient basis.

For varicose veins, surgery can occur in different ways; one of the new methods is the treatment of varicose veins with injections. The sclerotherapy procedure involves injecting a special sclerosing agent directly into the diseased vein. Under the influence of the active components of the drug, the middle layers of the vessel stick together, and blood circulates through healthy veins. The postoperative period is longer after this therapy, but the method gives excellent results, especially if the vein lesions are not large.

Intravascular laser coagulation, or as it is popularly called, laser treatment, is the simplest and most modern method. This operation for varicose veins of the lower extremities involves the action of a laser on the walls of the diseased vessel; when heated, they become welded together, and the blood changes its course. Negative consequences after the procedure are excluded, since only a small puncture is made through which the laser operates. Infection and injury to other vessels is impossible. After surgery, there are no scars left and there is no postoperative period at all. After an hour, the person can walk normally.

Sometimes, doctors can use radiofrequency surgery to eliminate varicose veins; it is often practiced by American doctors. The essence of the operation is the same as with laser coagulation, only the vein is exposed to radio waves of a certain frequency. The advantage of the method is that it does not leave scars and does not require anesthesia, as it is painless. It can be used if damaged veins are too close to the skin. In rare cases, exposure to a laser can damage healthy tissue during the process of vascular adhesion, and radio waves are completely safe.

Complications and consequences of surgical treatment

No matter how talented the surgeon, varicose veins sometimes make themselves known again after surgery in the form of complications. No one can predict how this or that organism will behave. After surgery to remove stage 2 and 3 varicose veins, there may be consequences that do not require treatment - bruises and hematomas, this is a normal reaction of the body to tissue damage. If the patient follows the recommendations, then everything will pass very quickly. Other consequences include:

• heavy bleeding;
• decreased sensitivity of the limb (manifested when the saphenous nerves are damaged);
• suppuration due to infection;
• numbness of the limb, etc.

As for pain, it can only be observed during phlebectomy; the other two treatment methods are practically painless. If subsequently there are unpleasant sensations, they are easily relieved with analgesics.

The consequences can be serious; thromboembolism is among the most dangerous. This is an acute blockage of a blood vessel by a thrombus that has broken away from its location and circulates along with the blood flow. If the patient is not provided with timely assistance, he may become disabled and even die.

Rehabilitation after surgery

Your recovery process directly depends on how correctly you behave after surgery. There are a number of tips that will help you get back on your feet as quickly as possible without encountering complications of the disease. From the first hours after the operation, you need to move your lower limbs; you do not need to stand up; you can bend or turn them to avoid congestion. It is better to lie down with your legs slightly elevated, this will improve blood flow. Two days after the operation, it is recommended to begin gymnastic procedures. The degree of load is decided by the attending physician. In order to prevent the formation of blood clots, therapeutic massage and contrast showers are prescribed.

Over the next two months, a person must follow a diet, avoiding foods that clog blood vessels and disrupt normal blood circulation. The diet includes vitamin-containing foods that thin the blood and promote normal blood circulation. These are carrots, beets, celery and citrus fruits. Enrich your diet with whole grain porridges; they contain B vitamins, which can restore the energy costs of the body after surgery. In the hospital they try to provide the patient with peace so that he recovers faster, you should do the same for your body and at home, reducing the load not only on the lower limbs, but also on the stomach, intestines and liver.

Be sure to walk outdoors in comfortable shoes. Women should stop wearing high heels; shoes should be light and not restrict movement. After a hard day, let your feet rest by taking contrast baths.

If necessary, the doctor will prescribe medications that must be taken according to the instructions. You should avoid visiting the sauna and bathhouse for a while; high temperatures can negatively affect the condition of your veins. Physical activity should be reduced, but at the same time you should not sit in one position for a long time. It is a sedentary lifestyle that is the main provocateur of varicose veins.

Each person decides for himself whether surgery is worth it, but it should be noted that only surgical treatment guarantees a complete recovery. The traditional method of treatment can be effective only at the initial stage of the disease, and people, as a rule, miss it, applying when the disease has become acute. The same applies to homeopathic techniques and hirudotherapy.

The process of treating varicose veins is very long and grueling; it must be carried out strictly under the supervision of a doctor. There are a number of cases when even after surgery the disease returns again. In order not to encounter a similar situation, it is better to prevent the development of the disease by visiting a doctor for preventive purposes once a year, and if you have even minor symptoms, seek help.

