Phlebectomy postoperative period recommendations. Phlebectomy: postoperative period, recommendations, complications

What complications can there be after surgery: what should you be afraid of and what should you not be afraid of?

Complications after surgery on the veins are: large, festering hematomas, fistulas, deep veins, wound suppuration. The leg, bandaged with an elastic bandage in the operating room, is supposed to be in an elevated position in the first days after, which is done with the help of a Beler splint, which provides the required angle of 45 degrees in the knee joint. A Beler splint is placed to prevent postoperative hematomas, thereby improving the outflow of blood from the lower leg and reducing the overall load on the limb.

When the anesthesia wears off, the pain may be very slight and will not require the use of strong analgesics. Walking around the ward is possible already in the first hours after surgery. Most often, the prescription of analgesics is not required the next day. In the following days, pain may appear only locally, most often in the area of ​​skin wounds in the area of ​​the knee joint and below it. An incision to separate the saphenous vein from the femoral vein in the groin area does not cause pain, but, fortunately, it is rare that damage to the lymphatic vessels in this area occurs, which then manifests itself as prolonged lymphatic flow.

After incisions on the lower leg, usually 3-4 days after the operation, the body temperature rises, which may be explained aseptic inflammation in places where blood accumulates under the skin. If such accumulations are large, then painful compactions may occur along the removed veins. There should be no redness of the skin over them, otherwise inflammation of the skin will develop, which may indicate an infection.
The necessary high-stretch bandages a few hours after the operation, having done their job and reducing bleeding from the remaining veins, can cause trouble. The high pressure that the bandages provide to the limbs at rest interferes with normal venous circulation, especially at night, when the legs are immobilized. Painful sensations force patients to stand up and take a few steps, only then the pain subsides.

On the 7th day after surgery, the sutures are removed. There are still hematomas, they finally disappear a month after the operation. Often the sutures slightly separate on the lower leg, a little reddish tissue fluid is released. In this case, the doctor recommends lubricating the wound with antiseptic solutions, which dry and speed up healing. After the stitches are removed, the wounds are left with crusts of blood and unwashed epidermis that has accumulated during this time. After washing them off with a soap solution, you need to lubricate the wounds for some time with a solution of potassium permanganate or brilliant green once a day. Once all the crusts have fallen off and there are no open wounds, this procedure can be stopped. These areas can be treated with a washcloth no earlier than two weeks after the sutures are removed. Well, hygienic treatment of the leg outside the wound area is possible at any time after the operation.

Sensory impairment occurs when the cutaneous nerves that accompany the main vein are damaged. Common places for numbness are at the ankle and, less commonly, along the inside of the lower leg. Restoring nerve function is a long process, you need to be patient.

For a month after surgery, you should wear elastic bandages or. If there are no large hematomas on the thigh, then the bandage after removing the sutures can be used up to the knee, but be sure to cover the heel area. Edema syndrome after surgery, it is possible as a reaction of the venous system to changed conditions of blood outflow from the lower extremities. During this restructuring, compression and phlebotonics help keep the remaining superficial veins in good shape.

The appearance of new varicose veins is possible after any phlebectomy. If veins appear in the scar area, this indicates a relapse of the disease. If new veins appear far from the incisions, this is progression. Neither the patient nor the doctor are immune from such problems.

There are fewer complications after laser destruction or stem surgery.

Video: Phlebectomy - removal of varicose veins (Consultation)

Introduction.

Before the operation, I started looking for information on phlebectomy, but I didn’t find anything meaningful (with rare exceptions) - everything was fragmentary and dry. I couldn’t get the overall picture out of these descriptions. Therefore, I wrote a fairly large review so that those who are about to undergo surgery understand what and how. We may have different situations and degrees of illness, something may be different, but in general everything will be something like this.

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Background to the appearance of varicose veins. If you are not interested in this, then immediately move on to the next point))

Now I'm 26 years old. Varicose veins appeared on my leg when I was 15 years old. I didn’t give birth, didn’t carry heavy weights and didn’t do professional training. sports. I had a slightly different situation. As a child, I suffered from a terrible disease, for which I was treated for a long time. And after a while, all this treatment began to affect the body and health. At the age of 14, I had knee surgery, which resulted in the formation of varicose veins at the age of 15... At about 20 years old, when it began to bother me with nagging pain, I went to the doctor. He told me to take the pills and not touch anything for now. The crown was indeed small, not tortuous, and was located on the back of the leg, on the “thigh”. I happily forgot about her until, at the age of 23, she began to bother me again. By that time, spider veins began to appear, not many, but still. I went to the doctor again. This time the doctor said that I needed to do sclerotherapy, but wait until autumn-winter (I came at the end of summer). During this period, the doctor recommended that I lose weight. At that moment I weighed 68 kg for my 160 cm and was just a barrel. I followed the doctor's advice and began to lose weight. So successful that I lost 13 kg. And the vein stopped bothering me. Apparently, the load on the legs has decreased and the vein has decided that it does not need to hurt. And of course, I happily forgot about her again.

