If varicose veins have already started to form, it is not possible to stop this process completely. They can and must be removed. Surgeons usually choose one of four methods of removing varicose veins. An experienced doctor will decide which one is best for you.

The surgeon first conducts an interview, and then has to carefully examine the entirelegs . It then estimates the size ofvaricose veinsand tracks the course ofof thesuperficial veins. It pays attention to the condition of the skin, whether it is he althy, warm or changed - red or pale with discoloration. He looks for puffiness. As he runs his fingers along the veins, he can sense, for example, hardening, thickening, and a wave of flowing blood in them. This allows him to see if the valves are working properly and keep the blood from flowing back. After this initial diagnosis is made, the doctor may also carry out additional, simple tests in his office.

Tests to check the condition of the veins

Wrap test

The patient is lying down with his leg up. The doctor massages his leg as if he wanted to "squeeze" all the blood into his abdomen. Then he puts a rubber tourniquet high on his thigh. After a while, the patient gets up. The leg is smooth, varicose veins are not visible. The specialist releases the band, the blood draws back and varicose veins appear immediately. It proves the insufficiency of the valves at the exit of the examined vein.

March rehearsal

When the patient is standing, the doctor places a rubber tourniquet high on his thigh. The patient has to walk for a few minutes. During this time, the blood from the superficial veins is pressed into the deep veins by the working muscles. If the varicose veins "disappear" after the walk, it will mean that the valves of the deep veins are efficient, because they retain blood. This is important because if during the operation the trunk and branches of the superficial vein are removed, its tasks will have to be taken over by the deep vein. So it should be in good condition.

Duplex-Doppler test

This modern ultrasound examination is extremely precise. When the patient is standing, sitting and lying down, the doctor runs the Doppler head over the skin of the leg. On the monitor, he can see if the valves are functional, he althy and there are no blood clots in the veins. He can also check if the blood is flowing smoothly and under good pressure - the right colors on the screen indicate if it is flowing inthe examined vein site is normal. For example, when the graph in the monitor shows red, it means that the blood is flowing quickly without any obstruction; when blue, the blood barely squeezes through the vein (perhaps there are clots in this place). Thanks to the duplex-Doppler examination, both the condition of the deep and superficial veins can be assessed. Before the surgeon decides which method to treat varicose veins, he or she orders a blood count and blood clotting test. Large varicose veins are removed surgically, slightly smaller ones are obliterated (the middle that closes them is injected into the sick vessels), and quite small ones - so-called spider veins can be destroyed with a laser or the photo-derm method (irradiating and destroying a diseased vessel).

Contraindications for surgery to remove varicose veins

At each stage of varicose disease, surgery can be performed to remove the altered vein. There are not many contraindications for the operation. However, the treatments are not performed when:

  • deep veins are obstructed, which should take over their work after removing the superficial veins,
  • during initial examinations, the doctor detected a thromboembolism,
  • general he alth is not good, e.g. recent heart attack, advanced diabetes, hyperthyroidism.

Methods of removing varicose veins

Surgeons usually choose one of four operating methods. Their goal is to remove all varicose veins. The differences here are the use of different tools or a different technique of the procedure.

Stripping

So Babcock's method. The main venous trunk and the departing venous branches are removed. When removing the saphenous vein, the surgeon makes two 5-cm incisions on the leg: in the groin and at the ankle (when removing the saphenous vein, he makes incisions under the knee and at the ankle). Then he introduces into the diseased vein - usually from the ankle side - a soft, metal rope, the so-called the stripper cuts and ties the vein and pulls it out with one jerk. In order to remove venous branches, he has to make several, a dozen or so 1-2 cm incisions on the skin along the course of the venous trunk, through which he will pull out the branches of the removed trunk in a similar way. There are stitches on the cuts, usually removed after 10 days, and the stripping takes about an hour. It is performed under general anesthesia (less often an epidural, which blocks feeling from the waist down), most often in a hospital. You can get up and walk the very next day after the surgery. The incisions hurt for a few days, and hematomas are visible for a month. During this time, the leg is wrapped with an elastic bandage from the groin to the toes. Unfortunately, after numerous large cutsscars remain.

Miniphlebectomy

It is also known as the Miller-Varady method. It is a bit like stripping, with the difference, however, that the main venous trunk is removed not in one fell swoop, in whole, but in sections. Along the course of the venous trunk, minimal, 2-3 mm incisions are made through which, using a crochet hook-like tool, pieces of the venous trunk are pulled out, and then small branches. The operation can be performed under local anesthesia. There are no sutures, and the incisions are sealed with a special plaster for a few days. Later, there is hardly any trace of them. You can go home immediately after the surgery. After the procedure performed with this method, the principles of convalescence are similar to those after stripping.

