Surgery of this type is particularly popular. It allows you to cope with all the hardships of varicose veins and completely cure a person. Phlebectomy is necessary in the following cases:
- extensive varicose veins spreading to the lower extremities;
- violation of the outflow of blood;
- trophic ulcers;
- excessive swelling and fatigue.
Modern methods have minimized any risks of surgical intervention. This allows you to quickly and efficiently cope with the impending problem. Despite such popularity and safety, not everyone can perform an operation.
Being overweight is a contraindication for phlebectomy.
The main and absolute contraindications:
- a history of thrombosis, prone to constant relapse;
- problems with the skin, in particular, the presence of boils;
- the impossibility of elastic compression;
- excess weight;
- deep vein thrombosis;
- oncological diseases;
- the last stage of diabetes;
- heart failure;
- the period of bearing a child and breastfeeding.
Also, before the operation, vein marking is performed. This action is performed using ultrasonic duplex scanning. This will determine the boundaries of the failure of the valve apparatus of the main veins. The procedure is aimed at marking the ducts and their places of confluence.
Before conducting a phlebectomy operation, it is necessary to undergo a comprehensive examination.
Scheme of surgical treatment of varicose veins.
Before phlebectomy, ultrasound duplex scanning of veins is mandatory.
Today, there are several main ways to conduct a comprehensive phlebectomy. These include:
- elimination of perforating discharge;
The course of the operation directly depends on the chosen type of phlebectomy.
Phlebectomy is recommended for patients with extensive varicose veins and in situations where the saphenous veins are very dilated, as well as in cases when conservative and other methods of treating varicose veins will be ineffective. Surgery can also be indicated for recurrent varicose veins.
In some situations, a phlebectomy is not recommended, as this can adversely affect the patient’s health. Phlebectomy is not performed in the following cases:
- with significant damage to deep veins;
- during pregnancy and lactation;
- in the presence of a serious concomitant disease (including infectious), which may affect the course of the operation and the course of the postoperative period;
- in the presence of inflammatory processes on the legs (complex erysipelas, pyoderma, progressive eczema, etc.).
- Severe general condition.
- Acute infectious diseases.
- Chronic diseases in the stage of decompensation (heart failure, decompensation of diabetes mellitus, renal and hepatic insufficiency, severe arterial hypertension).
- Pregnancy and lactation.
- Skin infection in the legs.
- Active thrombophlebitis (relative contraindication).
- Blood clotting disorder.
- Other diseases that limit the patient’s mobility in the postoperative period (paralysis, impaired walking due to articular pathology, etc.).
The operation is recommended in such cases:
- If there is severe varicose veins with an increase in the lumen of blood vessels over 1 cm.
- In the presence of trophic ulcers.
- With congestion and swelling in the lower extremities.
A venectomy is not recommended in the following cases:
- During pregnancy and lactation.
- If the patient has serious diseases of the cardiovascular system (IHD, arterial hypertension).
- If the skin in the area of surgical manipulation is affected by eczema, purulent formations.
- In acute vein thrombosis of the lower extremities.
- In the presence of any infectious diseases in the acute stage (SARS, influenza)
- With exacerbation of chronic diseases.
Contraindications for phlebectomy
There are various indications and contraindications for combined phlebectomy. The operation is assigned in the presence of such problems:
- Pain and burning sensation in the lower extremities.
- Swelling of the legs and their chronic fatigue.
- Bloated veins.
- Thrombophlebitis in the initial stage.
- Stagnation of blood in the legs.
- Venous insufficiency.
- The expansion of the diameter of the large saphenous vein.
- Soft tissue and skin ulcers.
Combined phlebectomy is performed if the pathology spreads above the knee.
If varicose veins are diagnosed, vein removal may not always be possible. There are such contraindications for surgery:
- Persistent increase in pressure.
- Coronary heart disease.
- Immune problems.
- Elderly age.
- Acute thrombosis of deep vessels.
- Skin diseases of an inflammatory or infectious nature.
- Atherosclerosis of the legs.
- Menstruation in women.
If a person is at risk, then with varicose veins, removal of the affected areas can be prescribed, but there is already a question about the type of procedure.
- Very cosmetic
- Advantages of surgical intervention
- Under local anesthesia
- Features of the rehabilitation period
- Without hospitalization and sick leave
- The main contraindications for miniflebectomy
- Preparation for phlebectomy of the lower extremities
- After operation
- What is an operation?
- Possible complications
- Do the operation?
- Patient examination
- Stages of
- Rehabilitation process
- Applicable Methods
- Sick leave
- What to do at home?
Most Russian hospitals remove varicose veins in the legs, both through a large incision in the groin (crossectomy) and through large incisions in the legs according to Narat or Linton. The consequences of such combined phlebectomy do not satisfy most patients. Our technology involves minimal intervention through skin punctures that leave virtually no scarring.
The dilated vein is “vaporized” by the laser without incisions. Varicose tributaries and nodes are eliminated by microflebetomy and Foam-Form sclerotherapy. The use of minimally invasive technique involves significantly less tissue injury than the “classical” combined phlebectomy, the patients’ reviews about the postoperative period are very good.
Advantages of surgical intervention
With varicose veins, the operation will help get rid of the symptoms. It has the following advantages:
- Reducing the likelihood of further development of the disease, since after the removal of large vessels, they can not grow again.
- It is possible to perform operations simultaneously on two limbs.
- Achieving a noticeable cosmetic effect.
- Short rehabilitation period.
- After the intervention, the scars are almost invisible.
The indicated operation can be carried out by compulsory medical insurance. In addition, combined phlebectomy, the course of the operation involves the combination of several procedures, is carried out quickly and simply.
This type of surgical intervention is a dressing with a further intersection of a large or small vein.
It allows you to determine reflux in most cases. Surgical intervention begins with an incision in the groin, its length does not exceed 5 cm. Immediately after this action, the second stage of phlebectomy follows – stripping.
The need for a lower crossectomy is explained by the fact that a typical anastomosis is found in only a quarter of people. This stage of the operation implies an incision, but it is performed in the area under the knee. The course of the operation is similar to upper crossectomy.