And so I actively play sports, I don’t pay attention to the vein. But my knees were extremely painful (an old problem from childhood resurfaced). And they sent me for an MRI. And there, in addition to problems with the knees, they also saw a huge internal knot. The most interesting thing is that this knot was not visible from the outside AT ALL!

So keep in mind that if you are even a little worried about your veins, but the problem does not seem worthy of attention to you, this does not mean that everything is so. It's quite possible it smells fried.

I was referred to an angiosurgeon (by the way, I only stopped at 4, because the previous ones did not suit me at all). The angiosurgeon referred me to the duplex of the vessels of the lower extremities. An ultrasound revealed valve incompetence and it was decided to operate, because... sclerotherapy could no longer cope with the problem.

Having brought the duplex results to a regular surgeon at the clinic, I asked for a referral to a vascular surgeon at the hospital. You can make a duplex yourself; in principle, you can start with it. All the same, this is a paid service and is not provided under the policy. That is, you do a duplex, then go to the clinic to see a surgeon.

With this referral, I came to SH at the hospital for registration. As it turned out later, you could skip the first point and go straight to the hospital for an appointment with a vascular specialist (at this hospital doctors are seen on a paid basis and you can save time and go straight to them, bypassing the surgeon from the clinic).

SH gave me a list of necessary tests and sent them to the clinic.

At the clinic, I went to a therapist, who gave me a referral for these tests (ECG, Stool for I/g, OBC, OAM, hepatitis, coagulogram and something else, I don’t remember).

I passed the tests (the shelf life of the tests is 10-12 days, so set the time so that they do not expire by the time of the operation).

I went to the therapist and received a conclusion from him. I went to the surgeon and received a referral for hospitalization.

I came with all this stuff to the hospital to see SH and they booked me in for surgery in 7 days.

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On Monday I showed up at the surgical department with all my worries and terrible fear.

Let me explain what we discussed with the doctor:

-Local anesthesia. General procedures for this operation are now practically not performed. I refused to do a spinal one, because... The reviews and consequences are scary.

- Time in hospital from 2 days. Sick leave - at least a week. According to the compulsory medical insurance policy, it is impossible to do less.

-Bring compression bandages, ointment and tablets with you.

-They cut 2 of my legs. On one everything was bad, but on the second a small wreath just started to appear and we decided to immediately remove it with the help of punctures.

I checked in at the hospital and waited in the ward for the operation. I haven't been so scared for a long time.

I’m a terrible coward and a pissant, so I simply couldn’t imagine how they would disembowel me alive.

The operation itself.

First, the doctor drew the puncture and incision sites on my legs. Then, during the procedure, they put a catheter in my arm for IVs.

Then a nurse came and gave me some terribly painful injection intramuscularly. As it turned out later, the drug was supposed to “addict” me a little, cloud my consciousness and incline me into a superficial sleep. But since I am an emotional person, he only began to act towards the end of the operation))

So, I walked into the operating room with my own feet, undressed, and lay down on the operating table. They cut me from behind, so I lay on my stomach.

We made a screen, treated the leg with an iodine solution and it began. All punctures and cuts are made in turn, i.e. First, one place is numbed and the vein is removed. The second point is numbed, the doctor removes the vein there, while the assistants suture the first point. 3 people worked on my legs. The anesthesia was extremely painful and, unfortunately, it didn’t last long on me, so I had to constantly be pinned.

During the operation I was fully conscious. And for me, as a coward and a suspicious person, it was scary. The doctors talked to me, asked questions, made contact. If they fell silent. I realized that I was starting to concentrate on sensations, and they were not the most pleasant. So I started singing or just loudly telling the doctors what I like to eat, how I walk the dogs and how we build a house. I didn't care whether they listened to me or not. The main thing is not to hear what’s going on with your feet.

How does it feel?

