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

18 November 2020

Varicose veins are a disease characterized by changes in the state of the leg veins with impaired blood circulation. When the shape is neglected, the vessels swell, which leads to swelling and soreness of the extremities (under load), as well as aesthetic discomfort. Surgical removal of damaged veins is effective for this stage.

Indications for varicose vein surgery

Surgery for varicose veins can only be performed if there are indications for the removal of blood vessels:

varicose veins affected most of the vein;
severe pain and swelling in the legs during physical exertion, which interfere with normal lifestyle;
the formation of open wounds and ulcers against the background of the development of the disease. It is dangerous to attach a secondary infection;
violation of blood permeability through the vessels, often accompanied by convulsions;
marked development of vascular necrosis;
pathological change in the veins, accompanied by their expansion and protrusion. The change is dangerous for trauma to the vessels and also causes aesthetic discomfort;
blood clots in the veins.

Surgical intervention is allowed only with advanced forms of varicose veins and in the absence of dynamics with conservative treatment.

Absolute and relative contraindications to surgery

Surgery to remove leg veins for varicose veins is performed not only if there are indications, but also in the absence of contraindications:

Absolute bans on the operation	List of related prohibitions
Stable hypertension	Presence of infectious diseases
Regular jumps in blood pressure	Dermatological disorders affecting the skin of the legs
Chronic heart disease	Inflammatory processes in the body, including blood vessels
Advanced age after 70	The recovery period after other surgeries
Presence of tumors	Chemotherapy
Diabetes mellitus and severe asthma	Severe soft tissue injury from trauma
Thinning and fragility of blood vessels	Hepatic and renal disorders in the acute phase
Patients with limited leg mobility (paralysis) or bedridden patients	Blood clotting disorder or anemia
Varicose veins in the last stage	Taking hormones, antibiotics or other aggressive drugs
Complicated leg fractures (with damage to blood vessels and nerve endings)	Being overweight
Allergic reaction to drugs used during surgery	Patient refusal from surgery

When carrying a child, there may also be a violation of the condition of the leg veins. More often, the pathology is eliminated by itself after childbirth. In the presence of contraindications, surgical intervention is dangerous with a worsening of the patient's condition, and even with a fatal outcome.

Phlebectomy

Phlebectomy is a surgical procedure to remove damaged veins and restore normal blood flow to the deep veins.

Anatomical significance, large surgery technique to remove veins

The circulatory system of the legs consists of a deep vein and many branches of the superficial veins, which affect varicose veins. Changes in vascular activity develop due to the dysfunction of the valves. During the normal functioning of the vessels, the valves are closed, which ensures blood flow in only one direction.

In the veins of those affected by varicose veins, the valves do not close, as a result, the blood can move in both directions, which leads to impaired blood flow, with stagnation of blood and protrusion of the veins.

To restore the blood supply to the limb, it is necessary to eliminate the affected vein (with reverse blood flow), that is, to perform phlebectomy. Before the operation, the patient undergoes preparation (carrying out tests, scanning the state of the veins, determining the general condition of the patient).

If there are no contraindications, the specialists perform a surgical procedure, which consists of the following stages:

Access to the affected vessel is provided through a small incision (in the groin or popliteal, depending on the location of the vein). Subsequently, the damaged vessel is ligated by a deep vein to block blood flow.
An incision is made near the varicose vein. With the use of a probe, the vessel is separated from muscle tissue, the lymphatic system and the small capillaries. Through a tube, or using a hook, the damaged vein is removed.
The capillaries are treated to prevent bleeding.
If there are damaged capillaries forming spider veins, they are removed.
Cosmetic stitches, a disinfectant dressing and an elastic bandage are applied at the end.

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

Level of efficiency

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

Rehabilitation

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

After phlebectomy, you need to:

suture care for 7-14 days in hospital;
wearing compression stockings or elastic bandages for 30 days is done around the clock;
after 30 days, for another 3 months, wearing special underwear during the day
procedures in water with washing of the feet (where the operation was performed) are possible only after removing the sutures;
saunas, baths and hot baths are prohibited during the recovery period;
Painkillers after surgery are prescribed by a doctor. Self-selection is prohibited;
additional medications are taken to prevent blood clots;
taking drugs to strengthen the walls of blood vessels (vitamins E and C);
it is forbidden to remain in an upright / sitting position for a long time, wearing high-heeled shoes and tight underwear;
during the rest period in the supine position, the legs should be above the level of the body. Promotes the outflow of excess blood and reduces swelling;
timely and gradually introduce physical activity to normalize blood flow (discussed with the doctor);
massages and physiotherapy are performed with the permission of the treating specialist;
refusal of alcoholic beverages and nicotine. Alcohol causes vasodilation, and tobacco, on the contrary, leads to their narrowing. These effects reduce the efficiency of the operation;
if you are overweight, a low calorie diet is prescribed.

