From this article you will learn: what varicose veins in the legs are, what are the main external signs of the pathology. Causes, symptoms and possible complications. Methods of treating the disease.
Varicose veins in the legs are called chronic vascular pathology, as a result of which deformations (lengthening, dilatation) of blood vessels and insufficiency of intravascular valves develop.
Click on photo to enlarge
What happens during pathology? Normal blood supply to the extremities is ensured by a whole system of blood vessels (deep and superficial). Blood flows from the heart to the extremities without difficulty (from top to bottom), the reverse flow (from bottom to top) is ensured by the contraction of the heart and a system of venous valves that “lock” the fluid between contractions, preventing it from moving in the opposite direction.
For various reasons (hereditary predisposition, excess weight during pregnancy, hormonal imbalance), the venous walls are stretched, deformed, lose elasticity, and the lumen of the vessel in this place increases. This entails insufficient closure of nearby valves, impaired blood flow, and blood stagnation. Due to stagnation, the deformation becomes more and more aggravated over time, and a varicose node, a loop, or a bend in the superficial veins of the leg is formed.
In the initial stages, the pathology is asymptomatic or reveals itself by the appearance of a so-called reticular pattern (in the form of a thin mesh), blue-violet spider veins, clearly visible through the skin. With such manifestations, the disease is considered harmless, does not worsen the prognosis, and does not complicate the patient’s life in any way.
Late stages of varicose veins in the legs are dangerous due to their complications. Due to impaired permeability of the vascular wall and the appearance of obstacles in the path of blood flow, blood clots begin to form in damaged veins, which eventually close the lumen of the vessel. Thrombophlebitis develops (inflammation of a vessel blocked by a thrombus), the blood supply to adjacent tissues is disrupted, which leads to necrosis of skin areas and the formation of trophic ulcers. At this stage, the disease greatly limits the patient’s motor activity and temporarily worsens the quality of life (trophic ulcers heal in about 3 months).
Varicose veins cannot be cured completely. Surgical methods can achieve a long-term, sustainable effect and the disappearance of superficial deformed veins, but over time the disease may reappear (in 80% of cases this happens).
Patients with varicose veins in the legs are treated and observed by a phlebologist, and angiosurgeons operate.
Varicose veins appear not only due to the weakness of the vascular walls and insufficiency of the venous valves. The third active link in the system of blood movement from bottom to top (from the limbs to the heart) is the muscle contractions of the legs and thighs, or the muscle pump.
Normally, these contractions lightly compress the vessels, allowing blood to move through the vessels from the lower leg and thigh upward into the pelvis.
When muscles weaken or relax (physical inactivity, sedentary lifestyle), the muscle pump does not work effectively enough, the flow of blood into the pelvis slows down, the pressure in the deep vessels increases, and under its influence, blood enters the superficial venous system.
In combination with valve insufficiency and weakness of the vascular walls, the weakening of the muscle pump creates favorable conditions for the development of varicose veins.
The main causes of varicose veins in the legs:
The following diseases and conditions contribute to weakening of the vascular wall and valve insufficiency:
Factors that increase the likelihood of varicose veins are age (in 60% the disease appears after 45 years) and gender (in men 2 times less often than in women).
Varicose veins on the legs have several characteristic external signs.
Varicose veins, or varicose veins, is a disease that is characterized by weakness of the valves in the veins and dysfunction of the vascular wall, as well as stagnation of blood in the veins of the lower extremities. This pathology is fraught not only with a violation of trophism, or tissue nutrition, which can result in difficult and long-healing trophic ulcers, but it is also dangerous because stagnant blood thickens and blood clots form in it, which can be carried by the blood flow throughout the body. In addition, if thrombotic deposits form inside the vascular wall (phlebothrombosis), it may become infected with the development of serious diseases - thrombophlebitis.
The operation for varicose veins of the lower extremities is radical and consists of removing the affected saphenous veins of the lower extremities (phlebectomy) or sclerosing the deep veins of the leg and thigh.
Traditionally, phlebectomy (crossectomy) is performed using the Babcock method and consists of inserting a probe into the lumen of the vein, followed by pulling the vein out completely along its length through an incision in the skin. The incision is closed at the end of the operation with a cosmetic suture.