I didn’t feel any pain as such. Well, except when they were given pain relief and when they were stitched up (by this time the anesthesia had weakened). I didn’t feel how the cuts were made. But I could very well hear the veins being pulled. And this is fufufufu, how terrible. I also felt the blood pouring down my legs. Nothing terrible, but I was covered in cold sweat. And several times, during the “cauterization” of the veins, I heard the smell of fried meat. Shish kebab from me.

In general, all this is absolutely not fatal, but for impressionable people it is very deadly. So if you are an impressionable person, then know that talking, singing and all that stuff is a very good distraction.

Towards the end of the operation, I began to fall asleep and it became easier for me to bear it. I just fell into a blissful sleep, but the needles kept getting me out of it. But I didn't care))

The operation lasted 2:45. During this time, I was wildly tired of lying in one position and very hungry. When they brought me to the ward, I ate and fell asleep. For the next 24 hours I slept constantly.

On this day it was forbidden to get up. I read a lot of reviews and everyone said that they were running in 2 hours. But they forbade me, so I didn’t even have to go to the toilet... I wasn’t allowed to get up, because... It may be bad from the anesthesia. The next morning I understood what it was about. I got up to go to the toilet, and then for another hour I felt sick, nauseous and unsteady. It would be better if she was still lying down.

About the pain. This is probably all very individual. I am a fellow pain-sensitive, the so-called dying swan. That's why it hurt me. For the first three days, I was perfectly addicted to Ketorol injections and didn’t give a damn. Then the pain began to subside and the injections seemed more painful to me than my stitches.

In total, I had 2 punctures on my left leg and 8 punctures and 1 deep stitch (under the knee) on my right leg. The punctures are small, approximately 0.5 cm, in the form of crosses. The seam is quite large, 3 cm long, but very neat. Small punctures did not cause any particular inconvenience, but a large incision, of course, pulled and hurt.

There were bandages every day. The stitches were smeared with brilliant green, the emerging hematomas were smeared with ointment, then everyone was bandaged and sent to the ward. By the way, the hematomas were much smaller than I expected after looking at the Internet pictures.

The first few days there was swelling of the feet. Due to the compression and the intervention in the tissue was not in vain.

On the 4th day I was sent home (not officially. They just freed up my bed).

I was scared at home without doctors' supervision. I tried to walk less. It’s not that my legs really hurt, but my suspiciousness was not in vain - something was pricking, pulsating and tugging at me all the time. That's why I preferred to lie down.

Exactly a week later, on the following Monday, I went to the hospital to get a discharge and have the stitches removed. The procedure itself is not pleasant, but that’s for me. Adequate and not snarky people tolerate this calmly. They removed the stitches and sent me to the clinic to extend my sick leave. I note that at that time I could not walk fully.

First of all, I was wearing compression bandages. They cannot put on pants and shoes properly. The bandages themselves restrict movement. In general, I walked like a cyborg killer, spreading my legs in different directions and not really bending them, so as not to burst my jeans. One more moment. That day I realized that I feel more comfortable walking in shoes with an instep. I was constantly pulling at the popliteal seam and at home, barefoot or in slippers, it got worse. And here I’m wearing boots with stable heels (cm 4) and I forgot about the seam. You won’t believe it, but then, at home, I sometimes walked in my boots to make it easier.

So, I came to the clinic and extended my sick leave. A day later I was given an appointment. I immediately agreed with the doctor that if I felt normal, I would return to work next Tuesday.

I arrived home, felt tired after such travels, and rested all day. And in the evening I unwound the bandages for dressing, and then...

The stitches began to bleed. I can distinguish ichor from blood. And it was not ichor... The bandages stuck to the skin, it all came off with pain. I didn't expect this, because... the doctor didn’t say anything... She started calling everyone in hysterics. In the end, they calmed me down and said that this was the norm, that everything was okay and that I was not dying. But my condition was still like that of a dying person)) I’ll jump ahead and say that the punctures were wet periodically for another 5 days, but the popliteal suture did not allow me to live in peace for another 10 days.

The next day I took off the bandages for the first time and went swimming. You can’t even imagine what a blessing it is to take a swim after a week of rubbing)) In general, my first trip to the shower ended with the veins on my feet and legs swelling up from warm water (not hot) and my legs very quickly, I don’t even know how call it “tired” or something. That is, I popped out of the shower and just lie there! And then she wrapped herself back in her dear bandages. The subsequent baths went fine, but I still didn’t spend a long time in the shower. You cannot take a bath for the first month. The bathhouse is generally contraindicated.

