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

18 November 2020

Varicose veins are a disease characterized by a change in the condition of the veins in the legs with decreased blood flow. When the shape is neglected, the vessels swell, which causes swelling and pain in the limbs (under load), in addition to aesthetic discomfort. Surgical removal of damaged veins is effective at 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 changes affected most of the vein;
severe pain and swelling of the legs during physical exertion, which interferes with a normal lifestyle;
the formation of open wounds and ulcers in the context of the development of the disease. It is dangerous to attach a secondary infection;
violation of blood permeability through the vessels, often accompanied by seizures;
marked development of vascular necrosis;
pathological change in the veins, accompanied by their expansion and protrusion. The alteration is dangerous due to trauma to the vessels, in addition to causing 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 for surgical intervention

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

Absolute prohibitions on the operation	List of relative prohibitions
Stable high pressure	Presence of infectious diseases
Regular increases in blood pressure	Dermatological pathologies that affect the skin of the legs
Chronic heart disease	Inflammatory processes in the body, including blood vessels
Old age after 70	The recovery period after other surgical interventions
Presence of cancer	Chemotherapy
Diabetes mellitus and severe asthma	Serious soft tissue injury from trauma
Thinning and fragility of blood vessels	Hepatic and renal pathologies in acute stage
Patients with limited mobility of the legs (paralysis) or bedridden patients	Blood clotting disorder or anemia
Varicose veins in the last stage	Taking hormones, antibiotics or other aggressive drugs
The presence of complicated leg fractures (with damage to blood vessels and nerve endings)	Being overweight
Allergic reaction to medications used during surgery	Patient's refusal of surgery

When carrying a child, there may also be a violation of the state of the leg veins. Most often, the pathology is eliminated on its own after delivery. In the presence of contraindications, surgical intervention is dangerous with worsening of the patient's condition and even with fatal outcome.

Phlebectomy

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

Anatomical meaning, major surgery to remove veins

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

In the veins of those who suffer from varicose veins, the valves do not close, which causes the blood to move in both directions, which leads to a decrease in blood flow, with blood congestion and protrusion of the veins.

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

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

Access to the affected vessel is made through a small incision (in the groin or popliteal, depending on the location of the vein). Then, the damaged vessel is connected to a deep vein to block blood flow.
An incision is made near the varicose vein. Using a probe, a vessel is separated from muscle tissue, the lymphatic system and small capillaries. By means of a tube or a hook, the damaged vein is removed.
Capillaries are treated to prevent bleeding.
If there are damaged capillaries forming spider veins, they will be removed.
At the end, cosmetic points, disinfectant dressings and elastic bandages are applied.

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

Efficiency level

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

Rehabilitation

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

After phlebectomy, you need to:

care for sutures for 7 to 14 days in a hospital;
wearing compression stockings or elastic bandages for 30 days is performed 24 hours a day;
after 30 days, for another 3 months, wearing specialized underwear during the day
water procedures with foot washing (where the operation was performed) are only possible after removing the stitches;
during the recovery period saunas, baths and hot showers are prohibited;
Pain medications after surgery are prescribed by a doctor. Self-selection is prohibited;
additional medications are taken to prevent blood clots;
taking medications to strengthen the blood vessel walls (vitamins E and C);
it is forbidden to stand / sit for a long time, wearing high-heeled shoes and tight underwear;
during the period of rest in the supine position, the legs should be above body level. It promotes the flow of excess blood and reduces swelling;
timely and gradual introduction of physical activity to normalize blood flow (discussed with your doctor);
massages and physiotherapy are performed with the permission of the responsible specialist;
refusal of alcoholic beverages and nicotine. Alcohol causes vasodilation and smoking, on the contrary, leads to its narrowing. These effects reduce the efficiency of the operation;
if you are overweight, a low calorie diet is prescribed.

If the rules are followed, the complete restoration of the member's functioning 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 are affected and with a small number of capillaries. The procedure consists of the action of light waves on the damaged vessels with their subsequent welding and destruction.

Equipment

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

Optical fiber type	Summary of the action
End (classic)	This light guide produces a beam of radiation from the end, that is, the vessel is sealed in front of it. The disadvantage is the formation of bruises and a painful sensation of tightness in the veins. Maximum vein diameter 0, 1 cm.
Radial (with elves painless radial light guide)	Light waves from the fiber form a circle that surrounds a vein in diameter. This allows veins of any size to be treated. Also the risk of bruising and the development of swelling is minimized.
From 3 types of radial fibers	Lasers with two rings of light are used to eliminate varicose veins. The first prepares the vein for the procedure (eliminating excess fluid), the second circle welds the walls. For the treatment, light guides are produced for thin and short veins and for large vessels.

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

Which veins can be removed with the EVLK method

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

As a result, laser therapy can be applied to the following groups of vessels:

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

For other veins, therapy is only possible with phlebectomy.

Efficiency

The removal of veins by 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 light guide, the effectiveness of the therapy is 94-96%. The operation with radial light guides allows reaching 100% of the result in the elimination of varicose veins in the legs.