Mini-phlebectomy is used to remove very short sections of a vein; the operation does not involve ligation of the veins. There are no incisions in the skin, and a piece of the vein is removed through a thin puncture in the skin that does not require stitches.
left - phlebectomy, right - mini-phlebectomy
In case of a small area affected by varicose veins, it is possible to perform a more gentle technique - stripping. This is pulling out only the varicose node using a thin hook. Traction is carried out through two incisions in the skin followed by suturing. A variation of this technique is cryostripping - “freezing” a vein to a cryoprobe using low temperatures, the destructured node is also pulled out.
phlebectomy using stripping method
Sclerosis of a vein is the introduction of a sclerosant into its lumen - a substance that “glues” the walls of the vein together, but the vein remains deep under the skin, not performing its function. The blood flow through the vein stops and goes through collateral vessels, without disturbing the outflow of venous blood from the lower limb. Sclerosis of the vein is carried out under ultrasound control.
Laser endovascular coagulation of varicose veins is the latest method in phlebology and consists of introducing a thin probe into the lumen of the vein with laser radiation, which has a cauterizing effect on the vein walls.
The method of radiofrequency obliteration of veins is also a more modern treatment of varicose veins, but not all medical institutions are equipped with the appropriate equipment. The technique consists of a “cauterizing” effect on the vascular wall of high-frequency radio waves.
Not all patients are eligible for surgery, but in some cases it is still necessary, since it is better to remove the source of potential inflammation and blood clots than to expect complications. Conditions requiring surgery include the following:
Even minimal vascular intervention is contraindicated in the following cases:
In any case, all indications and contraindications are determined by a phlebologist or surgeon during an in-person examination of the patient.
The use of a particular treatment method is assessed only by a doctor, based on the extent of the process.
Of course, for small nodes, less invasive methods are preferable, such as mini-phlebectomy, short stripping, laser obliteration and sclerotherapy, due to the fact that they are less traumatic and require virtually no rehabilitation period. At the same time, with a large extent of varicose veins, preference is given to traditional phlebectomy, which not only requires spinal anesthesia, but is also a rather traumatic operation that leaves an aesthetic defect in the form of postoperative scars on the legs.
In this regard, you should not postpone a visit to the doctor if you have the initial stage of varicose veins, and even more so, you should not refuse a less traumatic operation if the doctor saw the need for it during the examination.
The decision on the need for surgical treatment is made only after consultation with a phlebologist or vascular surgeon. However, at an early stage, when the patient is only concerned about aesthetic discomfort in the form of varicose veins, as well as slight swelling of the feet at the end of the day, one can try to stop further progression of the process with the help of compression hosiery and venotonic drugs.
In cases where there is pain in the extremities and there is a high risk of complications, it is not recommended to delay the operation.
Before scheduling vein removal surgery, the patient should undergo a number of necessary examinations. These include consultation with a surgeon or phlebologist, as well as ultrasound of the veins of the lower extremities. If the patient is indicated for vein removal, he is examined on an outpatient basis, in particular, general and biochemical blood tests, a blood clotting test (INR, APTT, etc.), ECG and chest x-ray should be performed.
On the day prescribed by the doctor, the patient must appear at a medical institution that practices phlebectomy. You can shave the hair on the lower leg, thigh and groin area on the side of the affected limb yourself. The day before, you should limit yourself to a light dinner; you must come to the operation on an empty stomach. The patient must warn the operating doctor and anesthesiologist about intolerance to previously taken medications.
After the patient arrives at the clinic and undergoes an initial examination by the operating surgeon and anesthesiologist, the issue of anesthesia is decided. In the case of a regular phlebectomy, spinal anesthesia is used; for mini-operations, local anesthesia is used by injecting the skin with solutions of novocaine or lidocaine.
After the onset of anesthesia, the surgeon determines the location of the vein using Doppler ultrasound (USD). Next, a probe is inserted into the lumen of the vein through an incision in the skin and the main stage of the operation is carried out - intersection and ligation of sections of the vein during phlebectomy, stretching of the vein during mini-phlebectomy (only through punctures, not through an incision) or laser exposure to the walls of the vessel. The main stage takes from half an hour to two to three hours, depending on the volume of the operation.
After the main stage, the incisions on the skin are sutured, a pressure aseptic bandage is applied to the wound, and the patient is escorted to the ward, where he will be under observation from several hours to a day. In the ward, the patient puts on compression garments, which are not removed for three days.
A day later, the patient goes home. If the surgeon prescribes dressings, the patient visits them daily or every other day. The sutures are removed seven days after the operation, and two months later a control ultrasound examination of the veins of the lower extremities is performed.