On Friday (on the 5th day, after the stitches were removed), I howled from sitting at home and went to a cafe. I can’t wear clothes over the bandages, so I very carefully put on compression tights (I still made a couple of snags on the sores). My path was 100 meters from the house to the stop and 50 meters from the stop to the cafe. I was in the cafe for an hour and a half. I came back by car. The result is that the punctures began to bleed, although I was sitting and didn’t even get up to go to the toilet... This was the last “bloody” day of the punctures. Then they agreed to a truce and didn’t bother me anymore.

I spent 2 weeks on sick leave, I managed to go crazy from loneliness and idleness, so I happily went to work, although the doctor allowed me to be sick for up to a month, but this is of no use to me, because... I have a sedentary job and have the opportunity to lie on the sofa upside down. If you have a hard job, if you have to stand/walk/carry heavy loads a lot, etc., then you can safely sit on sick leave for a month. There is a deadline for this operation!

Regarding compression garments. The choice is great - for different tastes and budgets. I took tights for 1650 rubles. and stockings for 1300. The tights were torn into trash after 2 weeks, the stockings are still alive. The pleasure is expensive. You need to wear it for the first 2 months (minimum), and ideally either wear it all the time, or at least put it on if the day is going to be too walking, sedentary or standing. This underwear is a very dense nylon with a special weave, which gives different compression at all levels of the leg. And then the blood flows through the veins in the right direction, which prevents the appearance of new varicose veins.

But it didn't help me. Less than 3 weeks after surgery, I noticed a new vein. It came out right next to the stitches, in the same place where the only visible vein was (the same one that appeared at the age of 15). Only now it has become much, much larger and more tortuous...

Needless to say, my mood instantly deteriorated and I burst into tears again. Although doctors warned that this could happen and no one is immune from this, I was simply offended that someone drinks/smokes/doesn’t watch their diet (unlike me, a BJU person) and everything is fine with them. And I’m falling apart piece by piece... I went to the doctor. They confirmed to me that I was not dying and prescribed sclerotherapy for this vein in the fall. I don’t really want to, but I will see it through to the end. As they say: “I’ve picked up the tug, don’t say it’s not strong”))

Exactly a month has passed. I'm waiting for my stitches to turn completely white. For now they are quite dark, but in a year or so they will be completely invisible.

Some punctures are still in the form of sores, but everything is already going away. The hematomas went away very quickly, in the first two weeks. I actively restored the skin of my legs after surgery, because... everything was peeling off and peeling off me in sheets; oils and creams helped me. 2 weeks after the operation, I allowed myself to sleep without bandages (with the doctor's permission). During the day I wear tights/stockings, and on weekends at home I wear bandages, because in my house, where two dogs, a cat and a husband live, it would be simply impossible not to tear them in the first hour.

1. Choose your doctor very carefully. I only stopped at the fourth doctor. The first one was going to sclerose me for the amount of 40 thousand. Moreover, he even noted to me the inguinal veins, which simply glow on thin skin. I didn’t even look at the results of the MRI and ultrasound... The second one didn’t care, he didn’t even listen to me. The third one began to intimidate me with the fact that almost Uzbeks from the construction site would perform a free operation on me, but he would do everything for me for a small fee. And only when I got to the fourth doctor did I see that she didn’t care about my health. From now on she will be my vascular surgeon.
2. It’s possible to get a free phlebectomy, if you have a regular compulsory medical insurance policy! I described the scheme above. It may differ in your city, but I think the general principle is clear. I didn't pay a penny! Only then did I thank the doctor, but that was my doing. She doesn’t take money on principle; I only managed to give her a bag of sweets and champagne.
3. Don't skimp when buying compression bandages like I did! My bandages are 200 rub. They were poorly attached to the piece, constantly slipped and eventually stretched. It’s better to immediately buy normal ones, not made from poop. When buying venotonics (the doctor will definitely prescribe them for you), take the ones that are cheaper. The active ingredient is the same, the manufacturer is different and the price is different. But the essence is the same. The same song applies to ointments for hematomas.
4. N Don't be afraid of surgery like I did. That day I realized what panic attacks are. Only after surviving the operation can I say that there is nothing fatal. Yes, it's not nice. But in our lives there is a lot of this and nothing, everyone is alive. All my fear was caused by the unknown - there are few extensive reviews about operations on the Internet, it is clear that everything was written after a while, without emotions, only facts. And a week before the intervention, you want to know every detail, and not just dry facts.
5. Don't be afraid of scars. A good doctor will do everything perfectly for you! They won't be visible. I had a miniphlebectomy, so there is no stitch in the groin. With a full phlebectomy, they also cut the groin (it also hurts for a long time and does not allow you to live). So be prepared.