Phlebectomy and thermobliteration, miniflebectomy, which operation to choose.
As an independent surgical intervention, a crossectomy is performed only in emergency situations. In particular, when there is a risk of developing acute thrombosis. Complications after a phlebectomy of this type are extremely rare.
However, their use is not always advisable. The advantages of alternative interventions is their implementation without the help of general anesthesia and hospitalization. This allows the patient to return home within a few hours after surgery. The minuses include the likelihood of a re-development of the disease.
Under local anesthesia
The operation to remove the veins with varicose veins is done under local anesthesia, which allows you to fully anesthetize the surgical field with a weak solution of local anesthetic – novocaine or lidocaine. The result of surgery should be the elimination of varicose veins with excellent aesthetic results. The meaning of aesthetic phlebectomy is to remove varicose veins through punctures, but not skin incisions under local anesthesia.
Features of the rehabilitation period
Combined phlebectomy includes several stages of its implementation. One of them is stripping, thanks to which it is possible to remove the trunk of a large or small saphenous vein.
This allows you to identify the affected area and during the operation to proceed with its elimination.
Varicose veins can only harm the trunk of a vein on the thigh. This phenomenon occurs quite often, which allows for short stripping.
Stripping is one of the stages of complex phlebectomy.
To date, there are several varieties of surgical intervention. This can be additional use of the Babcock probe, inversion stripping, PIN-stripping and cryostripping. An alternative method of removal is laser phlebectomy.
- Babcock Probe. This tool is a metal band with a handle and an edge. The probe is inserted into the vein trunk, after making an incision in the upper or lower part of the limb. You can enter the tool from any direction. The sharp edge is the removal of the affected vein. This method is characterized by its reliability, but it is the most radical of all existing types of phlebectomy.
- Inverse stripping. This method is based on the use of a probe, but a slightly different shape. There is no cutting edge at one end. The vein is fixed with a thread that allows it to be distinguished. A vein easily breaks away from surrounding tissues when turned ins >
Cryostripping is used quite rarely due to the high cost of the procedure.
Phlebectomy is selected by the attending physician depending on the complexity of the situation. Naturally, the wishes of the patient are taken into account. After all, most surgical interventions are expensive.
Most often, the postoperative period after phlebectomy is fairly easy. Naturally, the patient may experience pain, but in most cases they do not bring severe discomfort. If the pain intensifies, the doctor may prescribe analgesics. It should be borne in mind that radio-frequency and laser methods of treating varicose veins are less traumatic compared to surgery and suggest a shorter and more comfortable rehabilitation period, which is almost not accompanied by painful sensations.
There are several main recommendations that should be followed during rehabilitation:
- strictly comply with all the recommendations of the attending physician;
- wear compression underwear for at least 2 months;
- during the first 2-3 weeks after the intervention, refrain from doing sports, gymnastics, any excessive physical exertion, and also refuse to visit the bath, sauna, solarium, pool.
Proper care and compliance with all the doctor’s instructions will make rehabilitation quick and almost painless. And the qualified actions of IMMA clinic surgeons minimize the risk of any complications from phlebectomy.
For more information about the prices of the procedure and the features of its implementation, call our clinics. On the pages of the site, in the “Clinics” section, there is information about the addresses of our clinics in Moscow. Call and sign up: we are always happy to help you in solving any health problems!
Without hospitalization and sick leave
In the treatment of varicose veins in our clinic, hospitalization is not needed. Complex cases of varicose veins are made by combining laser coagulation and miniflebekomiya. Minimal trauma, as well as a small risk of intervention, allow this operation to be performed in a day hospital. After a modern miniflebectomy, the patient can be released home half an hour after the intervention.
The main contraindications for miniflebectomy
To date, two main variants of venous ligation are known: supra-fascial and sub-fascial methods.
The first type of intervention is less traumatic. Vein ligation is performed according to the principles of miniflebectomy. If the affected area of the vein is too large, an additional 2 cm incision is made.
This option is open and requires large incisions. As a result of such an operation, visible cosmetic defects remain.
Miniflebectomy is especially popular. It represents the removal of varicose nodes. During surgery, a puncture is performed over a vein. Through the resulting hole, part of the affected area is removed and removed. At the puncture site, the seams are not overlapped. In the postoperative period, the patient feels great.
Miniflebectomy is a method for removing varicose veins without cuts, through small punctures in the skin. It is carried out under local anesthesia, in a day hospital, that is, a few hours after the operation, the patient can go home.
Miniflebectomy can be an independent operation, but more often it is combined with other methods of treating varicose veins: crossectomy, perforating vein ligation, laser coagulation, sclerotherapy and others.
For the first time, the technique of miniflebectomy was proposed in the 1960s by the Swiss dermatologist Mueller. A little later, it was finalized and modified by various surgeons. The most famous for today is the modification according to Varadi (the German surgeon Zoltan Varadi developed special tools for her).
The main advantages of miniflebectomy
- General anesthesia is not required.
- It is possible to conduct on an outpatient basis.
- Minor tissue trauma.
- No time is required for recovery and rehabilitation. After 2 hours, the patient can go home.
- The operation is almost painless.
- The possibility of surgery in the elderly and patients with concomitant chronic diseases.
- Good cosmetic effect due to lack of scars.
As an independent operation, miniflebectomy is used:
- In the initial stages of varicose veins.
- For removal of varicose dilated inflows of BPV or MPV in the absence of reflux along the main trunk.
- In the presence of limited varicose nodes.
- To remove dilated veins in atypical areas of the body (face, feet, labia).
- To remove a vein after the main treatment for thrombophlebitis.
- With ascending thrombophlebitis of the saphenous vein.
As an additional operation, miniflebectomy is used:
- To remove inflows after removal of the main saphenous vein trunk by crossectomy (intersection of the anastomosis of the BPV with the femoral vein) and stripping (removal of the BPV with the probe).
- After endovasal laser coagulation.
- In combination with ligation of perforating veins.