The surgical technique, honed to perfection over decades, reduces the risk of postoperative complications to a minimum. However, in extremely rare cases (less than 1%), the development of such adverse consequences as:
The phlebectomy operation can be performed on an outpatient basis in a day hospital in the surgical department of a polyclinic or in the vascular surgery department of a 24-hour hospital. In most cases, operations are performed free of charge if indicated, but if the patient wishes, they can be performed for paid services or in private clinics.
The cost of operations varies, ranging from 20 thousand rubles for sclerosis of veins on one limb to 30 thousand rubles for mini-phlebectomy and 45 thousand rubles for phlebectomy with a one-day hospital stay. In some private clinics, services such as phlebectomy, a one-day stay in a 24-hour hospital, dressings and suture removal, as well as follow-up for a month can cost about one hundred thousand rubles.
After surgery, aching pain in the operated limb and minor swelling are possible for several days. To relieve unpleasant symptoms, the doctor prescribes non-steroidal drugs - ketorol, nise, etc. Immediately after the operation, the patient should start wearing compression garments and perform physical therapy exercises prescribed by the doctor.
On the second day after surgery, the patient is allowed to walk a little. After a week or two, you should ensure slow walking for a couple of hours a day.
Regarding lifestyle corrections, the following provisions are relevant:
In conclusion, I would like to note that, judging by the reviews, vein removal operations are tolerated quite favorably, and serious complications practically do not arise. Moreover, the risk of life-threatening complications of varicose veins (thromboembolism, for example) is sharply reduced after removal of the dilated vein. Currently, operations to amputate a limb due to severe inflammation and even gangrene due to thrombophlebitis (especially against the background of diabetes) are not uncommon, so it is better to contact a surgeon at an early stage and not refuse to remove veins if the need arises. Thus, you will preserve not only healthy limbs, but also the health of the entire body as a whole.
In modern methods of treating varicose veins of the legs, radical surgery is recognized as the “gold standard” in the fight against this disease. Operations are carried out in different ways depending on the nature and extent of the disease, the individual characteristics of the patient and many other factors; usually patients leave good reviews of the results of surgical procedures and do not have any special complaints about the condition during the rehabilitation period. However, in some cases, side effects and negative reactions of the body to such operations are still possible, and there is also a risk that a recurrence of varicose veins will occur. The doctor must warn the patient about what consequences can be expected before he decides to consent to surgery. Varicose veins after surgery: what consequences to expect?
Most often, the patient’s condition after surgery for varicose veins of the legs depends on the following factors:
Typically, rehabilitation after surgery to remove the veins of the lower extremities requires prescribing the patient a course of medications, and he is also recommended certain procedures and rules of behavior . Behavioral and treatment tactics are determined based on a study of the condition of blood vessels with varicose veins. So, if the operation was performed by sclerosing the veins in the legs or using a laser, the patient can go home an hour after the procedure; all that is required is to immediately put on compression garments immediately after the procedure or tightly bandage the operated limb to avoid complications; elastic bandages are used for this. Sick leave after minimally invasive operations for varicose veins and during rehabilitation is not required; the patient can go to work the next day.
If an operation was performed to remove the veins of the lower extremities and epidural anesthesia was used, then the patient must spend several days in the clinic; the doctor decides how long the rehabilitation after treatment of varicose veins will take. After the anesthesia wears off, the patient needs to spend a few more hours in a supine position, but light exercises for the legs are recommended, during which flexion and extension movements can be done. Such exercises for the legs will help restore normal blood flow in the veins of the lower extremities. Also, immediately after phlebectomy, compression garments are put on the operated lower limb or elastic bandages are used, which are not recommended to be removed from the legs, even at night. How to properly use bandages for legs with varicose veins, you can look at the photo on the Internet.
As soon as you are allowed to get out of bed, you need to walk as much as possible; physical activity is the best rehabilitation and prevention of complications in the postoperative period. From the very first days after surgery for varicose veins, it is necessary to do a massage and a special daily complex of therapeutic exercises; photos of such a complex are easy to find on the Internet. Medications are prescribed depending on the presence of complications with varicose veins; these can be painkillers, anti-inflammatory drugs and antiplatelet drugs. How many days to take them depends on the patient’s condition.
When the postoperative incision on the legs heals, this occurs approximately a week after the operation, the patient has the stitches removed, but the compression stockings should be worn for another 2-3 months. After phlebectomy of the legs for varicose veins, a sick leave certificate is issued for 7-10 days.