If you have any questions, ask, I will be happy to answer!

I wish you good health and that your legs always cope with stress and never get varicose veins.

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Varicose veins of the lower extremities are a very common pathology. According to statistics, more than half of the entire population of the planet suffers from some degree of varicose veins. The disease causes not only aesthetic discomfort, but also such negative manifestations as pain, swelling, and severe trophic changes. In such cases, phlebectomy (venectomy) is the only way to get rid of the disease once and for all.

Vein removal operations began to be performed at the end of the 19th century, but these interventions were very traumatic, accompanied by complications and gave an unsatisfactory cosmetic result. Today, surgeons have modern microsurgical equipment in their arsenal, and phlebectomy methods are becoming more gentle without losing their effectiveness.

Phlebectomy is performed through small incisions that leave behind barely noticeable scars. The operation is low-traumatic, safe and can be performed even on an outpatient basis, depending on the technique chosen by the surgeon in accordance with the course of the disease.

Interventions on the veins require a lot of experience, patience and painstaking work of the surgeon, so operations of this kind are carried out exclusively in specialized hospitals, where there is appropriate equipment and highly qualified phlebologists work.

The choice of vein removal method depends on the stage of the disease, the general condition of the patient, and in cases of high-tech interventions, also the patient’s ability to pay, since not all phlebectomy methods are available as free treatment.

Indications and types of operations on the blood vessels of the legs

Surgical treatment of diseases of the venous system of the legs is radical and is used in cases where other methods no longer bring results. The main indication for removal of the veins of the lower extremities is varicose veins, which may be accompanied by:

Usually the operation is carried out as planned, but if there is a risk of bleeding or a previous rupture of varicose nodes, urgent surgical treatment is indicated.

There are conditions in which traditional phlebectomy may be contraindicated. Thus, it cannot be performed on pregnant women and nursing mothers, if the skin of the legs is damaged by an infectious-inflammatory process, with widespread thrombosis of deep and superficial veins, as well as if it is impossible to provide adequate compression and motor mode in the postoperative period. Severe concomitant pathology of internal organs may become a contraindication due to the need for general anesthesia.

The purpose of surgery for varicose veins of the legs is to eliminate not only the vessels affected by the disease and achieve a good cosmetic result, but also to obstruct blood flow in the veins, as well as to create conditions where reflux, that is, the reverse movement of venous blood, is impossible. Only a tenth of all venous blood of the extremities flows through the saphenous veins, so removal of these vessels is safe and does not lead to circulatory problems.

Preparing for surgery

Preparation for the upcoming phlebectomy begins even before hospitalization. The patient will have to undergo a series of examinations and visit various specialists. Traditionally, before the intervention, it is necessary to take blood and urine tests, blood clotting tests, fluorography, and a cardiogram. In addition, you will need to be tested for HIV infection, syphilis, hepatitis, and establish your blood type and Rh factor.

The listed procedures can be completed in your local clinic 7-10 days before the scheduled date of hospitalization. When the tests are ready, the patient is sent to a therapist, who decides on the safety and possibility of surgical treatment, because some diseases of the internal organs can become a serious obstacle to intervention. If all organs are in order, the risk is eliminated, then the therapist gives his consent to the surgical operation.

Upon arrival at the hospital, the patient is examined by a surgeon and talks with an anesthesiologist, who chooses the method of pain relief. Duplex scanning of the veins is required to clarify the volume and stage of the disease.

On the eve of the operation, you need to take a shower and shave the hair from the limb and groin area. The last meal and liquid intake is allowed no later than 18:00 in the evening before the intervention. Before general anesthesia, a cleansing enema may be required, especially in elderly patients with impaired bowel function.

When all the preparatory stages have been completed, the surgeon marks the areas of the affected vessels, and the patient is transported to the operating room, where he is met by an anesthesiologist. General anesthesia or spinal anesthesia is possible. The latter option is better tolerated, and the patient can remain conscious throughout the operation (if desired).

Even in the preoperative period, it is worth choosing good elastic bandages or special knitwear, because the patient will have to use them for up to a month after phlebectomy, and the result of treatment largely depends on the quality of compression.

Phlebectomy technique

Phlebectomy is aimed at removing superficial veins and includes several stages, each of which can be an independent operation. In addition, certain surgical procedures are successfully replaced by minimally invasive procedures, including laser coagulation, the introduction of sclerosants, and radiofrequency exposure.

