Surgery to remove leg veins for varicose veins or laser resection? What's better

18 November 2020

Varicose veins is a disease characterized by changes in the state of veins in the legs and impaired blood flow. When the form is ignored, blood vessels can bulge, which can cause swelling and soreness of the limbs (under load) and aesthetic discomfort. At this stage, surgical removal of the damaged vein is effective.

Indications of varicose vein surgery

Varicose vein surgery can only be performed when there are signs of removal of blood vessels:

Varicose veins affect most veins;
Severe soreness and swelling of the legs during physical exercise interfered with normal lifestyle;
The formation of open wounds and ulcers in the context of disease development. Secondary infections are dangerous.
Violation of the permeability of blood through blood vessels, often accompanied by convulsions;
Significant development of vascular necrosis;
Pathological changes in veins, accompanied by their expansion and protrusion. This change can be dangerous due to vascular injury, and it can also cause aesthetic discomfort;
Blood clots in the veins.

Surgical intervention is only allowed in the case of advanced forms of varicose veins and conservative treatments without dynamics.

Absolute and relative contraindications of surgical contraindications

Not only in the case of indications, but also in the case of no contraindications, surgery to remove varicose veins in the legs.

absolutely prohibited operation	List of relative prohibitions
Stable blood pressure	The existence of infectious diseases
Blood pressure often rises	Skin pathology affecting the skin of the legs
Chronic heart disease	The inflammatory process in the body including blood vessels
Seniors after 70	Recovery period after other surgical operations
The existence of cancer	Chemotherapy
Diabetes and severe asthma	Severe soft tissue damage caused by trauma
Thinning and fragile blood vessels	Acute liver and kidney disease
Patients with limited leg movement (paralysis) or bedridden	Coagulation disorder or anemia
The final stage of varicose veins	Taking hormones, antibiotics or other stimulating drugs
There is a complicated leg fracture (damaged blood vessels and nerve endings)	Overweight
Allergic reaction to drugs used in surgery	The patient refused the operation

When holding a child, it may also violate the condition of the leg veins. After childbirth, the pathology usually disappears by itself. In the case of contraindications, surgical intervention can increase the patient's condition and even fatal consequences, so it is dangerous.

Vein extraction

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

Anatomical significance, the technique of major surgery to remove veins

The circulatory system of the legs is composed of deep veins and many branches of superficial veins, which can affect varicose veins. Due to valve dysfunction, blood vessel activity changes. During the normal operation of the blood vessel, the valve is closed to ensure that blood flows in only one direction.

In those veins affected by varicose veins, the valves will not close. As a result, the blood can move in both directions, resulting in impaired blood flow, blood congestion and vein protrusion.

In order to restore the blood supply to the limbs, it is necessary to eliminate the affected vein (reverse blood flow), that is, perform a phlebectomy. Before the operation, the patient should be prepared (check up, scan the vein status, determine the patient's overall condition).

If there are no contraindications, the specialist will perform surgery, including the following stages:

A small incision (in the groin or pop bone, depending on the location of the vein) allows access to the affected blood vessel. Next, ligate the damaged blood vessel from the deep vein to block blood flow.

Make an incision near the varicose veins. Using a probe, separate blood vessels from muscle tissue, lymphatic system and small capillaries. Use a tube or hook to remove damaged veins.

The capillaries are treated to prevent bleeding.

If there are damaged capillaries that form veins, remove them.

Finally, apply cosmetic stitches, sterile dressings and elastic bandages.

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

Efficiency level

Surgical removal of veins was used in different stages of varicose vein formation. The procedure is very effective (over 98%). The restoration of blood circulation occurs in a short time.

Rehabilitation

The effectiveness of surgery depends not only on the qualifications of the surgeon, but also on the compliance with the rules of surgery during the postoperative period.