Stages of preparation and implementation

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

Cancellation of hormonal medications (if taken). Since they can cause the development of thrombosis;
the day before the intervention, it is necessary to take anticoagulants;
screening of damaged veins to determine the extent of the damage;
perform tests to exclude the presence of a hidden infection or inflammatory processes in the body. Blood clotting is also determined;
the procedure site is carefully washed and shaved (without the use of cosmetics, only antibacterial soap is allowed).

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

EVLK is produced in stages:

Insertion of the catheter by means of a small puncture (the catheter insertion site is anesthetized with local anesthesia) in the marked area. The light guide will move along it.
Insertion of the light guide in the catheter and its subsequent advancement to the injured area. It is performed under ultrasound control on a monitor.
Anesthetic injection to anesthetize the vein and surrounding tissues.
Advance of the "active" light guide through the injured vein, followed by a delay in the capillary branching sites (to seal the outlets and prevent bleeding).
Laser removal with antiseptic treatment from the puncture site and application of elastic bandage (or use of elastic stockings).

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

Rehabilitation resources

To restore the functioning of the injured limb and prevent the development of complications, you need to become familiar with the nuances of rehabilitation after EVLK.

They are:

after completing the procedure, it is recommended to walk with your operated leg in a medical center for one hour;
for 2-3 days, ultrasound control of the treated vein is performed;
for 5 days, you need to wear specialized underwear 24 hours a day (the type of sock is discussed with the specialist responsible before the operation). Then, within 45-60 days, the clothes must be worn during the day;
perform daily kneading of the legs walking every day from 60 minutes;
avoid overloading your legs (sitting or standing for a long time) and going to saunas or taking hot baths.

If removal of varicose veins is still necessary, procedures can be performed within a maximum of 7 days.

The advantages of each method

Surgery to remove veins from the legs for varicose veins, depending on the type of intervention, has the following advantages:

Phlebectomy	EVLK
The incisions for the operation are about 5 mm, so there are practically no scars	No pain during the procedure (with local anesthesia). No general anesthesia is needed
No pain, as the operation is performed under local anesthesia. For miniflebectomy, local anesthesia is used.	EVLK is performed under ultrasound control. The result is high precision and efficiency.
Low cost	Bruises and pain at the surgery site are rare or mild.
Rapid restoration of skin tone (absence of stars and purple-cyanotic hue of the epidermis)	The operation requires 1 puncture, so no stitches or scars are needed
Short recovery period of about 30 days	Recovery period up to 5 days
Effective for all forms of varicose veins	After surgery, the patient can leave the clinic in 1 hour.
The return to normal life is possible in 24 hours.
EVLK can be performed when the integrity of the epidermis is compromised by ulcers.
The duration of the surgical intervention does not exceed 40 minutes.
EVLK can be done on both legs in one day. On a leg, a second operation is allowed after 7 days.

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

Complications after surgical and venous laser surgery

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

Vein removal methods	Minor procedural complications	Main complications
Phlebectomy	bruising and minor bleeding; temperature increase; swelling of the limb due to a temporary rupture of the lymphatic system, as well as if the rehabilitation rules are not followed; pain, decreased sensitivity in the area of the operation; the formation of seals due to minor bleeding under the skin of the capillaries of the removed vein; purification of seams due to improper processing; nausea after general anesthesia.	development of deep venous thrombosis (therefore, during the recovery period, it is necessary to take anticoagulants and follow the diet prescribed by the doctor); numbness of the tissue in the operated area. Perhaps if nerve endings are damaged during the operation; inflammation of a deep vein as a result of infection during surgery or in violation of treatment rules.
Intravenous laser coagulation	bruises when using a final light guide; edema in 3 days; sensation of muscle tension and pain 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 flow of blood to the "sealed zone"; with insufficient welding of the damaged vessel walls, it is possible to restore blood flow and progression of varicose veins. Repeated surgery is necessary; change in the tone of the epidermis during the "sealed vein decomposition" period. As long as the vessel is located close to the surface of the skin.	formation of blood clots in deep veins; laser burns to nearby tissues and nerve endings with subsequent interruption of limb function; development of the inflammatory process when an infection is introduced at the puncture site; chipping and adherence of a piece of light guide in the operated vein. This happens very rarely when using low quality equipment.

During both operations, an allergic reaction to anesthetic medications may occur.

Measures to minimize complications

Surgery to remove veins from the legs with varicose veins is sometimes accompanied by the development of complications; to prevent its appearance, it is necessary: 

test for allergic reactions to the medications 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 wearing 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;
foot rest during working hours;
undergoing an examination after surgery to monitor the dynamics of limb recovery;
for massages and physiotherapy procedures to quickly restore blood flow.

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

Comparison of predictions

With both methods of removing veins from the legs, the probability of complete recovery is over 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, blood flow and the external condition of the legs are restored after 3 months, and with laser therapy, recovery is noticed after 30 days.

In advanced forms, the removal of blood vessels is performed by surgical intervention. The treatment method 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 doctor's qualifications and the implementation of foot care rules after surgery.