Kriostripping

So La Piverte's method. Several 2-3 mm incisions are made along the course of the venous trunk. A probe coated with 24 carat gold at the end is inserted into the vein through the incision. The probe is connected with a wire with a special apparatus containing nitrous oxide. When it reaches the place designated by the doctor, its tip is rapidly cooled down to minus 80-100 degrees C. A piece of the vein sticks to it and is pulled out. For the next microincision, the probe is reintroduced into the vein and the procedure is repeated. Piece by piece, the main venous trunk is removed. Venous branches can be removed through the same small incisions. If the varicose vein is tortuous and the probe is difficult to enter the diseased vein, individual pieces of it can be "glued" to the frozen tip of the probe and pulled out. The procedure is mainly local anesthesia. The operation lasts about an hour. the patient comes home and should wear a pressure bandage (elastic bandage) or special compression tights for two weeks.

Sclerotherapy (obliteration)

It is a non-surgical method of treating varicose veins. This procedure is used on veins with a small cross-section (also when there are only so-called spider veins on the legs). The doctor sometimes injects a substance that causes its walls to fuse into the affected vein several times, at intervals of 7-10 days. Then he bandages the leg. The compressed vein becomes overgrown with the given preparation. The blood takes a new path without damaging circulation. The procedure is short, 10-30 minutes, and can be performed on an outpatient basis. After sclerotherapy, the patient should walk, but the pressure dressing must be worn for up to 2 weeks. Removal or closure of the vein, by any method, does not disturb the circulation. After the procedure, the blood flows through smaller transverse veins or side branchesto the deep veins and to the heart.

You must do it

After treatments:

  • To prevent blood clots in the veins, start walking as soon as possible.
  • Usually for 4-14 days you have to wear a pressure dressing, which can be replaced with time for specially selected stockings or tight tights.
  • On the doctor's recommendation, you need to take medications to prevent blood clots for some time.
  • 1-2 weeks after the surgery, it is worth choosing massages (including hydro massages) to improve blood circulation in the venous system.
  • During the convalescence period (approx. 6 weeks), you should not sunbathe intensively. There is no need to completely avoid the sun, but you cannot lay your cake on a hot beach like a pan.
  • Since veins do not like high temperatures, those who are prone to varicose veins, have varicose veins, or have had them removed should not go to the sauna.
  • After the treatments you must not wear heavy weights, stand or sit for too long and wear high heels.

Complications that can occur if varicose veins are not treated

There may be complications that are even dangerous for your life. The most common of them are:

  • Thromboembolism (called phlebitis or venous thrombosis). When blood remains in the veins, clots form. The skin above them is red, it hurts and there is swelling. If it is a superficial vein, you need to unburden the leg and take anti-inflammatory drugs for several weeks. When such a condition occurs in a deep vein, the clot breaks away from the vessel wall at some point. The clot, which travels with the blood, can lead to, for example, a blockage of the lungs.
  • Haemorrhage. The skin above the varicose vein is thin and dry as parchment. When the blood pressure in a diseased vein increases dangerously, its walls may not be able to withstand it. The varicose veins are bursting and the skin above it. There is a haemorrhage that is difficult to control. In this case, to prevent bleeding, you need to quickly call an ambulance, lie down and raise your leg as high as possible.
  • Leg ulcers. When hypoxic blood remains in the veins, it begins to seep through tiny vessels into the fatty and subcutaneous tissue. It is as if the sponge is soaking more and more water. First, bloody ecchymoses appear in the area of ​​the ankles, and then the tissues 'soaked' with hypoxic blood gradually die. This creates a painful ulcer that is difficult to heal. From this outbreak, inflammation can spread throughout the body.

Tights, stockings and compression stockingspreventing varicose veins

If someone has had varicose veins once, they may have them again in a different place. An effective method of preventing them is wearing special knee socks, stockings or tights, which, by putting pressure on the leg in the right places, prevent the blood from flowing back through the non-closing valves and remaining in the veins. They should be selected individually by a doctor. For this purpose, the patient's rested leg is measured, e.g. in the ankle, calf, under the knee and in the middle of the thigh (with tights also in the groin and waist). Then he recommends the correct size, determining the strength of the pressure. Price of tights: approx. PLN 100.

Relief for sore legs

  • In the evening, before going to bed, massage your legs with your hand or a sponge in the direction from the fingers to the groin (always towards the heart). You can perform a massage using a gel or ointment, e.g. arcalen, lioton 1000, venoruton, venescin, aescin, aesculan, haematoven, rutinoven, hirudoid, phlebogel, heparin ointment, emo-gel.
  • Every now and then. Medicines that strengthen blood vessels and have anti-inflammatory properties will also help to prevent and treat varicose veins. These are preparations made of horse chestnut extract, ginkgo biloba, arnica, rue and some citrus. Oral include detralex, rutoven, venoruton, venotrex, venastat. The use of oral preparations, even over-the-counter ones, should be discussed with your doctor.

"Zdrowie" monthly

Category:

Cardiology