After phlebectomy, you need:

Suture in the hospital for 7-14 days;

Wear compression socks or elastic bandages 24 hours a day;

30 days later, another 3 months, wearing professional underwear during the day

Only after the pins are removed, can the foot washing (where the operation is performed) be used for washing procedures;

During the recovery period, the use of saunas, baths and hot baths is prohibited;

The painkillers after the operation are prescribed by the doctor. Prohibit self-selection;

Take other drugs to prevent blood clots;

Take medicine to strengthen blood vessel walls (Vitamin E and C);

It is forbidden to wear high heels and tight underwear for a long time to stay standing/sitting;

During the rest period in the supine position, your legs should be above body level. Promote the outflow of excess blood and reduce swelling;

Step by step physical exercise in time to normalize blood flow (discuss with your doctor);

Massage and physical therapy are performed under the permission of the attending specialist;

Reject alcoholic beverages and nicotine. Alcohol causes vasodilation, on the contrary, tobacco causes its blood vessels to narrow. These effects will reduce operating efficiency;

If you are overweight, you should eat a low-calorie diet.

If you follow the rules, you can fully recover limb function within 6 months.

Use laser for vein coagulation

When direct blood vessels with a diameter of at least 0. 02 cm are affected and the number of capillaries is small, a laser will be performed to remove varicose veins in the legs. The procedure involves applying light waves to the damaged container, followed by welding and destruction.

Equipment

Any of the following three types of optical fibers can be used for vein laser coagulation:

Fiber type Introduction to operation

Ending (Classic) This kind of fiber produces beam radiation from the end, that is, the container is sealed on the front. The disadvantage is the formation of hematoma and the pain of tight veins. The maximum vein diameter is 0. 1 cm.

Radial (Elf painless radial light guide) The light waves from the optical fiber form a circle with a diameter around the vein. This allows for the treatment of veins of any size. Moreover, the risk of hematoma formation and edema is minimized.

Three types of radial fiber A laser with two halos is used to eliminate varicose veins. The first one prepares the vein for surgery (eliminates excess fluid), and the second circle welds the wall. For treatment, light guides for fine and short veins and large blood vessels were made.

The choice of equipment should not only be decided by the patient, but also by the attending physician based on the vascular status.

Which veins can be removed using the EVLK method

Before selecting EVLK by a phlebologist (an expert who examines veins and eliminates varicose veins), the characteristics of the damaged blood vessel must be determined. They must be straight and at least 2 mm in diameter.

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

Small and Great Saphenous Veins;

Occult accessory vein, at least 5 mm from the surface of the epidermis;

The blood vessel that connects the deep vein with the superficial vein.

Other veins can only be treated by venectomy.

Efficiency

Using 3 types of fibers, veins can be removed by the EVLK method. Depending on the type of equipment, the treatment effect will vary. When the end light guide plate is used for surgery, the effectiveness of the treatment is 94-96%. The operation using radial light guides can achieve 100% elimination of varicose veins in the legs.

Preparation and implementation phase

When choosing to use EVLK to remove varicose veins, patients should undergo the following training:

Cancellation of hormone medications (if taken). Because they can cause thrombosis;

The day before the intervention, blood thinners are required;

Screen damaged veins to determine the extent of damage;

Perform tests to rule out hidden infections or inflammatory processes in the body. The coagulation function is also determined;

Thoroughly wash and shave the surgical site (no cosmetics, only antibacterial soap is allowed).

Before starting the operation, please mark the boundary of the damaged blood vessel, the location where the laser/fiber is inserted, and the location of the branched capillary. These marks allow you to weld the beginning and end of veins and the exit of capillaries. This process is carried out under the control of an ultrasonic machine.

EVLK is produced in stages:

Pierce the catheter through a small hole in the marked area (use local anesthesia to numb the catheter insertion site). The light guide plate will move along it.

Insert the fiber into the catheter and push it into the damaged area. It is performed under the ultrasonic control of the monitor.

Injection of anesthetic numbs veins and adjacent tissues.

Advance the "active" light guide through the damaged vein, then delay the position of the capillary branch (to seal the output and prevent bleeding).