If the rules are followed, complete restoration of limb function is possible in 6 months.

Intravenous coagulation using a laser

An operation to remove veins in the legs with varicose veins using a laser is performed when direct vessels with a diameter of at least 0. 02 cm and with a small number of capillaries are affected. The procedure consists in the action of light waves on damaged vessels with their subsequent welding and destruction.

Equipment

Laser coagulation of the veins can be performed with any of the 3 types of optical fibers:

Type of optical fiber	Brief on actions
Fine (classic)	This light guide produces a radiation of the beam from the end, ie the vessel is sealed in front of it. The disadvantage is the formation of hematomas and a painful feeling of tension in the veins. Maximum diameter of the vein 0, 1 cm.
Radial (with painless radial elf light guide)	The light waves of the fiber form a circle that surrounds a vein in diameter. This allows the treatment of veins of any size. And the risk of hematoma formation and the development of swelling is also minimized.
Of 3 types of radial fibers	Lasers with two light rings are used to eliminate varicose veins. The first prepares the vein for the procedure (eliminating excess fluid), the second circle welds the walls. For treatment, light guides are produced for fine and short veins and for large vessels.

The choice of equipment is made not only by the patient, but also by the treatment specialist for the state of the vessels.

Which veins can be removed with the EVLK method

Before choosing EVLK, a phlebologist (a specialist who examines the veins and eliminates varicose veins) determines the characteristics of the damaged vessels. They must be straight and at least 2 mm in diameter.

Consequently, laser therapy can be applied to the following groups of vessels:

small and large saphenous veins;
accessory saphenous veins, which are located at least 5 mm from the surface of the epidermis;
vessels that connect the deep veins with the superficial ones.

For other veins, therapy is only possible with phlebectomy.

Efficiency

The removal of veins with the EVLK method is possible with 3 types of optical fibers. Depending on the type of equipment, the effectiveness of the treatment changes. When performing an operation using a final optical guide, the effectiveness of the therapy is 94-96%. Operation with radial light guides allows you to achieve 100% results in the elimination of varicose veins on the legs.

Preparation and implementation phases

When choosing to remove varicose veins using EVLK, the patient must undergo the following training:

Cancellation of hormonal drugs (if taken). Since they can cause the development of thrombosis;
one day before surgery, it is necessary to take blood thinners;
screening of damaged veins to determine the extent of their damage;
do tests to rule out the presence of a hidden infection or inflammatory processes in the body. Blood clotting is also determined;
the procedure site is thoroughly washed and shaved (without the use of cosmetics, only antibacterial soap is allowed).

Before the start of the operation, the boundaries of the damaged vessels, the site of insertion of the laser / fiber and the site of branched capillaries are marked. These marks allow you to weld the beginning and end of the vein, as well as the outlets of the capillaries. The process is carried out under the control of an ultrasound machine.

EVLK is produced in several stages:

Catheter insertion through a small puncture (catheter insertion site is anesthetized with local anesthesia) in the marked area. The light guide will move along it.
Insertion of the light guide into the catheter and its subsequent advancement into the damaged area. It is performed under ultrasound control on a monitor.
Injection of anesthetic to numb the vein and adjacent tissues.
Advancement of the "active" light guide through the damaged vein, followed by a delay in the branch points of the capillaries (to seal the outlets and prevent bleeding).
Laser removal with antiseptic treatment of the puncture site and application of an elastic bandage (or using compression stockings).

After completing the procedure, the patient can leave the hospital immediately.

Characteristics of rehabilitation

To restore the functioning of the injured limb and prevent the development of complications, it is necessary to familiarize yourself with the nuances of rehabilitation after EVLK.

They are:

after the completion of the procedure, it is recommended to walk the operated leg in the medical facility for an hour;
for 2-3 days, ultrasound control of the treated vein is performed;
for 5 days, it is necessary to wear specialized undergarments all day (the type of socks is discussed with the specialist present before the operation). Also, within 45-60 days, the garments must be used during the day;
performs the daily kneading of the legs by walking every day for 60 minutes;
avoid overloading the legs (prolonged sitting or standing position) and visiting saunas or taking hot baths.