Preparation for phlebectomy of the lower extremities
To clarify the method of surgical treatment and the volume of surgery, patients with varicose veins are assigned an ultrasound scan. This examination allows you to identify the level of valve failure, patency of deep and perforating veins, the presence of blood clots.
Immediately before the operation (10 days), standard preoperative tests are prescribed:
- General detailed blood test.
- Analysis of urine.
- Blood for markers of viral hepatitis, HIV, syphilis.
- The study of coagulability and coagulation of blood components.
- Blood chemistry.
- X-ray of the chest.
- Therapist examination.
The patient is warned about the cancellation of blood-thinning drugs (aspirin and other anti-inflammatory drugs) several days before the operation.
Before surgery, you need to purchase compression stockings of the right size of the second degree of compression. It is recommended to wear compression hosiery 1-2 weeks before surgery, this makes it easier to put on after surgery (new hosiery is quite difficult to stretch).
Before surgery, you need to shave your legs.
In order for the operation to go without complications, it is necessary to carry out preliminary preparation. It includes:
- Consultation of a phlebologist and angiosurgeon.
- Conducting laboratory tests (general blood test, HIV tests, hepatitis).
- Performing Doppleroscopy.
- If the patient has concomitant diseases, it may be necessary to conduct additional examination methods (ECG, fluorography).
Phlebectomy is an operation to remove affected leg veins. The main goals of the surgery are to improve the outflow of blood and restore blood circulation. Venectomy – surgical removal of a vein – is performed according to strict indications and in the absence of effectiveness from conservative treatment.
The main indications for phlebectomy of the veins of the lower extremities include:
- Varicose veins. The most common cause of phlebectomy. Pathology affects subcutaneous and deep veins, contributes to circulatory disorders. In the initial stages, the use of drugs is possible. In more severe stages of the course of the disease, surgery is prescribed.
- Thrombophlebitis of superficial veins. The operation is performed with an acute or chronic form of pathology. The disease leads to the fact that the lumen of the vessel is clogged by the formed clot. As a result, an obstacle arises in the path of blood flow, followed by a violation of blood circulation. In cases where medications do not contribute to the resorption of the clot, surgery is performed.
- Trophic ulcers. The disease can affect the skin and soft tissues. Indication for emergency surgery to remove the veins is the appearance of heavy bleeding from the affected areas.
- Venous insufficiency. Pathologically, the process affects the valves of the vessels. As a result, there is a violation of the outflow of blood, which leads to stagnation. Phlebectomy is the most suitable option for surgical intervention in this condition.
Despite the large number of advantages and indications for the appointment, phlebectomy has some limitations for conducting. These include:
- Acute viral or infectious diseases. Such conditions increase the possibility of developing postoperative complications in the form of sepsis.
- Severe hypertension, uncontrolled by medication.
- Chronic heart failure in the stage of decompensation.
- Period of pregnancy. The absolute contraindication is the second half of the gestation period. This is due to the fact that any intervention can provoke the development of spontaneous abortion.
- The presence of inflammatory diseases in the lower extremities. These conditions can trigger the spread of inflammation in other organs and tissues.
- Age over 65 years. With age, surgical interventions are more difficult to tolerate. This is due to the presence of a sufficient number of concomitant pathologies. Vein phlebectomy can lead to exacerbation of chronic diseases, which will negatively affect the course of the recovery period.
Some of these contraindications are temporary. This means that after removing the restrictions, surgery can be carried out in full. Depending on the severity of the condition and the type of affected vessel, the doctor selects the phlebectomy technique, which will be most effective in each case.
The following types of surgical removal of veins of the lower extremities are distinguished:
- Crossectomy The operation to remove varicose veins in the legs involves ligation of the confluence of the superficial vein into the deep vein in the upper thigh. Surgical scars may not be visible. Operational access is performed in the area of inguinal folds.
- Stripping. Removal of affected veins is carried out using a special probe. Surgery consists in performing several punctures from both ends of the vessel. After stripping, relapses occur in 30% of cases.
- Safenectomy During the surgical procedure, large venous trunks are removed.
- Phlebectomy with sclerosis. The essence of the operation to remove veins with varicose veins is the introduction of a special substance, which leads to their dissolution.
- Laser phlebectomy. It differs from the classical version of surgical intervention in that a low-frequency laser is used to remove the affected veins. Thanks to its action, coagulation and adhesion of the inner lining of the veins occurs. Over time, the walls of the vessel collapse. Similarly, it is excluded from the general blood flow system.
- Miniflebectomy. It is used for lesions of small caliber veins. With the help of point punctures, the vessels are removed. After this surgery, relapses are extremely rare.
Phlebectomy, like any other surgical intervention, requires special training. In this way, the readiness of the body for the upcoming surgical treatment is checked. The main tests required for delivery include:
- general blood and urine analysis;
- blood biochemical parameters;
- analysis for HIV, hepatitis B and C, syphilis;
- blood type and Rh factor;
- Ultrasound of the vessels of the lower extremities.
After passing the studies, it is necessary to obtain a conclusion from the therapist about the absence of contraindications for surgical intervention. The following is a referral to an anesthetist. After conducting a survey and examination of the patient, the doctor selects the most suitable anesthesia. Hospitalization is carried out a day before the planned date of surgery.
Phlebectomy of the veins of the lower extremities is performed under local anesthesia. In rare cases, general anesthesia is used. As a rule, it is prescribed for the removal of large trunks. To ensure maximum muscle relaxation, the patient is asked to take a lying position.
- After the patient is located on the operating table, the operated area is freed from clothing.
- Next, markup is carried out to determine the location of the operated vein. This stage is necessary for the accurate installation of the injection site of medical instruments.
- Local anesthesia. The injected drug begins its action in a few minutes. This can be understood by the presence of a characteristic pattern along the vessel.
- Antiseptic treatment of the surgical field. A necessary measure to reduce the risk of infectious complications in the postoperative period.
- Performing punctures through which the removal of the affected vein will be performed. For this, special hooks are used. The distance between the punctures is selected individually depending on the severity of the pathological changes.