Varicose veins are one of the common diseases these days. Unfortunately, patients often turn to a doctor when the disease is already too advanced and the damage to the veins is quite large. Therefore, wearing special compression garments or following a diet and lifestyle is no longer enough. In this case you will need removal of the great saphenous vein and other affected vessels. Laser surgery is quite expensive and not always available, so traditional surgical procedures remain in high demand.

Why do you need to have surgery to remove a vein?

You should know that phlebectomy or surgery to remove a vein is not dangerous, although the possibility of complications cannot be ruled out. Before prescribing an operation, the doctor must examine the patient to exclude contraindications and possible complications, clarify the diagnosis and assess the risks.

Why is such an operation needed? Its goal is to eliminate stagnation of venous blood in a vessel by removing these very vessels. Another important step: this way you can prevent the flow of blood from deep veins to superficial ones, that is, change the movement of blood flow. During the operation, the specialist removes those parts of the vein in which the valves do not work. This is necessary so that stagnant blood stops putting pressure on the walls of the vessel, the soft tissues that surround it, fiber and skin. If this blood pressure is not eliminated, it will lead to expansion of the tributaries of the superficial venous network.

Removal of the great saphenous vein called stripping. This is one of the most common operations to remove varicose veins. This is due to the fact that, as a rule, patients seek help too late, when low-traumatic methods of vein removal are no longer effective. Usually, deep veins are not affected by varicose veins; it affects mainly the superficial vessels, so you should not be afraid that as a result of removal, the blood will not be able to move through the lower limb - it will simply move through the deep veins.

The main stages of removing the great saphenous vein

There are two types of stripping:

. Traditional stripping or Babcock's operation;

Cryostripping.

The first type of operation involves removing the vein using a special surgical probe. The patient is prepared for the operation, and it begins with two incisions being made: in the groin area and in the upper part of the lower leg. The surgeon inserts a probe into one of them, directing it into the lumen of the vessel. The probe is then advanced to the second incision, engaging and pulling out the damaged vein. Manipulation is accompanied by bleeding and tissue damage, sometimes complications are possible, but this is the only way to get rid of varicose veins in particularly advanced cases when the vein cannot be saved.

During cryostripping, the vessel is glued to a surgical probe at a temperature of -85 degrees Celsius. The vein is then pulled out and removed. This method has the following advantages: less trauma, the need for only one incision, and a quick recovery period.

At the end of the operation, the patient is given an elastic bandage and motor activity must be restored as quickly as possible to avoid the occurrence of thrombosis and other complications. Compliance with all stages and features of the operation guarantees its success, so you should not ask the surgeon to make fewer incisions. The fact is that in this way the doctor is deprived of the opportunity to remove the entire trunk of the damaged vein, which means a high probability of relapses a short time after the operation.

Rehabilitation period

Any operation involves some degree of risk and the possibility of complications. You shouldn't be afraid of them, you just need to be prepared for their appearance and have information on how to avoid them. The most common occurrence after surgery to remove the great saphenous vein is bruising and small lumps - these will subside within a few months.

You should not apply compresses to the operated leg or apply warming ointments. In some cases, sensitivity may be impaired in some areas of the leg, especially on the inner surface of the ankles - this phenomenon will also go away on its own. It is caused by the fact that during the operation the sensitivity of the nerve endings was disrupted. Sometimes the patient experiences postoperative swelling or pain; this may also be associated with physical activity. In this case, it is necessary to use compression garments and eliminate the cause of the swelling.

If you follow all the doctor’s recommendations, the likelihood of varicose veins returning is low. After surgery, you will need to use an elastic bandage every day for several months. The doctor may prescribe additional medications to improve the tone of the veins. The duration of the rehabilitation period depends on the severity of varicose veins. It is better to refrain from visiting a bathhouse or sauna during the first ten days, but simple exercises in the form of flexion and extension, turning the legs are recommended to be performed from the first hours after the operation.

In our medical center, you will undergo a complete diagnosis of varicose veins using modern equipment and will select an effective treatment method. Follow the specialist’s recommendations and you will get rid of this unpleasant disease. You can go for a consultation at a time convenient for you, but it is better not to postpone a visit to the doctor so that the disease does not progress to a severe stage.

Treatment of varicose veins on the legs with medications does not always have a positive effect. It is especially difficult to cure varicose veins if they are in an advanced stage. In this case, surgery is the only option to eliminate the pathology.