Combined phlebectomy requires hospitalization of the patient and is performed under general anesthesia or epidural anesthesia. The intervention lasts about two hours, and upon completion, cosmetic sutures are applied to all incision sites. A prerequisite for vascular surgery is elastic bandaging, which is performed by a physician assistant in the operating room. This allows you to avoid hematomas and bleeding in the postoperative period.

If any of the stages of the combined operation is replaced by a minimally invasive technique, then hospitalization is not required, nor is general anesthesia required. The procedure is performed on an outpatient basis under local anesthesia. Cases of advanced varicose veins usually require classical phlebectomy, observing all stages of the operation. The intervention is high-tech, and the result is largely determined by the skill and experience of the phlebologist.

Combined phlebectomy consists of several stages:

1. Crossectomy.
2. Stripping.
3. Ligation of perforating vessels.
4. Miniphlebectomy.

Crossectomy, usually performed first, but may be the final treatment option when there is a risk of blood clots spreading into the deep venous system. The operation consists of ligating and crossing the saphenous vein at the point where it flows into the deep veins. This manipulation achieves cessation of blood flow through varicose vessels and reverse discharge of blood (reflux). The incision during crossectomy is in the groin or popliteal fossa, which depends on the location of the lesion and the final goal of the procedure.

An example of combined phlebectomy, which usually includes crossectomy

Crossectomy can be replaced by laser or radiofrequency treatment, the advantages of which are considered to be less trauma and the ability to be performed on an outpatient basis. These procedures do not involve any incisions and do not require general anesthesia.

The second stage of combined phlebectomy is stripping. After crossing the saphenous veins, it becomes necessary to remove them. Preoperative ultrasound allows you to accurately determine the area of ​​the affected vein, and in most patients this is only the thigh, so you can limit yourself to removing only part of the saphenous vein (short stripping) without compromising the radicality and effectiveness of the treatment.

Stripping is carried out using various tools and techniques that determine the type of manipulation:

• Using a Babcock probe;
• Intussusception stripping;
• Cryostripping;
• PIN stripping.

phlebectomy using stripping method

Vein removal with a Babcock probe - the most effective and, at the same time, the most traumatic method. The Babcock probe is equipped with an extension and a cutting element at the end, which, when moving the device along the vein, cuts it off from surrounding tissues, perforating veins and lymphatic vessels.

After a crossectomy, there is an incision in the groin, and a second surgeon makes it in the ankle or upper leg area. A Babcock probe can be inserted into any of the holes, which reaches the opposite end of the vessel and is fixed to it, then the surgeon pulls the probe toward himself, removing the vein out.

Intussusception stripping is done in a similar way, but the difference is the use of a probe without a cutting element. The end part of the instrument is fixed to the vessel, and as the doctor pulls the probe toward himself, the vein is turned inside out and brought out into the wound. The method is less traumatic, since the surrounding structures are not damaged, and the vein is simply separated from them.

PIN stripping – an even more gentle modification of venectomy, when the surgeon only needs one incision, already available after crossectomy. A puncture is made at the other end of the vein, through which the probe is removed and tied with a thread to the wall of the vessel. Next, the vein is everted and removed.

Cryostripping is a modern method of removing leg veins, but it is used relatively rarely due to the need to use expensive equipment. Its essence lies in the introduction of a probe, the end of which freezes when it reaches the distal segment of the vein, due to which the vessel seems to be glued to the device, and then the vein is everted in the usual way. The advantages of this manipulation are that no additional incision or puncture is required in the ankle area, and as the cold device moves through the vein, the perforators are narrowed, due to which the risk of hematomas and bleeding is significantly reduced.

Like crossectomy, this stage of combined phlebectomy can be replaced with minimally invasive options (laser, radiofrequency obliteration), which we will talk about a little later.

After crossectomy and extraction of the main trunks of the saphenous veins, it is necessary to ligate the perforating vessels through which blood flow can continue. This is fraught with relapses, hematomas and bleeding. If the lesion is small, these veins are ligated without cutting the muscle fascia, which is less traumatic. If it is necessary to ligate a significant number of vessels, the surgeon is forced to resort to dissection of the fascia, which gives a lasting result, but a poor cosmetic effect.

To reduce surgical trauma, the endoscopic venectomy technique is used, through which the veins are ligated using small incisions. Endoscopic dressing is very aesthetic, but requires expensive equipment and highly qualified phlebologists, so the procedure is not cheap and is not always available in regular hospitals.

The final stage of combined phlebectomy is miniphlebectomy. This operation can also be used independently if the patient wants to get rid of single varicose veins that cause subjective cosmetic discomfort.

