Surgery to remove leg veins for varicose veins or laser removal? What is better

18 November 2020

Varicose veins is a disease characterized by a change in the state of the veins in the legs with impaired blood flow. When the shape is neglected, the vessels bulge, leading to swelling and pain in the extremities (under load), as well as cosmetic discomfort. For this stage, surgical removal of the damaged veins is effective.

Indications for varicose vein surgery

Surgery for varicose veins can be performed only if there are indications for the removal of blood vessels:

indications for surgery for varicose veins

Varicose changes have affected most of the vein;
severe pain and swelling of the legs during physical exertion, interfering with a normal lifestyle;
the formation of open wounds and ulcers in the context of the development of the disease. It is dangerous to attach a secondary infection;
impaired permeability of blood through vessels, often accompanied by seizures;
marked development of vascular necrosis;
pathological changes in the veins, accompanied by their expansion and protrusion. The change is dangerous due to trauma to the vessels and also causes aesthetic discomfort;
blood clots in the veins.

Surgical intervention is allowed only in advanced forms of varicose veins and in the absence of dynamics with conservative treatment.

Absolute and relative contraindications for surgical intervention

Surgery to remove leg veins for varicose veins is carried out not only if there are indications, but also in the absence of contraindications:

Absolute prohibition of the operation	List of relative prohibitions
Stable high blood pressure	Presence of infectious diseases
Regular jumps in blood pressure	Dermatological pathologies that affect the skin of the legs
Chronic heart disease	Inflammatory processes in the body, including blood vessels
Old age after 70	The recovery period after other surgeries
Presence of cancers	Chemotherapy
Diabetes mellitus and severe asthma	Severe soft tissue injury from trauma
Thinning and fragility of blood vessels	Acute liver and kidney disease
Patients with limited leg mobility (paralysis) or bedridden patients	Blood clotting disorder or anemia
Varicose veins in the last stage	Taking hormones, antibiotics, or other strong medications
The presence of complicated fractures in the legs (with damage to blood vessels and nerve endings)	Being overweight
Allergic reaction to medications used during surgery	Patient refusal to surgery

When carrying a child, there may also be a violation of the condition of the veins of the legs. Most often, the pathology clears up on its own after delivery. In the presence of contraindications, surgical intervention is dangerous with a worsening of the patient's condition and even with a fatal outcome.

Phlebectomy

Phlebectomy is a surgical procedure to remove damaged veins and restore normal blood flow to deep veins.

Anatomical significance, large surgical technique to remove veins

The circulatory system of the legs consists of a deep vein and many branches of superficial veins, which affect varicose veins. Changes in vascular activity develop due to valve dysfunction. During the normal functioning of the vessels, the valves are closed, ensuring blood flow in only one direction.

In the veins of those affected by varicose veins, the valves do not close, as a result, blood can move in both directions, leading to poor blood flow, with stagnation of blood and bulging of the veins.

To restore the blood supply to the limb, it is necessary to remove the affected vein (with reverse blood flow), that is, perform a phlebectomy. Before the operation, the patient undergoes a preparation (carry out tests, scan the state of the veins, determine the general condition of the patient).

If there are no contraindications, the specialists perform a surgical intervention that consists of the following stages:

Access to the affected vessel is provided through a small incision (groin or popliteal, depending on the location of the vein). The damaged vessel is then ligated from a deep vein to block blood flow.
An incision is made near the varicose vein. With the use of a probe, the vessel is separated from muscle tissue, the lymphatic system, and small capillaries. Through a tube or with a hook, the damaged vein is removed.
Capillaries are treated to prevent bleeding.
If there are damaged capillaries that form spider veins, they are removed.
At the end, cosmetic stitches, a disinfectant dressing and an elastic bandage are applied.

The operation is performed under general or local anesthesia. It depends on the size of the boat and its location.

Efficiency level

Surgical vein removal is used at different stages in the development of varicose veins. The procedure is very effective (more than 98%). Restoration of blood circulation occurs in a short time.

Rehabilitation

The effectiveness of the procedure depends not only on the surgeon's qualifications, but also on compliance with the rules in the postoperative period.