For many people, surgery seems like a scary procedure, so they are afraid to go to the doctor for a long time, relying on some home forms of treatment. The disease continues to progress, and the patient’s condition worsens.

Surgery for varicose veins of the lower extremities is prescribed under the following circumstances:

• if the saphenous veins are enlarged as a result of physiological pathology;
• if the disease is in an advanced stage, when or no longer helps;
• with the formation of trophic ulcers on the skin;
• if vascular circulation disorders occur, as a result of which the patient experiences constant fatigue, gets tired quickly, feels pain and heaviness in the legs;
• if formed;
• if trophic skin lesions occur.

For some patients, surgery for varicose veins on the legs may be contraindicated.. Factors preventing surgical intervention are:

• hypertension;
• severe infectious diseases;
• ischemic disease;
• patient age (over 70 years);
• skin diseases - eczema, erysipelas, etc.;
• second half of pregnancy.

Surgery is the most effective and safest. An experienced doctor will be able to quickly eliminate the pathology, and the patient will return to normal life, without experiencing the suffering that the disease caused him.

Types of intervention

Type of surgery determined depending on the individual characteristics of the disease. Some types of surgery that are suitable for one person may not be suitable for another. Before prescribing surgery, the doctor studies the form of the disease, symptoms, and the likelihood of complications.

Surgical

The most labor-intensive and complex procedure associated with a high likelihood of complications is phlebectomy surgery to remove varicose veins. It is prescribed only in cases where other treatment methods are not able to have any beneficial effect.

During this operation, small (3-5 mm) incisions are made in the patient's groin area, through which the affected vein is ligated at the place where it flows into a deep vein, then it is cut and pulled out of the leg using special probes. After the vein is removed, absorbable sutures are placed at the incision sites. The operation lasts from 1 to 2 hours, while the patient remains in the hospital for no more than a day, then he is sent home.

A type of phlebectomy is a procedure called miniphlebectomy, in which punctures rather than incisions are made on the body. This method allows the operation to be performed with less trauma to the skin and shorten the rehabilitation period.

Stripping– another type of surgical treatment for varicose veins. During this procedure, not the entire vein is removed, but only a small section of it that has undergone varicose veins. Removal is carried out through punctures in the skin, which avoids stitches.

How to perform surgery for varicose veins, watch the video:

Sclerosis

Sclerotherapy is considered a less traumatic method of surgical intervention. It consists in using ultrasound to determine the exact location of the dilated vein into which a special substance (sclerosant) is injected. Given the substance glues the affected vessels together, preventing blood flow through them. After this operation, scar tissue forms at the site of the diseased vein, and swelling disappears. The patient is no longer tormented by heaviness and pain in the legs, and if there were trophic ulcers, they will heal quickly.

There are two types of sclerotherapy:

1. Echosclerotherapy. This operation is used if the diameter of the affected veins has reached 1 cm or more. First, the veins are examined using a special device - a duplex scanner, then a puncture is made under its control, after which a sclerosant is injected into the vein. This procedure allows you to reduce the diameter of the affected vessel and restore normal blood flow through it.
2. Foam sclerosis. The safest and completely painless type of sclerotherapy. A special foam is injected into the affected vessel, which fills it and stops the flow of blood inside this vessel.

For maximum effect, several sclerotherapy procedures are usually performed. There are almost no relapses of varicose veins after it.

For more information about sclerotherapy for this disease, watch the video:

Laser coagulation

Surgery to remove varicose veins on the legs with a laser is considered the most technologically advanced type of fight against varicose veins and helps eliminate pathological varicose veins in 90% of patients. During this procedure no tissue incisions are made, which avoids cosmetic defects.

A laser light guide is inserted through a puncture in the skin, which emits light waves. Under their influence, the diseased vessel dissolves. This method has a low number of relapses - recurrent cases of varicose veins occur in only 5% of patients.

A method for treating varicose veins, similar to laser coagulation, is radiofrequency obliteration. The essence of the method is to expose the diseased vein to microwaves, which heat the vessel, causing it to “solder together.” This method of treatment is considered the simplest and most painless. It can also be used in severe cases when the veins reach large sizes.

How to perform surgery to remove varicose veins on the legs with a laser, watch the video:

Possible consequences and condition in the postoperative period

Almost all types of operations performed to eliminate varicose veins of the legs are successful and cause any complications in very rare cases.