- Insertion of the probe and hooks through the holes made. With their help, the vessel is removed. Bleeding that occurs during surgery is eliminated by tamponade with your own tissues.
- The final stage of the operation is suturing followed by repeated antiseptic treatment.
The duration of leg vein removal surgery is determined individually. On average, surgery lasts about 2 hours. A few days after phlebectomy, the patient should observe bed rest and be under the supervision of doctors. Compliance with medical recommendations in the postoperative period accelerates the duration of rehabilitation.
Indications for surgery in each case are determined by the doctor. Before phlebectomy, the patient should be recommended ultrasound examination of blood vessels. It helps to objectively assess the condition of the veins. Some steps to prepare for phlebectomy, the patient can perform on their own:
- take a shower;
- hair removal or shaving;
- prepare comfortable shoes and loose clothing.
The patient should consider that before surgery, you can not take some medications. If immediately before the procedure there are any changes in health, it is important to immediately inform your doctor. We will tell you about other precautions and preparations in our clinic.
Before surgery for varicose veins on the legs, patients need to give up aspirin or aspirin-related drugs for a week before the procedure. They should not eat or drink after midnight on the day of surgery. On the day of the procedure, do not apply any moisturizing creams or suntan lotions. The patient should arrive at the surgical center about one and a half hours before the procedure.
Skin punctures are made with a needle, at points according to preoperative marking. The varicose node must be carefully selected along the vein with a special hook, and then it is removed by pulling through a small puncture. The video shows the operation to remove varicose veins through micro-punctures on the legs. Sutures are not required if the doctor uses minimal incisions (1-3 mm) and good postoperative compression.
This eliminates the consequences in the form of noticeable scars and seals in the incision area. Experienced surgeons remove large venous networks on both legs in a single session lasting from 60 to 120 minutes. Additional sclerotherapy of residual varices and telangiectasias allows you to remove small vessels after phlebectomy.
With laser phlebectomy, small punctures are made, and the removal of the vein in small parts minimizes the appearance of blood clots and contributes to the best cosmetic effect. This method requires special training of the surgeon. After all expanded varicose segments have been removed, a compression bandage must be applied.
In the future, you need to take diosmin preparations (Detralex), it is not recommended to stand in one place for 2 weeks for a long time. This helps to minimize the risk of blood clots in the deep veins of the leg. A compression dressing prevents postoperative hemorrhage and reduces the likelihood of pain, bruising, and the formation of other complications.
Additional sclerotherapy should be postponed for several weeks and done after the disappearance of postoperative edema. Many spider veins can spontaneously regress and also disappear spontaneously after removal of varicose veins through outpatient phlebectomy. Patients should avoid early exposure to the sun because hyperpigmentation may appear at the site of the puncture or incision.
The patient is advised to monitor whether redness, swelling, suppuration, fever and other signs of infection have appeared. When these signs appear, you should immediately consult a doctor.
After the procedure, it is required to wear special stockings. This will speed up the restoration of veins and limbs. Stockings are worn for 3 days, then switch to daily compression. The duration of wearing a special knitwear is determined by the attending physician.
In the first hours you need to bend and unbend the limbs, this will improve blood circulation. After a day, you must replace the sticker at the puncture site. It is impossible to lift weights and perform physically difficult work for 10 days.
After the procedure, it is required to wear special stockings.
Rehabilitation after phlebectomy is based on a systematic visit to the doctor. The first examination is carried out after 7 days, then – after a month. This will track the patient’s health status. The patient is recommended to do an ultrasound of the vessels. The duration of the rehabilitation period directly depends on the recommendations implemented.
The sooner the patient seeks help, the higher the likelihood of his full recovery.
Combined phlebectomy involves a rehabilitation period. Immediately after the operation, non-steroidal anti-inflammatory drugs, anticoagulants and venotonics are prescribed to the patient. The duration of bed rest depends on the type of surgical manipulation: after a miniflebectomy, it is limited to 1 hour, and after a Beccoccus operation, it can reach 7 days.
After discharge from the hospital, a person must adhere to a number of restrictions – this is necessary to restore the body after phlebectomy. The duration of the rehabilitation period is individual and depends on the complexity of the operation, the number of vessels removed, the presence of concomitant pathologies, the age and general health of the patient. Typically, the minimum recovery time is about 2 weeks.
Rehabilitation after phlebectomy: doctors’ recommendations
Within a few months after phlebectomy, it is recommended:
- use elastic bandages, then elastic knitwear;
- Do not rub your feet with a rough washcloth or towel;
- Do not use too hot water while swimming;
- refuse to visit the baths and saunas;
- eat balanced;
- refrain from sex and power sports;
- perform special exercise therapy after phlebectomy.
The postoperative period after phlebectomy of the veins of the lower extremities on average takes about 6 months. Rehabilitation begins when the patient is transferred from the operating room to the ward. The patient is under the supervision of doctors for 7-14 days. This is necessary for the timely provision of medical care in case of early complications.
In order to reduce the risk of blood clots, within 1 month after surgery, patients are advised to wear compression stockings or perform elastic bandaging. Before removing the seams, it is forbidden to wet the operated area. The wearing time for compression garments or bandages is determined individually. The duration is influenced by the severity of the condition, the volume of surgical intervention.
In order to perform adequate pain relief in the postoperative period, analgesics and phlebotonics are prescribed. The first few days of recovery after phlebectomy are prescribed antiplatelet agents and anticoagulants. With their help, thrombosis is prevented, the risk of developing which increases in the early period of rehabilitation after phlebectomy on the leg.
The occurrence of a sensation of hot flashes in the legs and a tingling sensation is the expected reaction of the body in the first days after phlebectomy of the veins of the lower extremities. These symptoms are associated with the accumulation of blood and the formation of edema. A few days later, the clinical signs should go away. In case of fever, increased pain or other pathological symptoms, it is recommended to consult a doctor immediately.