After phlebectomy, you need:

Suture care for 7-14 days in a hospital;
the use of compression stockings or elastic bandages for 30 days is carried out throughout the day;
after 30 days, for another 3 months, wearing specialized underwear during the day
Water procedures with foot washing (where the operation was performed) are possible only after removing the stitches;
during the recovery period saunas, baths and hot baths are prohibited;
Pain relievers after surgery are prescribed by a doctor. Self-selection is prohibited;
additional medications are taken to prevent blood clots;
taking medications to strengthen the walls of the blood vessels (vitamins E and C);
it is forbidden to stand / sit for a long time, wearing high-heeled shoes and tight underwear;
during the supine rest period, the legs should be above body level. Promotes the exit of excess blood and reduces swelling;
timely and gradually introduce physical activity to normalize blood flow (discussed with your doctor);
massages and physiotherapy are performed with the permission of the attending specialist;
refusal of alcoholic beverages and nicotine. Alcohol causes vasodilation, and tobacco, on the contrary, leads to its narrowing. These effects reduce the efficiency of the operation;
if you are overweight, you are prescribed a low calorie diet.

If the rules are followed, complete restoration of limb function is possible in 6 months.

Endovenous laser coagulation

An operation is performed to remove leg veins with varicose veins using laser when direct vessels with a diameter of at least 0. 02 cm and with a reduced number of capillaries are affected. The procedure consists of the action of light waves on the damaged vessels with their subsequent welding and destruction.

Team

Laser vein coagulation can be performed with any of the 3 types of optical fibers:

Type of optical fiber	Action report
End (classic)	This light guide produces beam radiation from the end, that is, the container is sealed against it. The downside is bruising and a painful feeling of tightness of the veins. Maximum vein diameter 0. 1 cm.
Radial (with elven painless radial light guide)	The light waves from the fiber form a circle that surrounds a vein in diameter. This allows treating veins of any size. And the risk of bruising and the development of swelling is also minimized.
Of 3 types of radial fibers	Lasers with two rings of light are used to remove varicose veins. The first prepares the vein for the procedure (removing excess fluid), the second circle welds the walls. For treatment, light guides are produced for thin and short veins and for large vessels.

The choice of equipment is not only made by the patient, but also by the specialist who attends to the condition of the vessels.

Which veins can be removed with the EVLK method

Before choosing EVLK by a phlebologist (a specialist who examines the veins and removes varicose veins), the characteristics of the damaged vessels are determined. They must be straight and at least 2mm in diameter.

As a result, laser therapy can be applied to the following groups of vessels:

small and large saphenous veins;
saphenous accessory veins, which are at least 5 mm from the surface of the epidermis;
vessels that connect the deep veins with the superficial ones.

For other veins, therapy is only possible with phlebectomy.

Efficiency

Vein removal by the EVLK method is possible with 3 types of optical fibers. Depending on the type of equipment, the effectiveness of the treatment changes. When an operation is performed with a final light guide, the effectiveness of the therapy is 94-96%. The operation with radial light guides allows to achieve a 100% result in the elimination of varicose veins in the legs.

Preparation and deployment stages

When choosing to remove varicose veins with EVLK, the patient must undergo the following training:

Cancellation of hormonal medications (if taken). Since they can provoke the development of thrombosis;
one day before the intervention, it is necessary to take anticoagulants;
examination of damaged veins to determine the extent of damage;
performing tests to exclude the presence of a hidden infection or inflammatory processes in the body. Blood coagulation is also determined;
the procedure site is thoroughly washed and shaved (without the use of cosmetics, only antibacterial soap is allowed).

Before the start of the operation, the margins of the damaged vessels, the laser / fiber insertion site and the site of the branching capillaries are marked. These marks allow you to weld the beginning and end of the vein, as well as the outlets of the capillaries. The process is carried out under the control of an ultrasound machine.

EVLK occurs in stages:

Insertion of the catheter through a small puncture (the catheter insertion site is anesthetized with local anesthesia) in the marked area. The light guide will move along it.
Insertion of the light guide into the catheter and its subsequent advancement to the damaged area. It is performed under ultrasound control on a monitor.
Injection of anesthetic to numb the vein and surrounding tissues.
Advancement of the "active" light guide through the damaged vein, followed by a delay at the places where the capillaries branch (to seal the outlets and prevent bleeding).
Laser removal with antiseptic treatment of the puncture site and application of an elastic bandage (or using compression stockings).

After the procedure is completed, the patient can leave the hospital immediately.

Characteristics of the rehabilitation

To restore the function of the injured limb and prevent the development of complications, you need to familiarize yourself with the nuances of rehabilitation after EVLK.

They are:

after completing the procedure, it is recommended to walk the operated leg in a medical facility for one hour;
for 2-3 days, an ultrasound control of the treated vein is performed;
within 5 days, it is required to wear specialized underwear 24 hours (the type of stockings is discussed with the specialist who treats you before the operation). Then within 45-60 days, the clothes should be worn during the day;
perform the daily kneading of the legs by walking every day from 60 minutes;
avoid overloading your legs (sitting or standing for a long time) and visiting saunas or taking hot baths.