The greatest likelihood of complications and a difficult rehabilitation period is observed with phlebectomy. In the area of ​​the removed vein there may be hematomas, and sometimes blood may flow from the incisions because there are tributaries of other veins nearby.

2-3 days after surgery, some patients may temperature rise. This occurs due to aseptic inflammatory processes in the blood, which accumulates under the skin.

If there is a lot of accumulated blood, lumps may form on the veins, painful to the touch. If the skin above the lumps has acquired a reddish tint, then bacterial inflammation has begun. In this case, urgent hospitalization will be required.

Other possible complications after surgery may include:

After surgery, most patients lead a sedentary lifestyle. Due to physical inactivity, such a dangerous phenomenon as... To prevent it, you need to do special exercises, follow a diet and take medications that prevent blood clots - Curantil, Heparin or Aspirin.

Rehabilitation after removal of varicose veins of the lower extremities

Compliance with doctor's instructions in the postoperative period is the most important part of treatment and prevention of relapses varicose veins Most patients are recommended:

1. Wrap your leg tightly with an elastic bandage.
2. special compression underwear - knee socks or tights.
3. Do not lift weights exceeding 10 kg for the first six months after surgery.
4. Play sports with moderate physical activity - race walking, swimming, cycling.
5. Monitor body weight if you have problems with excess weight.
6. Take an annual course of venotonic drugs - for example, Detralex.

For 3 days after the operation, patients are strictly prohibited from smoking and drinking alcohol, sunbathing, lifting weights, driving a car and taking hot baths.

If pain occurs in the operated leg A light massage may help, which can be done independently.

Even if the operation to eliminate varicose veins was performed successfully, there is always a risk of recurrence of the disease. To minimize the likelihood of relapses, Preventive measures must be followed:

• lead an active lifestyle - play sports, walk in the fresh air more often;
• in a sitting position, you need to ensure that your posture is straight, do not put one leg on the other, as this leads to disturbances in venous blood flow;
• fight excess weight;
• drink coffee and tea in moderation;
• do leg exercises every morning;
• refuse too tight and tight shoes and clothes.

Varicose veins are a disease that, even after complete recovery, requires adherence to a certain lifestyle. Preventive measures after surgery will need to be observed not for the first few months, but throughout life. This is the only way to normalize the condition of your body and eliminate the possibility of a recurrence of the disease.

anonymous, Female, 32 years old

Hello! Please help me determine whether the GSV needs to be removed based on the following symptoms and ultrasound results. Symptoms: The condition of the veins deteriorated during pregnancy. During pregnancy and after, there was thrombophlebitis of the GSV inflow at the level of the knee on the right leg. The veins on the right leg stand out in the area of ​​the calf (there is a nodule where there was a blood clot), the inside of the lower leg (there is a nodule) and the back of the foot. On the left leg, veins on the inside of the leg with nodules stand out. Ultrasound: Deep veins: external iliac vein, common femoral vein, superficial femoral vein, deep femoral vein, popliteal vein, sural veins, deep veins of the leg - patent, not dilated, completely compressed when compressed by the sensor, phasic blood flow is located, no signs of valvular insufficiency revealed. The saphenous veins (great and small saphenous vein) are passable, fully compressible when compressed by the sensor, phasic blood flow is located. The GSV on the right in the v/3 thigh is 7.0 mm in diameter, in the middle/3 - 6.1 mm, in the n/3 - 5.7 mm, in the v/3 shin - 4.8 mm. The GSV on the left in the v/3 thigh is 6.2 mm in diameter, in the middle/3 - 5.4 mm, in the n/3 - 5.9 mm, in the v/3 shin - 4.2 mm. MPV on the right - 4.0 mm, on the left - 4.4 mm. The ostial valve is wealthy - reflux on the right - 0.5 sec., on the left - 0.3 sec. Perforating veins are patent. Conclusion: Echoscopically, the patency of the deep and saphenous veins of the lower extremities is preserved. Varicose transformation in the GSV basin on the right. What is confusing is that the ostial valve is intact. The strange thing is that I had an ultrasound done half a year ago in another place and it was written that the SPS on the right and left was not consistent. Could this be possible? According to the latest ultrasound, is it necessary to remove the GSV on the right and left? Thank you!