If removal of varicose veins is still required, the procedures can be carried out no earlier than 7 days.

The advantages of each method

Surgery to remove leg veins for varicose veins, depending on the type of surgery, has the following advantages:

Phlebectomy	EVLK
The incisions for the operation are approximately 5 mm, so almost no scars remain	No pain during the procedure (using local anesthesia). General anesthesia is not required
Painless, as the operation is performed under local anesthesia. Local anesthesia is used for miniflebectomy.	EVLK is performed under ultrasound control. The result is high precision and efficiency.
Low cost	Hematomas and pain at the surgery site are rare or mild.
Rapid restoration of skin tone (absence of stars and violet-cyanotic shades of the epidermis)	The operation requires 1 puncture, so no stitches and scars are required
Short recovery period of approximately 30 days	Up to 5 day recovery period
Effective for all forms of varicose veins	After surgery, the patient can leave the clinic within 1 hour.
Return to normal life is possible within 24 hours.
EVLK can be performed when the integrity of the epidermis is compromised by ulcers.
The duration of surgery does not exceed 40 minutes.
EVLK can be performed on both legs in one day. A second operation is allowed on one leg after 7 days.

The risk of infection during the procedure is minimal, as the incision / puncture is small.

Complications after surgical and laser vein surgery

There is a risk of complications after removal of the vein by surgery or laser. Negative reactions may occur due to the low qualifications of a specialist or due to the violation of the rules during the rehabilitation period. Possible complications of phlebectomy and intravenous coagulation.

Vein removal methods	Minor complications from procedures	Major Complications
Phlebectomy	bruises and minor bleeding; increase in temperature; swelling of the limb due to temporary disruption of the lymphatic system, as well as in case of non-compliance with the rehabilitation rules; pain, decreased sensitivity in the area of the operation; the formation of seals due to small subcutaneous hemorrhages from the capillaries of the removed vein; impurities in the seams due to improper processing; nausea after general anesthesia.	development of deep vein thrombosis (therefore, during the recovery period, it is necessary to take blood thinners and follow the diet prescribed by the doctor); numbness of the tissues in the operated area. Perhaps if the nerve endings are damaged during the operation; inflammation of a deep vein as a result of infection during surgery or in violation of the rules of care.
Intravenous laser coagulation	hematomas when using a final optical guide; swelling within 3 days; a feeling of muscle tension and tenderness at the site of the removed vein, especially when the leg is moved; slight increase in temperature; the appearance of seals at the site of the removed vein due to the blood supply to the "sealed zone"; with insufficient welding of the walls of the damaged vessel, it is possible to restore blood flow in it and the progression of varicose veins. A new surgery is needed; change in skin tone during the "sealed vein decomposition" period. Provided that the vessel is located close to the surface of the skin.	formation of blood clots in the deep veins; laser burns to nearby tissues and nerve endings resulting in disruption of limb function; development of the inflammatory process when an infection is introduced into the puncture site; chipping and sticking of a piece of fiber in the vein to be operated on. It happens extremely rarely when using low quality equipment.

During both operations, an allergic reaction to anesthetic drugs may develop.

Measures to minimize complications

Surgery to remove leg veins with varicose veins is sometimes accompanied by the development of complications, to prevent their occurrence it is necessary: 

test for allergic reactions to the drugs used;
exclusion of infectious diseases and inflammatory processes in the body before the operation;
selection of proven clinics with highly qualified specialists and modern equipment;
compliance with the rules during the recovery period. Especially wear compression underwear;
observe dietary nutrition during the recovery period (discussed by a specialist after the procedure). The amount of pure water increases in the diet, food intake is made in small portions, the diet is enriched with vitamins and minerals;
rest your legs during working hours;
undergo an examination after surgery to monitor the dynamics of limb recovery;
to perform massages and follow physiotherapy procedures to quickly restore blood flow.

If unacceptable deviations are found for this operation, you should immediately contact the clinic.

Comparison of forecasts

With both methods of removing leg veins, the probability of a full recovery is more than 95%, but subject to the elimination of contraindications, compliance with the rules during the rehabilitation period and when choosing a proven clinic. With surgical treatment, the blood flow and external condition of the legs are restored after 3 months, and with laser therapy, recovery is noted after 30 days.

In advanced forms, the removal of blood vessels is performed by surgery. The method of treatment is determined not only by the patient's desire, but also by the presence of indications and contraindications for the procedure. The effectiveness of therapy depends on the qualifications of the doctor and the implementation of the rules of foot care after surgery.