After returning home, doctors are advised to follow the following recommendations that will accelerate the postoperative period after phlebectomy:
- abandon excessive physical exertion;
- swimming pool, cycling and outdoor walks are allowed;
- choose comfortable shoes;
- every 30 minutes, try to change the position of the body: sitting or standing;
- while in a horizontal position, try to raise your legs a little higher;
- exclude the use of alcoholic beverages and smoking;
- refuse to eat fatty, spicy, salty and spicy foods;
- adhere to a balanced and balanced diet.
The daily diet includes foods rich in fiber, healthy vitamins and minerals. They are found in fresh vegetables, fruits, herbs. In addition, it is necessary to adhere to the drinking regimen. It is recommended to drink 1,5-2 liters of pure water per day.
Strict bed rest is only observed while in the hospital. On average, this time lasts about 1-2 weeks. Further, it is recommended to gradually expand motor activity. To do this, it is necessary to perform extension and bending of the legs in the knee joints, rotation in the lower leg and feet. These exercises help prevent the development of congestion in the lower extremities.
Starting from the second day of the hospital stay, the patient is assigned to perform a specially designed complex of therapeutic physical culture. It includes the following exercises:
- lying on your back, an imitation of riding a bicycle;
- lifting and lowering straight or bent legs;
- bending and pulling the knees to the chest;
- rotation in the ankle joint;
- performing the exercise “scissors”;
- gradual walking on heels and toes.
The regular implementation of medical recommendations will significantly reduce the risk of postoperative complications. In addition to exercise therapy, the patient can undergo a massage course. Thanks to him, blood circulation is normalized and the possibility of thrombosis is minimized. In addition, exercise therapy in combination with massage relieves swelling and pain.
In the future, physiotherapy can be prescribed to accelerate the recovery period. It contributes to the activation of regeneration processes. As a result, the healing of joints is accelerated, and the occurrence of scars is prevented. As methods of physiotherapeutic treatment in the recovery period after phlebectomy, magnetotherapy and ultra-high-frequency therapy are prescribed.
In order to anesthetize, relieve the severity of edematous syndrome and inflammation after phlebectomy, special ointments, creams or gels are recommended. They are selected by the doctor individually. Means for external use are used in the presence of postoperative seals or hematomas. As a result of the use of these drugs, the recovery period is accelerated, formations in the area of the surgical field are resolved.
Like all surgical interventions, phlebectomy can be accompanied by postoperative complications. It is not possible to predict their appearance. It all depends on the individual characteristics of the body. The following conditions are among the main complications after phlebectomy:
- heavy bleeding;
- the development of infectious, inflammatory reactions in the area of the surgical suture;
- the formation of subcutaneous seals or hematomas;
- development of thromboembolism;
- suppuration of the suture;
- decreased sensitivity, numbness of the limb in the ankle region due to damage to the nerves innervating this area;
- violation of the integrity of the lymph nodes;
- thrombosis in deep veins;
- swelling of the lower extremities;
- the development of a new lesion requiring repeated phlebectomy.
If any pathological symptoms appear, it is recommended to consult a doctor. Some of the complications after phlebectomy require urgent hospitalization and appropriate treatment. It is impossible to predict how long the compaction and other consequences of phlebectomy will take. It all depends on the individual characteristics of the body. To reduce the risk of developing postoperative complications, it is necessary to comply with medical recommendations throughout the recovery period.
What is an operation?
Combined phlebectomy is the removal of affected blood vessels. Some pathologies lead to an increase in their clearance, as a result of which the blood pressure decreases. In this case, the heart should work much more.
To get rid of the problem, the vessel must be removed. The main task of combined phlebectomy is the normalization of blood circulation. Perform it in an inpatient or outpatient setting. It all depends on the severity of the lesion. Intervention involves the use of several techniques.
After a combined phlebectomy, the reviews are mostly positive. A person’s life activity improves, he can walk without pain. However, the procedure can give some complications:
- Severe bleeding during surgery. He is not always able to quickly stop. More often, such a complication occurs in those patients who have blood problems.
- Constant pain in the legs, the appearance of seals, which can also be painful.
- Decreased sensitivity in the limbs. This condition is characteristic of those patients whose nerves were damaged during the operation,
- Suppurations. This complication appears due to non-compliance with the rules of septic tanks and antiseptics.
Sometimes a patient develops deep vein thrombosis after the intervention. In case of complications, the patient requires drug therapy. It will help to quickly remove postoperative symptoms.
Despite the prefix “mini”, it is still an operation. As with any operation, the patient should be warned of the possible consequences and complications, although they are quite rare.
- Thrombosis, thrombophlebitis.
- Long lasting hyperpigmentation (darkening of the skin).
- The appearance of scars.
Miniflebectomy does not guarantee the appearance of new varicose nodes in other places.
Basically, the reviews about this operation are only positive: without incisions, without anesthesia, practically without pain, in just an hour the patient gets rid of varicose veins. Special rehabilitation is also not required.
Varicose veins are a systemic pathology of veins that is most often found on the lower extremities.
The disease is accompanied by swelling and increased leg fatigue, over time, a deficiency of nutrients occurs in the tissues, which results in cramps, acute pain, and trophic ulcers.
If in the early stages the removal of varicose veins can be carried out with the help of medications and a minimally invasive method, then with an advanced disease everything is much more complicated: only phlebectomy of the veins will help get rid of unpleasant symptoms.
Despite the fact that this radical method is among the most traumatic, it surpasses minimally invasive methods in terms of effectiveness.
In addition, this operation for varicose veins can be performed when other interventions have been ineffective.
Phlebectomy (a synonym for venectomy) is one of the oldest methods of eliminating varicose veins on the legs through openings on the skin by surgery. Modern medicine has several methods for phlebectomy of the veins of the lower extremities, named after their creators: according to Madelung, Müller, Bebkot and Narat.
Regardless of the name of the operation to remove sections of veins on the legs, they have only one expected result – the exclusion of the vessel from the general blood flow and the normalization of blood supply to tissues in which trophic changes are observed. During the operation to remove varicose veins, specialists redirect blood flow through deeply lying veins.