Hello. I’ll say right away that yours is uninformative. In addition to the ostial (terminal) valve, there are other valves in the veins, but, unfortunately, nothing is said about them. Is there reflux along the trunks and tributaries of the GSV and/or SSV (?). The diameters of the veins are given - this is good, but relying only on them, it is impossible to decide whether treatment is needed and what kind of treatment, since even with a vein diameter of 6-7 mm the valves can be healthy (although in your case this is unlikely). And, if we take into account that there are varicose transformed tributaries on the left and right legs (branches flowing into the GSV, the great saphenous vein), then most likely there are varicose veins. Indications for a particular treatment method depend on many reasons. If the trunks are wealthy, then we can limit ourselves to sclerotherapy of the tributaries; if, however, there is reflux along the trunks of the GSV, then with such dimensions, endovasal laser or radiofrequency obliteration, or phlebectomy, can be done. The condition of the ostial valve should not confuse you, since, as I have already said, the overall condition of the trunks of the great saphenous veins and their valve apparatus along their entire length is important. I would recommend that you contact a specialist, perhaps repeat the ultrasound, and it is better to do this in a specialized institution.

anonymously

Thanks for the answer! I have already had laser obliteration of the veins on the right leg of the GSV and SSV. Now I'm worried about this. About 20 minutes after the operation I had to take off the compression stocking to put a bandage on the area where the blood was leaking. And I walked through the corridor into the room without a stocking (about 30-60 seconds), but then immediately put it on while lying down. Could this lead to negative consequences?

anonymously

Hello! Please tell me, using laser obliteration, only the GSV and SVC are removed, or it is possible to remove other veins. They wrote to me for payment that they removed 5 veins on one leg using laser obliteration. Although the punctures were only along the GSV (4 punctures, a miniphlebectomy of the GSV was done on the shin) and one at the back of the shin (the upper third of the SSV was removed). Is it possible that other veins in the GSV area were removed with laser? The ultrasound also shows that the GSV and SSV in the upper third have been removed. Thank you!

Good afternoon. Laser coagulation of the GSV, SSV and their unconvoluted (more or less) tributaries is possible. The light guide will not pass through a tortuous vein. Tortuous tributaries are usually removed using a miniphlebectomy. Sometimes perforating veins are coagulated using a laser.

anonymously

Good afternoon. Please tell me, if the GSV tributaries on the thigh and/or lower leg were removed with a laser, can they not be visible on ultrasound? The ultrasound doctor said that he didn’t see any tributaries, but for what reasons, whether the tributaries were removed with a laser or simply decreased due to the glued GSV, he could not answer. Does it make sense to repeat the ultrasound in another place? How long do you recommend wearing compression stockings after laser surgery? Thank you.

Good afternoon. Yes, tributaries may not be visible, either after treatment or simply due to the fact that they are not there. More precisely, there are no large tributaries. Why repeat the ultrasound in another place? If everything is fine, then there is no need to worry. Knitwear is usually recommended to be worn for 1 month after laser coagulation.

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Good afternoon. Please tell me what the phrase in the ultrasound report means: Small saphena, mouth +1 cm pl.poplitea, SPS are wealthy, diameter 0.3-0.5 cm. Does this indicate that the vein needs to be removed? Thank you.

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Hello. Thank you very much for the previous answers!!! Please answer a couple more questions. 1) After laser removal of the GSV and SSV in the upper third, 2.5 months have passed; darkening of the skin remains along the vein. How long can it last? 2) The leg on which the operation was performed hurts slightly, but constantly in the area of ​​the arch of the foot on the side of the sole (inner side of the sole), sometimes below the removed third of the SVC on the lower leg. Externally, the leg looks normal. Could this be a consequence of surgery (removed SVC in the upper third). If the vein above is glued together, how does blood flow through the vein below the removed section? Doesn't this impair blood flow in the foot area? 3) With the arrangement of five punctures as in the photo (4 on the lower leg and in the knee area and 1 at the back in the upper third of the lower leg, with the vein below the upper puncture removed using a miniphlebectomy), is it possible that 5 veins were removed with a laser? 4) Is there a need to remove the SVC if there are ultrasound indications, but the vein does not hurt and does not stand out externally? Thank you!

