The last century or why a patient should not undergo a conventional operation for varicose veins

Features of performing standard operations for varicose veins

So, let's dwell on the features and details of ordinary or standard operations for varicose veins.

One of the oldest diseases of mankind, as well as one of the most common, varicose disease has always attracted the attention of various specialists, many methods of its treatment have been developed. Approaches to treatment have changed significantly over time and in different countries. The classic vein removal operation was developed back in the 19th century and has undergone numerous modifications and modernizations. But these interventions were very traumatic, accompanied by multiple complications and gave an unsatisfactory cosmetic result. Only at the end of the last century, common principles of operative treatment of this disease were more or less developed, which became the standard for a long time. Interventions on veins require great experience, patience and painstaking work of the surgeon.

Standard operation to remove veins (venectomy, phlebectomy) is performed exclusively in hospital conditions. You will have to stay in the hospital for 2-10 days. As a standard, the operation is performed under spinal anesthesia (SMA, when the patient is conscious, but there is no sensation in the legs). Such anesthesia has certain contraindications and sharp limitations for use in elderly patients and patients with osteochondrosis, and also immobilizes a person until the next day. This is a significant negative point, because after any operation on the vessels, the patient should be as active as possible as early as possible in order to prevent postoperative complications. SMA does not allow this.

Classic veneectomy consists in removing all affected veins from separate skin incisions throughout the leg. Therefore, one of its most negative aspects is surgical trauma, that is, pronounced and massive tissue damage due to the need to perform many incisions, as well as sufficiently rough manipulations to find and remove the affected veins, which are located deep enough. This leads to a pronounced and long-lasting pain syndrome, which depends on the massiveness of the vein damage and persists for 5-7 days after the operation. In addition, there is always a significant decrease in physical activity. The patient cannot fully load the leg for 7-10 days, limps. After such an operation, daily bandages are necessary, which are quite painful and unpleasant. You can observe multiple, sometimes extensive, hematomas, hemorrhages in the skin and bruises, significant and persistent swelling of the leg. Very often, patients complain of leg numbness, a decrease in skin sensitivity in some places. The presence of many incisions, on the one hand, causes a high risk of infection, on the other hand, the prescription of certain medications. The rehabilitation period after such an operation is 2-3 months, during which you will have to follow the regime of elastic compression. The period of incapacity for work, as a rule, is about a month. A significant negative of standard veneectomy is the lack of cosmetic effect of the operation due to the large number of incisions and their significant size. The healing of such wounds is long, the formation of a postoperative scar lasts up to a year. Most patients report dissatisfaction with the postoperative period due to long-term distraction from work, inability to lead a normal lifestyle and do usual household chores.

A modern modification of the standard venectomy can be considered an operation in a gentler version. In such an operation, trunks of main subcutaneous veins are removed using special tools - probes (the operation is called stripping), and varicose veins are removed from skin punctures using phlebological hooks. This operation is called a miniphlebectomy and is more gentle than removing veins through incisions. This intervention can be performed under intravenous anesthesia, however, in accordance with modern requirements, modern drugs should be used, after the use of which there are no pronounced side effects and complications typical for standard intravenous anesthesia with the use of narcotic analgesics. When performed professionally, such anesthesia allows patients to be quickly activated. As for the removal of veins by zones, it is necessary to note the need to perform incisions, especially inguinal. Among the possible complications are multiple and pronounced hematomas due to the separation of many tributaries, damage to lymphatic vessels and, as a result, frequent and persistent swelling, as well as frequent nerve damage, which sharply reduce the quality of life, and sometimes the ability to work. Fragmentation of pieces of the trunk of the saphenous vein during removal with a probe is also noted, which subsequently leads to relapse. This situation most often occurs when the diameter of the veins is large enough, which is typical for our patients. Therefore, a specialist who performs such an intervention must have good training and extensive professional experience.

Severe technical limitations arise when performing standard operations in the advanced stages of the disease, in the presence of pronounced skin changes, because when making cuts on the changed skin, they do not heal and lead to the formation of trophic ulcers. In our country, this is very relevant for patients with varicose veins, because patients seek help already in advanced stages. In such cases, due to the impossibility of making incisions, surgeons often do not perform the full scope of the operation, that is, not all affected veins are removed. Then the effect of the operation is positive, but usually short-lived. Thus, the most characteristic changes and violations of venous blood circulation exist precisely in the area of ​​trophic changes of the skin, where it is necessary to make major surgical efforts, but it is impossible to perform surgical manipulations due to the extremely high probability of developing complications. Varicose veins left in this area determine the persistence of disease manifestations and complaints, as well as the progression of trophic disorders of the skin. In addition, in various hospitals, such patients are often refused help, because surgeons are afraid to take responsibility, knowing the high probability of developing complications.

In addition, such operations have significant limitations in some categories of patients. The procedure may be refused to patients of older age groups who fall into the risk group due to serious concomitant diseases. Also, the operation is contraindicated for pregnant women and nursing mothers, in whom the operation can be performed only if thrombophlebitis develops. With a certain apprehension, operations are performed on people with a lot of excess weight. In the presence of accompanying inflammatory or allergic skin lesions, initial treatment of the skin disease is necessary, and then surgery. The treatment of advanced stages of the disease with the presence of trophic ulcers is particularly difficult. In such situations, long-term preparation of the patient, a course of conservative therapy and remediation of ulcers are required.

Thus, standard operations are traumatic, inconvenient in terms of a long period of recovery and rehabilitation, they ""tear"" the patient out of the usual mode of life and work, have many limitations, unpleasant consequences and complications. These operations do not meet the expectations and wishes of patients, and also do not meet the requirements of modern vein surgery.

Standard surgical interventions can currently be characterized by one phrase: ""Last century"".

Thus, all the specified features and unattractive aspects of the standard surgical treatment of varicose veins for many years led to patient dissatisfaction and, as a result, reluctance to seek help from specialists in time, which in turn led to a large number of advanced forms of the disease.

At the same time, this forced specialists to look for new, modern, more acceptable types of interventions in the treatment of this common vascular pathology.

There has been a ""revolution"" in the surgical treatment of varicose veins, treatment methods have been developed that are radically different from the standard ones and that fully meet the expectations of patients. Today, such operations are the ""gold standard"" of treatment all over the world. But about this - in the next article.

To receive information about treatment and make an appointment, call the contact center of MM ""Dobrobut"": 044 495 2 888 or 097 495 2 888.

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