The affected vessels are cut off from the bloodstream, separated from the surrounding tissues and stretched through cuts on the skin. Despite the complexity of the operation, this vein surgery is as safe and effective as minimally invasive procedures in the initial stage of varicose veins – sclerotherapy or laser coagulation. Doctors often combine these methods with surgical treatment of varicose veins in order to achieve a better result.
In addition to alleviating the general condition and restoring tissue nutrition, phlebectomy can improve the aesthetic appearance of the lower extremities: the venous pattern becomes invisible.
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Do the operation?
Classical or combined phlebectomy, like any other surgical intervention, often scares the patient, because of which he has doubts whether to perform an operation in his case, or if conservative methods can be dispensed with. Specialists do not prescribe it if there is an opportunity to ease the symptoms and eliminate varicose veins in other ways. If they do not lead to positive results, it is unlikely to avoid an operation to remove a vein on the leg.
The patient should not get hung up on fears and think that such an intervention can be dangerous. Modern techniques are practically devoid of flaws that can lead to negative consequences.
The doctor makes the choice of anesthetic and type of anesthesia after assessing the estimated extent of the intervention and the individual characteristics of the patient, including the general condition, the presence of concomitant diseases and the level of pain threshold.
In the future, the progress of the operation depends on the selected method:
- A crossectomy is performed when a combined phlebectomy is planned. The operation is a ligation of the large saphenous vein, designed to prevent the reverse flow of blood. After constriction is applied to the veins on the legs, the risk of bleeding and blood clots is eliminated. In the presence of inflammation, which is a contraindication to the removal of a large saphenous vein, phlebectomy itself is postponed to a later date.
- Madelung stripping or phlebectomy, in which a vein is removed through 2 small incisions along the upper and lower borders of the altered portion of the vessel. The lower part of the vein is ligated, and the upper is crossed. A vein is pulled or left depending on its condition. As a result of the lack of blood supply, the vessel subsides, is gradually replaced by connective tissue.
- Muller miniflebectomy, also known as classical phlebectomy, is performed by extracting veins through small incisions on the skin located along its path. The lower end of the vein is ligated, and the upper intersects. The sections of the vessel are extracted outward with the help of special tools resembling hooks and excised. The method can be used in conjunction with laser therapy and crossectomy.
- Bebkok’s saphenectomy or phlebectomy is a procedure for ligating all the tributaries of the great saphenous vein through an incision in the groin, ankle and along the vein. After the cessation of blood flow, a probe is inserted into the vessel, through which the vein will be pulled out. This operation is suitable for advanced cases.
- Narat phlebectomy is performed under the supervision of an ultrasound scan so that the doctor can monitor the quality of the manipulations during the operation. The method is used for severely convoluted veins, as well as for the removal of individual varicose nodes. Before the operation, the doctor with the help of ultrasound determines the localization of pathological sections of the veins and makes the appropriate markup. After that, cuts about 20 mm long are made on the skin at the marked points, and the veins are removed in parts.
- Kokket phlebectomy is the most traumatic, therefore it is used only with extensive damage to the veins. The operation is performed by dissecting the skin on the inner surface of the lower leg from its upper third to the ankle. After that, the doctor bandages the vessels that underwent the most significant changes, and sutures the skin. After surgery, daily dressings are shown until the postoperative suture is completely healed.
The procedure lasts from 1 to 3 hours, depending on the condition and length of the vessels and the anatomical features of the patient. In severe cases, removal takes up to 5 hours.
After the end of any type of intervention, the skin surface is again treated with antiseptics, the surgical field is covered with a napkin and cold is applied for several hours. It will help reduce postoperative compaction and prevent bruising and bruising. In most cases, a long stay in surgery is not required. After a day, the patient returns home.
The risk of various complications after surgical treatment of varicose veins is negligible if the doctor’s actions comply with the standard algorithm.
Since the operation to remove veins on the legs involves trauma to the skin and soft tissues in which the nerves, lymphatic vessels and blood capillaries are located, it is likely that the leg will become ill after a phlebectomy, slightly swell or bruises appear on it. When nerves are damaged, numbness appears in certain areas.
Such phenomena are considered the norm and do not require special actions, except for taking painkillers.
Non-compliance with the recommendations on the prevention of complications in the early postoperative period can also provoke a number of negative consequences of phlebectomy. Failure to wear a tight bandage and compression underwear under the pretext that the limb swells and squeezes it too much can lead to the formation of blood clots in the veins.
To ensure that this process is successful and there are no problems with other veins, recovery after phlebectomy involves:
- Prevention of complications – infection of postoperative wounds, the formation of blood clots and others. Immediately after the operation, the doctor conducts a conversation with the patient in which the hygiene requirements are voiced. They will depend on the method used. For example, after a Kokket phlebectomy, it is not recommended to wash the ankle of the legs until the suture is tightened, while after varicose vein operations performed through micro-incisions, a shower can be taken already on the first day. After hygienic procedures, the wounds are treated with drying antiseptics: brilliant green, iodine. To reduce the risk of thrombosis, the doctor may prescribe blood thinners, but only if there is no tendency to bleeding.
- Maintaining the muscular system in the area where the intervention was carried out on varicose veins in the legs, in sufficient tone. As you know, muscle contraction helps to more actively push venous blood upward, removing a fraction of the load from the vascular walls. In the first week, restrictions prohibit increased activity and weight lifting. They are relevant for any type of intervention, but you should not switch to bed rest: the earlier you start moving, the lower the risk of congestion and, accordingly, thrombosis. Starting from 5-7 days, patients are shown exercise therapy, gymnastics, physiotherapy exercises under the supervision of a specialist. After mastering the exercises, you can do it yourself.
- Accelerating the healing and restoration of tissues with the help of physiotherapy: UHF therapy, quartz irradiation and others. With them, rehabilitation after phlebectomy will be much faster, and in combination with massage and reflexology, they will reduce the risk of trophic changes. Procedures are prescribed by the doctor individually.
Phlebectomy has a good cosmetic result, is effective in the treatment of varicose veins and has a small risk of serious complications. When performed by a qualified physician under appropriate conditions, phlebectomy gives 90% long-term success. With the resorption of postoperative bruises, the disappearance of varicose veins will be noticeable. Since only tiny incisions are made, there are no noticeable scars, and most patients are satisfied with the results of the procedure.