Photo attached to the question

Hello. 1) Skin pigmentation after laser coagulation of veins occurs quite often, especially when the vein is close to the surface of the skin. These symptoms resolve within approximately 6 months, but may persist longer. There is no need to worry, because in any case it will all disappear. 2) There may also be pain (discomfort) along the course of the coagulated vein. Gradually, these symptoms also regress. Regarding pain in the foot area, I can assume that this is most likely due to the foot itself. In any case, this is unlikely to be a consequence of the operation. If this appears after the operation, it should gradually disappear. Regarding blood flow. If the vein (SVC) had incompetent valves, then it no longer performed its function. In its upper segment, the outflow of blood was already disrupted. Instead of flowing upward, the blood was dumped downward through incompetent (non-closing) valves. That is, it was worse than before the operation, since this abnormal blood flow would “punch” its way down, involving new areas of the venous system in the pathological process. By removing or coagulating a vein, we essentially eliminate a leak in the venous system, thereby improving the flow of blood from the leg. Imagine that some of the veins are working correctly and blood flows through them as expected, that is, to the heart. Another part of the veins does not work properly because the valves do not hold blood. Blood flows down through these veins. If the vein at the top is coagulated, then the remaining part at the bottom continues to work, since the veins have many branches through which the blood flowed, first bypassing the affected area, and now bypassing the coagulated one. Only the presence of an affected, enlarged area would lead to progression of the disease. Thus, the outflow of blood from the foot does not worsen, but rather improves. 3) This question is difficult to answer, because you need to know what is meant by five veins, maybe these are five sections of a certain length. Outwardly, it looks like they were doing something in the area of ​​the GBP and its tributaries. Do I understand correctly that this is a question of the price of the operation? It seems to me that it is better to clarify this with the attending doctor. What does the statement say? The statement usually describes what was done. Maybe the operation was complicated, maybe the vein spasmed in response to the puncture and had to be punctured several times. Perhaps this is due to the fact that 5 veins were written in the payment documents. We can wonder for a long time what was meant by five veins. What is written on the receipt and statement? 4) Yes, if according to ultrasound the vein is dilated, the valves are incompetent, there are indications for treatment. Because, as I said in the second paragraph, the condition will gradually worsen. Believe me, it is easier to puncture a vein of larger diameter and it is unlikely that anyone will remove a healthy vein. If the vein is slightly dilated, its puncture is very difficult. Please contact us if you have any questions.

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Thank you very much for your answer! 1) Regarding the third question. Yes, it's a question of price. The extract only says Endovenous laser coagulation, Varadi miniphlebectomy on the right. And in the receipt - laser destruction of varicose veins (one main), number of services 1 and laser destruction of varicose veins (subsequent vein), number of services 4. Payment was made before the operation and before the ultrasound by the doctor himself. I would like to know if it is possible that after 4 punctures (see photo), in addition to the GSV, 3 tributaries were removed with a laser. Despite the fact that the GSV itself below the upper puncture was removed using a miniphlebectomy. 2) If the diameter of the SVC is 6.5 mm, there is no reflux, the SVC without SPS goes to the femur via the Giacomini vein, is there a need to remove the vein? Thank you.

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1) On the other hand, the statement says about miniphlebectomy, but the receipt does not. Maybe there is no separate miniphlebectomy service, that’s why the doctor wrote that? How much does it cost, if it’s not a secret, for the destruction of the main and subsequent veins according to the receipt? It’s difficult for me to judge what was done to you. And I cannot and do not have the right to judge that through these punctures they could not do anything except remove the GSV, since I don’t know what you had before the operation, I don’t know what happened during the ultrasound, what happened during the operation, I don’t I know the full picture. Varicose veins are very diverse in their manifestations and the picture is individual for all patients. In practice, it is found that accessory veins run parallel to the GSV, so anything can happen. In addition, if you want to understand what you paid for, you need to do this based on medical documentation, ultrasound data. 2) 6.5 mm is too much for the MPV even in the absence of reflux and SPS. Although it seems to me that reflux should exist at such a size. I wouldn't leave MPV in any case. In general, the issue of treatment is largely based on trust in the doctor, despite the fact that this often comes down to dry numbers on receipts. I don't know what happened before the surgery, but now my leg looks good. There are no dilated veins. The work, in my opinion, was done well.

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1) Destruction of the main vein according to the receipt costs 190 bel. rub (~100$) subsequent veins (4 of them) 153 bel. RUB (~80$) (+set cost 721 BYR (~370$)). Once again, thank you very much for your detailed and informative answers and attentive attitude!!! Your patients are very lucky!