Having previously marked the operation area, the surgeon makes a small puncture, only 1-2 mm, through which he extracts the vein and screws it onto a clamp. The intervention is low-traumatic, does not require sutures and allows you to remove small altered areas of blood vessels visible to the eye.

The operation does not leave any scars, and the patient will undoubtedly be very pleased with the result. By the way, with miniphlebectomy, reviews are especially positive among the fair sex, who want to remove even small vessels that spoil the appearance of their legs. The ability to perform manipulations under local anesthesia makes it accessible to those patients who are afraid of general anesthesia or have certain contraindications to it. In addition to removing the vessels of the legs, miniphlebectomy can be used when the pathology is localized on the face, hands, feet, but such treatment will require even more painstaking care and experience of the surgeon.

Minimally invasive and modern methods for removing varicose veins involve the use of laser, high-frequency radio waves, and sclerosants. These methods are used on an outpatient basis, mainly in the early stages of varicose veins and have virtually no contraindications. As mentioned above, they can replace certain stages of classical phlebectomy, while giving a good cosmetic result with an equal degree of effectiveness. Minimally invasive procedures are performed under ultrasound guidance.

Endovasal laser phlebectomy consists of introducing a light guide into the lumen of the vessel, through which a beam of laser radiation is supplied into the vein. Heating causes soldering of the vessel walls and sclerosis. A puncture in the projection of the affected vessel does not require sutures, but this method is hardly possible to remove giant conglomerates of varicose veins, therefore, if you want to carry out treatment with “little blood”, you should think about this option of phlebectomy when the disease has not acquired alarming proportions.

New generation devices for miniphlebectomy demonstrate the possibility of removing veins without punctures at all. The doctor just needs to move the manipulator over the vascular trunk, which will disappear right before our eyes. Of course, this treatment option is applicable to small visible vessels, but can complement classical surgery to achieve a beautiful appearance of the limbs.

Radiofrequency ablation varicose veins is similar to laser coagulation, but is based on the use of radio waves. A special conductor moves through the vein, causing heating and gluing of its walls, that is, the principle is the same as with laser treatment.

What to do and what to avoid after phlebectomy

The postoperative period is usually favorable. After combined phlebectomy, the patient remains in the hospital for one to two weeks, after which the sutures are removed. Cosmetic stitches can be removed by the end of the first week after treatment. Possible complications include bleeding and hematomas, suppuration of postoperative wounds. If the lymphatic vessels are damaged, swelling and lymphostasis occur.

After phlebectomy, rehabilitation includes performing simple leg movements, which can be done even while lying in bed. A light massage of the limb is possible. To prevent complications, venotonics are prescribed, according to indications - anticoagulants, and for pain - analgesics. You will have to give up showers, baths, and especially saunas and pools for a while. Even after the stitches are removed, the patient should avoid hot baths.

For a month after vein removal, you must wear compression stockings or elastic bandages around the clock. They are not allowed to be removed even temporarily, so during this period the patient will not be able to fully wash himself. After a month, the compression is maintained only during the daytime, and at night you can remove the stockings (bandages) and take a shower.

After phlebectomy, recommendations boil down to wearing compression garments and adequate physical activity. These are the two main conditions for successful treatment. You can and even need to get up and walk the very next day after the operation. Early activation serves as an effective measure for the prevention of thrombosis and other postoperative complications.

After the main goal has been achieved - varicose veins have been removed, one should not forget about a lifestyle that excludes heavy lifting and prolonged sitting or standing. If due to the nature of the work the patient is forced to stand or sit for a long time, then if it is impossible to change jobs, it is necessary to change the load alternately on both legs, periodically get up and walk.

In general, recovery after phlebectomy is quite easy, and patients are almost always very satisfied with the result, as evidenced by a lot of positive reviews and thanks to doctors. After treatment, legs stop hurting and swelling, and the cosmetic effect is so good that ladies return to dresses and high heels.

However, in some cases, the treatment experience can be spoiled by side effects from anesthesia (severe headache, for example). In addition, some of the negative reviews are related to the surgeon’s lack of qualifications and experience, so you should be very careful when choosing a clinic.

Vein removal operations are high-tech, often requiring very expensive equipment and a highly qualified surgeon, so their cost can seriously hit the patient’s wallet. As long as quotas for traditional phlebectomy are maintained, treatment under the compulsory medical insurance system is still possible, free of charge, but in this case the patient may face a waiting list for treatment, and he will not have the opportunity to choose the attending physician. High-tech operations are carried out only for a fee.