Before removing damaged vessels, a person should be carefully examined. The main diagnostic method is an ultrasound of the veins and vessels of the lower extremities. The study will assess the severity of the pathology, the location of the damaged vessels and choose the appropriate method of removal.
During diagnosis, vein marking is done. This requires duplex ultrasound scanning. An additional analysis of urine and blood, a blood test (coagulogram). To prevent complications, it is also necessary to carry out fluorography, ECG.
For phlebectomy, preliminary preparation is needed. Here the patient needs to wear compression underwear for several weeks, take prescribed medications, and also undergo a course of physiotherapeutic procedures.
Immediately before the intervention, you should shave your legs, prepare compression stockings or an elastic bandage. It is forbidden to have dinner or drink medicine the night before. You also need to make an enema, since it is forbidden to go to the toilet for several days after the operation. You should also take a shower.
When prescribing a phlebectomy of the veins of the lower extremities, the course of the operation involves the following steps:
- Crossectomy At this stage, the large saphenous vein is ligated. After that, at the place where it flows into the deep venous system, it intersects. The movement of blood through the vessels stops. This stage can be carried out both at the beginning of the operation, and at the time of its completion. It is not always needed, only when the risk of deep vein thrombosis is increased. For removal, an incision is made on the inside of the leg under the knee or in the inguinal region.
- Stripping. After crossing the vein, its complete removal is carried out. Such a procedure is radical. However, only a small part of the vessel can be removed in this way.
- Bandaging of perforating vessels. It is carried out after the subcutaneous vessels are removed. Through such veins superficial and deep vessels are connected.
- Miniflebectomy. This stage is considered final. It involves the removal of damaged vein fragments. Such a procedure can be used as an independent full intervention.
After surgery, small cosmetic stitches are applied to the incisions. After skin healing, traces of them are almost invisible. Sometimes, to connect the soft tissues, the edges of the incision are glued using special surgical adhesives.
If necessary, some of these steps can be replaced by more gentle methods of treating varicose veins: radiofrequency or laser. The standard duration of the procedure does not exceed 2 hours.
After combined phlebectomy, the postoperative period requires full compliance with the recommendations of the doctor. Its duration is 6 months. The rehabilitation period begins even while the patient is in the hospital. Seams after removal are removed after 7 days.
During the first 3-4 hours, the patient remains in bed. But he should not be passive. At this time, he performs simple exercises: turns with ankles, turns from side to side. Such exercises will help restore normal blood circulation.
A month after the intervention, the patient will need to wear compression stockings. Moreover, they must be worn around the clock. Such underwear improves blood flow.
You can wash your operated leg only after removing the sutures. This should be done very carefully. After this period, stockings may be removed at night. It is forbidden to tear off the crusts formed at the site of the seams. This area needs to be lubricated with antimicrobial agents for some time. They will help prevent infection from entering the wound surface.
Within 2-3 months after the intervention, the patient should not go to the bath, visit the sauna, take a hot bath. At the same time, compression garments should continue to be worn during the day. In the first days after phlebectomy, the patient is prescribed phlebotonics and pain medications.
In addition, the following drugs are prescribed to the patient:
- Medicines based on salicylic acid, Pentoxifylline. They normalize microcirculation.
- Preparations containing ginkgo biloba.
To accelerate recovery, multivitamin and mineral complexes will be needed. Drugs are prescribed in a course that lasts 14 days.
In addition, physiotherapeutic procedures are prescribed for the operated person. They prevent the development of inflammatory processes and trophic disorders. The patient will be helped by quartz irradiation, UHF therapy.
Surgery is a big stress for the body. Therefore, it takes time to put in order the disturbed functions. This time is called the rehabilitation or recovery period.
A person is prescribed measures to restore normal blood flow in the veins, to heal damage.
Rehabilitation is also necessary to prevent the undesirable consequences of phlebectomy, and during their development, to eliminate complications.
Like any operation, phlebectomy can be accompanied by a number of complications:
- Damage to nerve fibers leads to a violation of the sensitivity of the limbs;
- Bruises on the legs;
- Inadequate wound care, the presence of diabetes mellitus – a high risk of suppurative processes;
- The pathology of blood coagulation leads to bleeding or vice versa, venous thrombosis;
- Due to impaired blood flow, eczema on the legs may develop after phlebectomy;
- The most unpleasant possible complication after phlebectomy on the legs is pulmonary thromboembolism, which occurs due to the ingress of a blood clot from the veins of the legs into the vessels of the lungs.
An infrequent complication is a relapse of the disease.
The risk of developing undesirable consequences is increased due to incomplete rehabilitation.
The average duration of the postoperative period is 7-10 days. This period may vary depending on the course of the operation, the general condition of the patient. If there are any additional pathologies, the doctor sets an individual rehabilitation period.
The recovery period after surgery is divided into two stages – early and late. The early period begins immediately after the operation, lasts two days. Then the patient undergoes a major recovery, which can take up to three months after surgery.
During rehabilitation after phlebectomy, it is necessary:
- Create the best conditions for wound healing;
- Restore blood properties;
- Prevent the development of complications;
- Return the ability to work to a person.
To achieve these goals, the doctor makes the necessary recommendations in the postoperative period of phlebectomy.
The rehabilitation period in its significance is no less important than the operation itself. The effect of surgery is halved if a person ignores the recommendations issued to him. Relapses of the disease are mainly associated with the incorrect implementation of rehabilitation measures or their complete absence.
For recovery after surgery, a whole range of techniques is used, including nutrition and regimen, medication, and therapeutic exercises.
The early period after phlebectomy involves a strict bed rest, carried out in stationary conditions. The main goal of this stage is to avoid thromboembolic complications. You can step on the leg only after two days after surgery.
In the future, the person receives recommendations where all the necessary activities are painted.
Methods of rehabilitation after surgery
After the operation, the person should be on bed rest. Low motor activity leads to a decrease in intestinal motility.