Remove the laser while disinfecting the puncture site and wrap it with an elastic bandage (or use compression stockings).

After completing this process, the patient can leave the hospital immediately.

Rehabilitation function

In order to restore the function of the injured limb and prevent the development of complications, you need to be familiar with the nuances of rehabilitation after EVLK.

They are:

After the operation is completed, it is recommended to walk the operated leg in the medical facility for an hour;

2-3 days, ultrasound control of the treated vein;

Professional underwear must be worn all day for 5 days (the type of stockings will be discussed with the attending specialist before the operation). Then, within 45 to 60 days, clothes must be used during the day;

Start kneading the legs every day from a 60-minute walk;

Avoid overloading your legs (sitting or standing for long periods of time) and going to the sauna or hot bath.

If varicose veins still need to be removed, surgery is allowed within 7 days.

Advantages of each method

Depending on the type of intervention, surgery to remove leg varicose veins has the following advantages:

Vein extraction EVLK

The surgical incision is about 5 mm, so there is almost no scar No pain during the operation (using local anesthesia). No need for general anesthesia

The painless operation is performed under local anesthesia. For small fibrillectomy, local anesthesia is used. EVLK is executed under ultrasound control. The result is high precision and high efficiency.

Low cost There is little or slight hematoma and pain at the surgical site.

Fast recovery of skin tone (purple violet shade without stars and epidermis) This operation requires 1 puncture, so no sutures and scars are needed

Short recovery time of about 30 days The longest recovery period is 5 days

Effective for all forms of varicose veins After the operation, the patient can leave the clinic within 1 hour.

can return to normal life within 24 hours.

EVLK can be performed when the ulcer damages the integrity of the epidermis.

The duration of surgery does not exceed 40 minutes.

EVLK can complete leg training in one day. One foot was allowed a second operation after 7 days.

Since the incision/puncture is small, the risk of infection during the operation is minimal.

Complications after surgery and laser vein surgery

There is a risk of complications after vein removal by surgery or laser. Adverse reactions may be due to low qualifications of experts or violations of regulations during the recovery period. Possible complications of venectomy and venous coagulation.

Vein removal method Minor complications caused by the procedure Major complications

Vein extraction
hematoma and minor bleeding;

Temperature rise;

Limb swelling due to temporary destruction of the lymphatic system and failure to follow the rehabilitation rules;

Pain, decreased sensitivity of the surgical area;

The seal formed by the small bleeding under the skin caused by the removed venous capillaries;

The seams fester due to improper handling;

Nausea after general anesthesia.

Deep vein thrombosis occurs (so, during the recovery period, you need to take blood thinners and follow your doctor's diet);

Tissue numbness in the surgical area. Maybe the nerve endings were damaged during the operation;

Deep vein inflammation caused by infection or violation of nursing rules during the operation.

Vein laser coagulation
Hematoma when using the end light guide;

Swelling within 3 days;

Muscle tension and soreness in the removed vein, especially when moving the leg;

The temperature rises slightly;

As blood poured into the "sealed zone", seals appeared in the removed vein;

In the case of insufficient welding of damaged vessel walls, blood flow and varicose veins can be restored. Needs another operation;

The tone of the epidermis changes during the decomposition of the "sealed" vein. As long as the blood vessels are located near the surface of the skin.

The formation of deep vein thrombosis;

Laser burns nearby tissues and nerve endings, and then the limb function is damaged;
When infection is introduced to the puncture site, the development of the inflammatory process;
Fiber peeling and adhesions in veins during surgery. This rarely happens when using poor-quality equipment.

During both operations, allergic reactions to anesthetics may occur.

Measures to reduce complications

Surgery to remove leg veins with varicose veins is sometimes accompanied by complications. To prevent them from occurring, you need to do the following:

Test allergic reactions to the drugs used;

Eliminate infectious diseases and inflammatory processes in the body before surgery;

Choose reliable clinics with high-quality experts and modern equipment;

Comply with the rules during recovery. Especially wearing compression underwear;

Observe diet and nutrition during the recovery period (discussed by experts after surgery). The amount of pure water in the diet increases, the food intake is small, and the diet is rich in vitamins and minerals;

Rest your feet during working hours;

After the operation, undergo an examination to track the dynamics of limb recovery;

Massage and participate in physical therapy procedures to quickly restore blood flow.