The main side effects after various types of operations for varicose veins of the lower extremities are associated with pain after them, however, in the case of sclerotherapy or laser removal of leg veins, pain may be almost completely absent. Some discomfort may occur during laser surgery in the groin area, but they usually pass quickly.
Severe pain in the legs is usually a consequence of phlebectomy, when the vein affected by varicose veins is completely removed; a person may experience pain for a fairly long period after surgery and during rehabilitation. In addition, in those places where there were varicose veins in the legs, hematomas may form after surgery. You can see what postoperative hematomas on the legs look like in photos in medical publications or on the Internet.
For several days after surgery for varicose veins, bleeding from the wounds may be observed, this is due to the influx of venous blood. A person may have a fever; if it persists for more than two days, it is necessary to prescribe a course of antibacterial and anti-inflammatory drugs.
In some cases, lumps may form under the skin on the legs due to the accumulation of blood. This is a normal phenomenon in the postoperative period; usually they do not cause any discomfort other than an unaesthetic appearance. However, if the seals begin to turn red, this may indicate that an inflammatory process has begun, in which case urgent antibacterial therapy is required. How many days you need to take antibiotics depends on the patient’s condition.
Another unpleasant consequence of phlebectomy is the possible appearance of scars on the legs at the site of the incisions, which usually quickly resolve during the rehabilitation period. However, in some patients, these scars turn into keloids, which can be treated with various ointments and gels for scar resorption, and in difficult cases, with laser.
To prevent edema during the period after surgery, patients are recommended to follow a strict diet that excludes salty and spicy foods, as well as a special drinking regime.
Regardless of whether vein sclerosis, laser treatment or phlebectomy was performed, there is always a risk that a recurrence of varicose veins of the lower extremities will occur. To prevent this and minimize the consequences of surgery, it is necessary to follow certain medical recommendations:
Despite the fact that all methods of radical treatment of varicose veins of the legs are well developed, have good reviews and do not pose any particular difficulties for surgeons, they can cause some complications and side effects. Modern techniques such as laser treatment or sclerotherapy do not guarantee that varicose veins will not recur. To minimize risks during the rehabilitation period, you must strictly follow all medical recommendations, which include diet and physical activity, as well as compression garments or bandages to prevent subsequent varicose veins.
Varicose veins of the lower extremities are a complex and long-lasting pathology, leading to heaviness and pain in the extremities. Drug treatments do not always bring the expected results, so you have to resort to surgical intervention. Surgery for varicose veins in the legs is performed according to indications. Radical measures are especially important in the presence of trophic ulcers, which can provoke extremely serious consequences, including the addition of infection.
Varicose veins of the lower extremities are a complex and long-lasting pathology, leading to heaviness and pain in the extremities.
Removal of varicose veins on the legs is carried out only in the presence of an advanced form of the disease. Indications:
The operation is also performed for aesthetic reasons, when a woman does not like the appearance of her legs.
Surgical treatment for dilation of the lumen of blood vessels is carried out in different ways.
The choice of method depends on the condition of the body, the stage of pathology and other concomitant diseases that may become contraindications.
For example, an incorrectly selected treatment method can provoke dangerous complications in diabetes mellitus, acute infections and immunodeficiency conditions.
Sclerotherapy involves inserting a needle into the lumen of a vessel, through which a drug is administered that can glue the venous walls together. This manipulation is performed using local anesthesia. After the procedure, the vessels are sclerosed, and the flow of blood through them stops.
Immediately after the operation, wearing compression bandages is recommended to help maintain the result.
Phlebectomy is an operation aimed at removing pathologically altered vessels. For this purpose, several methods are used:
Phlebectomy is an operation aimed at removing pathologically altered vessels.
Before the intervention begins, the doctor performs an ultrasound of the veins. Ultrasound examination helps to differentiate the affected area and healthy areas.
Laser coagulation is the most effective method. The procedure is safe and minimally invasive. Through a small puncture, a thin wire is inserted into the diseased vessel, which emits laser waves of the required frequency. In this case, heating occurs in the area of influence.
As a result, the walls of the veins are welded together, which eliminates the problem forever. The use of laser techniques gives the lowest number of relapses.
The operation is performed even in severe cases and is ahead of surgical removal in the quality and quantity of favorable outcomes.