Therefore, nutrition after phlebectomy should be easy, quickly digestible. A milk and vegetable diet with the inclusion of vegetables, fruits, herbs is recommended.
These products contain rutin and vitamin K, necessary to strengthen the walls of the veins, prevent bleeding.
Basically, recovery after phlebectomy at home is carried out, therefore hygiene procedures are of great importance. It is forbidden to wash a leg 2-3 days after operation. When crusts form on the seams, it is allowed to take a shower, after phlebectomy only warm or cool water is allowed. It is forbidden to take hot baths, rub the area of the seams with a washcloth.
The sutures are usually removed 10 days after surgery, so in the second week it is allowed to perform normal hygiene measures. Suture treatment is carried out daily, with the help of an antiseptic. Then a dry sterile dressing is applied to the wound.
The goal of drug treatment is to improve the rheological properties of blood, that is, its fluidity and viscosity. Also, drugs are prescribed to eliminate side effects after surgery:
- Venotonics – Detralex, Phlebodia. Contribute to a decrease in blood viscosity, improve the tone of the vein wall. Take a course of two weeks;
- Heparin ointment, cream Lyoton. They are indicated for the formation of hematomas or seals on the legs after surgery;
- NSAIDs (Nonsteroidal anti-inflammatory drugs) – Ibuprofen, Nimika. Assign to prevent inflammation of the veins, if the leg hurts, there is numbness of the legs, with increasing temperature. Take 3-4 days;
- Antibiotics – Ceftriaxone. They are used for the development of complications after phlebectomy – suppuration, the formation of fistulas.
The necessary medications are prescribed by the doctor, explaining how and how long to take them.
You can not prescribe or cancel medications on your own, this can lead to the development of dangerous complications.
Medicines, diet and hygiene rules
A prerequisite for recovery after phlebectomy is the wearing of compression hosiery. Bandaging the leg after a phlebectomy operation is recommended on the first day – this is the prevention of thromboembolic complications. Duration of bandaging with elastic bandages – until the seams are removed, that is, about ten days.
After that, a person is prescribed to wear compression stockings. They are also the prevention of thrombosis, help strengthen the walls of the veins, reduce the load on the legs. Stockings are selected individually, measuring the circumference of the lower leg, ankle and hip. Wearing compression hosiery continues for 2-3 months after surgery.
Performing gymnastics after phlebectomy helps to reduce pain, strengthen muscles and the wall of veins. Exercises after phlebectomy begin to be performed on the first day – flexion and extension of the legs, slow rises of the legs, turns. After the tenth day, a full range of physiotherapy exercises is prescribed:
- Jogging – 2 minutes;
- Mahi kicking left and right – 10-15 approaches;
- Squats – 10-15 times;
- Lunges forward – 10-15 times;
- Marching on the spot – 2 minutes.
The lesson ends with a light massaging.
The operation and the period after it is the time of a person’s disability. If the patient is officially employed, he is issued a sick leave. After a standard operation on 1-2 veins, without complications, the period of disability is 2 weeks. If a combined phlebectomy was performed, or the work involves harmful factors – the sick leave is extended to 30 days.
Compresses and gymnastics after surgery
Exercising is a big burden on the veins of the limbs. Immediately after surgery, any sport is prohibited. You can deal with it two months later, phlebectomy, but with some limitations. Allowed and useful are swimming, jogging, aerobics, gymnastics. Any power sports, marathon running are prohibited.
Phlebectomy is an important treatment for vein diseases. The operation is carried out according to strict indications, requires a mandatory recovery period. The frequency of complications with a full rehabilitation is significantly lower than in the absence thereof.
Thrombophlebitis, varicose veins, thrombosis were among the ten most common diseases from which humanity was dying. After all, the causes of these diseases were far from always determined by the working or living conditions of the patient.
There is an opinion of experts that the elasticity of the veins and their ability to reduce can be lost by inheritance, but not only from direct relatives.
This diet can be provoked by amateur diets depleted in fiber, improperly selected clothes, pinching the blood flow of the pelvis and even the habit of sitting leg by foot.
Considering that up to 50% of people living on Earth are affected by chronic venous diseases. And this is only official statistics, taking into account visits to doctors.
And how many those who consider fatigue in their legs, cramps and “stars” to be temporary! In developed countries, where 25% of the able-bodied population needs constant monitoring by a phlebologist, vascular surgery has become the last radical method of fighting for the health of the patient’s legs.
an example of a typical combined phlebectomy with advanced varicose veins with the removal of a large saphenous vein
Phlebectomy as a medical term appeared on the border of the 19th and 20th centuries and meant surgical intervention to eliminate severely affected varicose veins, when neither drug treatment nor compression treatment stopped the development of the disease.
What to do at home?
During recovery, you need to engage in swimming, walk more in the fresh air. The following recommendations of specialists should also be observed:
- Wear only comfortable shoes that will not tighten or crush your foot.
- Do not lift more than a kilogram.
- During rest, it is required to keep the limbs on a raised platform.
- It is forbidden for a long time to be in the same position. If a person has sedentary work, then it is worth periodically kneading both legs.
- After discharge, the patient is assigned moderate physical activity (physiotherapy exercises). It should be done regularly. Exercises are performed standing on the floor (tilting down, with the fingers touching the floor and keeping the legs straight), sitting on the floor (tilting forward with legs wide apart), kneeling (walking on your knees back and forth with your hands apart ) You can also perform circular leg movements, standing on toes.
- Stop smoking and drinking alcohol.
- Eat rationally and fully. The diet involves the use of those products that thin the blood, strengthen the vascular wall. There should be no fat in the diet. It is required to increase the number of fruits and vegetables.
If itching appears in the scar area, then it should be treated with iodine. Self-massage will help to recover faster. It prevents the appearance of blood clots, stagnation. Any movements must be performed carefully. Massage should be prescribed by a doctor.
Varicose veins are a dangerous disease. With untimely treatment, it can provoke tissue death and loss of limbs. The operation to remove the affected vessels is a radical method of combating pathology, but it allows you to restore normal life.
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