If unacceptable deviations are found during this operation, you must contact the clinic immediately.

Forecast comparison

The two methods of removing leg veins are more than 95% likely to recover completely, but to eliminate contraindications, follow the rules during the recovery period and when choosing a validated clinic. Through surgical treatment, the blood flow and external conditions of the legs were restored after three months, and through laser treatment, it returned to normal after 30 days.

In the advanced form, the removal of blood vessels is performed surgically. The treatment method depends not only on the patient's wishes, but also on the indications and contraindications of the operation. The effectiveness of treatment depends on the qualifications of the doctor and the implementation of postoperative foot care rules.

Fiber type	Introduction to operation
Ending (Classic)	This kind of fiber produces beam radiation from the end, that is, the container is sealed on the front. The disadvantage is the formation of hematoma and the pain of tight veins. The maximum vein diameter is 0. 1 cm.
Radial (Elf painless radial light guide)	The light waves from the optical fiber form a circle with a diameter around the vein. This allows for the treatment of veins of any size. Moreover, the risk of hematoma formation and edema is minimized.
Three types of radial fiber	A laser with two halos is used to eliminate varicose veins. The first one prepares the vein for surgery (eliminates excess fluid), and the second circle welds the wall. For treatment, light guides for fine and short veins and large blood vessels were made.

Vein extraction	EVLK
The surgical incision is about 5 mm, so there is almost no scar	No pain during the operation (using local anesthesia). No need for general anesthesia
The painless operation is performed under local anesthesia. For small fibrillectomy, local anesthesia is used.	EVLK is executed under ultrasound control. The result is high precision and high efficiency.
Low cost	There is little or slight hematoma and pain at the surgical site.
Fast recovery of skin tone (purple violet shade without stars and epidermis)	This operation requires 1 puncture, so no sutures and scars are needed
Short recovery time of about 30 days	The longest recovery period is 5 days
Effective for all forms of varicose veins	After the operation, the patient can leave the clinic within 1 hour.
can return to normal life within 24 hours.
EVLK can be performed when the ulcer damages the integrity of the epidermis.
The duration of surgery does not exceed 40 minutes.
EVLK can complete leg training in one day. One foot was allowed a second operation after 7 days.

Vein removal method	Minor complications caused by the procedure	Major complications
Vein extraction	hematoma and minor bleeding; Temperature rise; Limb swelling due to temporary destruction of the lymphatic system and failure to follow the rehabilitation rules; Pain, decreased sensitivity of the surgical area; The seal formed by the small bleeding under the skin caused by the removed venous capillaries; The seams fester due to improper handling; Nausea after general anesthesia.	Deep vein thrombosis occurs (so, during the recovery period, you need to take blood thinners and follow your doctor's diet); Tissue numbness in the surgical area. Maybe the nerve endings were damaged during the operation; Deep vein inflammation caused by infection or violation of nursing rules during the operation.
Vein laser coagulation	Hematoma when using the end light guide; Swelling within 3 days; Muscle tension and soreness in the removed vein, especially when moving the leg; The temperature rises slightly; As blood poured into the "sealed zone", seals appeared in the removed vein; In the case of insufficient welding of damaged vessel walls, blood flow and varicose veins can be restored. Needs another operation; The tone of the epidermis changes during the decomposition of the "sealed" vein. As long as the blood vessels are located near the surface of the skin.	The formation of deep vein thrombosis; Laser burns nearby tissues and nerve endings, and then the limb function is damaged; When infection is introduced to the puncture site, the development of the inflammatory process; Fiber peeling and adhesions in veins during surgery. This rarely happens when using poor-quality equipment.