Sclerosis allows you to fill the vessel with a therapeutic substance, which prevents blood flow and allows you to reduce the diameter of the pathological area. In this case, 2 drugs are used - sclerosant and foam. The first medicinal substance glues the walls of the veins, and the second simply fills the enlarged area, leading to its blockage.
Both types of drugs are administered through a small puncture. The exact location of the problem area can be detected using duplex scanning.
Sclerosis allows you to fill the vessel with a therapeutic substance, which prevents blood flow and allows you to reduce the diameter of the pathological area.
Stripping is carried out using a miniature probe, which is inserted through a small incision and glues the pathological area of the vessel, then is pulled to the surface and removed. Another type of operation is cryostripping. During the intervention, liquid nitrogen is injected into the vein, which leads to destruction of the affected area and makes it non-functional.
The process takes from 40 minutes. It is performed both under general anesthesia and using local anesthesia.
Preparation for surgery includes compliance with mandatory rules, which include:
Before surgery, you must inform your doctor if you have an allergic reaction to any drug.
Depending on the nature of the intervention, a different surgical technique is used. Sclerotherapy involves the following steps:
During sclerotherapy, a puncture is made using a long needle and a drug is injected that glues the walls of the blood vessels.
Phlebectomy involves a more invasive operation. If the volume of pathologically altered tissue is large, then a technique is used that involves 2-3 incisions. If there is a small fragment, use a small hook. The operation can be performed under general and local anesthesia.
First of all, antiseptic treatment of the limb is carried out. After this, the affected section of the vein is removed and removed, suturing if necessary. Laser coagulation is also performed under general or local anesthesia. After anesthesia, the limb is treated with an antiseptic (usually Chlorhexidine) and a thin wire that delivers a laser is slowly advanced through a miniature puncture. Reaching the problem area, the light guide melts the walls of the vessel under the influence of heat. As a result, the vessel becomes clogged and decreases in diameter.
Sclerotherapy is similar to the sclerotherapy procedure. But in the first case, different substances are used depending on the nature of the problem. The vein-clogging medication is also administered using a needle and local anesthesia. The doctor controls the manipulation by observing the process on the monitor screen. The operation takes no more than 30-40 minutes.
Stripping involves a small cut or puncture. It all depends on the scale of the damage.
Stripping involves a small cut or puncture. It all depends on the scale of the damage. The probe advances to the pathological area, solders it, then the doctor pulls up the instrument and pulls the affected area of the vessel to the surface of the skin. The modified section is deleted. If necessary, stitches are applied.
Removal of varicose veins is carried out only by an experienced surgeon under the control of the process using an ultrasound machine.
Rehabilitation lasts 6 months. During this time, it is prohibited to lift things that weigh more than 8 kg.
In the first month, it is necessary to wear compression hosiery to regulate the functioning of the venous system and to prevent complications.
As you recover, physical therapy, swimming, active walking, etc. are indicated. It is necessary to monitor your body weight.
Possible postoperative complications: relapse, hematomas, thromboembolism, cicatricial skin changes with small nodes. The most common consequence is pain, which may persist for 1-2 months.
It is impossible to feel changes immediately after surgery. The fact is that heaviness may be present due to swelling of the operated limb. This symptom disappears after 2 weeks. A month later, the heaviness completely disappears along with the pain.
The cost of the operation depends on the type of intervention. For sclerotherapy you will need from 1500 rubles. Phlebectomy costs about 60 thousand rubles. You will have to spend from 29 thousand rubles on laser coagulation. Sclerotherapy will cost 5 thousand rubles. You need to spend about 18 thousand rubles on stripping. The price may vary depending on the complexity of the case.
Victoria, 40 years old, Nizhny Novgorod
I had to resort to sclerotherapy. Before the operation I was a little scared. But the manipulation itself took no more than 30 minutes. Now the legs look much more aesthetically pleasing, the pain has gone away, and the heaviness has disappeared. I didn’t regret that I overcame myself and came to the doctor.
Tatyana, 36 years old, Samara
Terrible veins spoiled the appearance of my legs. I went to the clinic. Laser coagulation was recommended. The operation was performed under local anesthesia. I'm happy with the result, because now I'm not ashamed to walk without tights.
Veronica, 43 years old, Moscow
The large vessels protruding under the skin were simply driving me crazy. It was embarrassing and uncomfortable to appear on the beach or in a short skirt. After stripping the veins, I forgot what wild pain in the limbs was. The shins look much more aesthetically pleasing than before the surgery.