If removal of varicose veins is still required, procedures are allowed to take place no earlier than 7 days.

Benefits of each method

Surgery to remove varicose veins from the legs, depending on the type of intervention, has the following advantages:

Phlebectomy	EVLK
The incisions for the operation are about 5 mm, so there are hardly any scars	No pain during the procedure (using local anesthesia). General anesthesia is not required
Painless, since the operation is performed under local anesthesia. For miniphlebectomy, local anesthesia is used.	EVLK is performed under ultrasound control. The result is high precision and efficiency.
Low cost	Bruising and pain at the surgery site are rare or mild.
Rapid restoration of skin tone (absence of stars and purple-cyanotic hue of the epidermis)	The operation requires 1 puncture, so no stitches or scars are required
Short payback period of approximately 30 days	Recovery period up to 5 days
Effective for all forms of varicose veins	After surgery, the patient can leave the clinic in 1 hour.
It is possible to return to normal life in 24 hours.
EVLK can be performed when the integrity of the epidermis is compromised by ulcers.
The duration of the surgical procedure does not exceed 40 minutes.
EVLK can be performed on both legs in one day. On one leg, a second operation is allowed after 7 days.

The risk of infection during the procedure is minimal, as the incision / puncture is small.

Complications after surgery and laser vein surgery

There is a risk of complications after vein removal by surgery or laser. Negative reactions can occur due to the low qualification of a specialist or due to the violation of the rules during the rehabilitation period. Possible complications of phlebectomy and intravenous coagulation.

Vein removal methods	Minor procedural complications	Major complications
Phlebectomy	bruising and minor bleeding; temperature rise; swelling of the limb due to a temporary disruption of the lymphatic system, as well as in case of non-compliance with the rules of rehabilitation; pain, decreased sensation in the area of the operation; the formation of seals due to small hemorrhages under the skin from the capillaries of the excised vein; suppuration of the seams due to improper processing; nausea after general anesthesia.	development of deep vein thrombosis (therefore, during the recovery period, it is necessary to take anticoagulants and follow the diet prescribed by the doctor); numbness of the tissue in the operated area. Perhaps if the nerve endings are damaged during the operation; inflammation of a deep vein as a result of infection during surgery or in violation of rules of care.
Endovenous laser coagulation	bruising when using a final light guide; swelling in 3 days; a feeling of muscle tension and pain at the site of the removed vein, especially when the leg is moved; slight increase in temperature; the appearance of seals at the site of the removed vein due to the rush of blood to the "sealed area"; with insufficient welding of the walls of the damaged vessel, it is possible to restore blood flow in it and the progression of varicose veins. Repeat surgery is required; change in the tone of the epidermis during the period of "decomposition of the sealed vein". As long as the glass is located close to the surface of the skin.	formation of blood clots in deep veins; laser burns nearby tissues and nerve endings with consequent disruption of limb function; development of the inflammatory process when an infection is introduced at the puncture site; peeling and sticking of a piece of light guide in the operated vein. It occurs very rarely when using low-quality equipment.

During both operations, an allergic reaction to anesthetic drugs may develop.

Measures to minimize complications

Surgery to remove the veins of the legs with varicose veins is sometimes accompanied by the development of complications, to prevent their appearance the following are required:

tests to detect allergic reactions to the drugs used;
exclusion of infectious diseases and inflammatory processes in the body before the operation;
selection of proven clinics with highly qualified specialists and modern equipment;
compliance with the rules during the recovery period. Especially wearing compression underwear;
observe dietary nutrition during the recovery period (discussed by a specialist after the procedure). The amount of pure water is increased in the diet, food intake is carried out in small portions, the diet is enriched with vitamins and minerals;
rest your feet during work hours;
undergo examination after surgery to track the dynamics of limb recovery;
to perform massage and physical therapy to quickly restore blood flow.

If you find unacceptable deviations during this operation, you should immediately contact the clinic.

Forecast comparison

With both methods of removing leg veins, the probability of complete recovery is more than 95%, but it is subject to the removal of contraindications, adherence to the rules during the rehabilitation period and when choosing a clinicproven. With surgical treatment, blood flow and external condition of the legs are restored after 3 months, and with laser therapy, recovery is noticeable after 30 days.

In advanced forms, the removal of blood vessels is carried out by surgical intervention. The method of treatment is determined not only by the desire of the patient, but also by the presence of indications and contraindications for the procedure. The effectiveness of therapy depends on the qualifications of the doctor and the implementation of the rules of foot care after surgery.