Paid treatment is possible both in government institutions and in private clinics. On average, phlebectomy costs 25-30 thousand, but it may be more expensive, depending on the level of the clinic and the regalia of the phlebologist. Laser coagulation, carried out only on a paid basis, is even more expensive - about 30-35 thousand. With miniphlebectomy, prices are more affordable: treatment will cost approximately 10-12 thousand rubles.

Video: how quickly does recovery occur after phlebectomy?

Even the ancient Egyptians, many thousands of years ago, considered vascular disease in the legs to be terrible and incurable. They saw that “snake-like convolutions” on the legs lead to open wounds, and ultimately to inevitable death. The Jews and Greeks considered the only, albeit temporary, salvation from this disease to be the creation of compression using sponges and linen strips. Even then, the diagnosis and treatment of blood vessels became an independent area of ​​surgery, but for a very long time no one dared to perform phlebectomy in the formation of nodes in the saphenous veins of the legs.

Thrombophlebitis, varicose veins, and thrombosis were among the ten most common diseases from which humanity died out. After all, the causes of these diseases were not always determined by the working or living conditions of the patient. There is an opinion among experts that loss of the elasticity of veins and their ability to contract can be inherited, but not only from direct relatives. This disease can be provoked by amateur diets low in fiber, incorrectly chosen clothing that restricts the blood flow of the pelvis, and even the habit of sitting cross-legged.

Considering that chronic venous diseases affect up to 50% of people living on Earth. And these are only official statistics that take into account visits to doctors. And how many of those who consider fatigue in the legs, cramps and “stars” to be a temporary phenomenon! In developed countries, where 25% of the working 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 operation that is 100 years old

Phlebectomy as a medical term appeared at the border of the 19th and 20th centuries and meant surgical intervention to eliminate veins affected by severe varicose veins, when neither medication nor compression treatment stops the development of the disease. The first operations set the priority task of radical excision of the diseased vessel with all varicose nodes, and were performed in a hospital under spinal anesthesia. A wide skin incision from the thigh to the shin was very traumatic and dangerous due to its postoperative period, when the risk of complications increased.

Phlebectomy according to Babcock

A real breakthrough in operations for varicose veins was the method of the American surgeon Babcock, tested in practice in 1908. Phlebectomy according to Babcock involves subcutaneous pulling out of veins using a rigid metal probe - exeresis, as this procedure was called at that time. To do this, two small incisions were made, through which the vein was ligated - crossectomy, and finally, the affected area was pulled out with a probe hook. In an improved form with greater technical equipment, this method of surgery for removing varicose veins is still used today.

Operation Narat

Phlebectomy according to Narat is also carried out using a medical probe, but through short incisions (from 1 to 6 cm) on the thigh and lower leg, the affected vessel is removed in separate parts using the tunneling method, sometimes using percutaneous stitching of the affected areas with catgut. The desire of vascular surgeons to obtain a cosmetic effect from surgery has constantly led to the improvement of operating instruments.

Muller's discovery

In some cases, the improvement of surgical instruments occurred on a whim, as, for example, the Swiss dermatologist Robert Müller, when the surgical tweezers in his hands broke. Müller began to use a narrow, pointed scalpel and a large needle to make micropenetrations into the operated area. This is how the miniphlebectomy method appeared.

Müller phlebectomy is performed on an outpatient basis using local anesthesia, both on small areas of the saphenous vein and on the great vessels. With miniphlebectomy, there is no need for sutures; it is enough to tighten the edges of the punctures with a bandage. This is very painstaking, almost jewelry work. The method can be presented independently or as part of a larger operation. It can significantly reduce the patient’s recovery time and provide excellent cosmetic results. That is why the Muller method is so in demand in the medical beauty industry.

Modern methods of phlebectomy

Currently, with a perfect diagnostic system, it is possible to select for each patient an individual surgical procedure or their combination in the interests of the predicted result. The task of combined phlebectomy is one - to normalize blood flow to prevent the risk of irreversible pathologies.

First, an ultrasound duplex scanning of the veins is certainly carried out with simultaneous marking of the affected areas and (if appropriate) phlebography - diagnostics using a contrast agent. Biochemical tests of urine and blood provide significant information about the condition of the patient’s veins, which has a positive effect on the consequences of phlebectomy.

In addition to miniphlebectomy, which was already discussed above, vascular medicine specialists have several more surgical methods for removing affected veins. In combined phlebectomy, the surgeon identifies several successive stages, based on the results of the examination. Thus, knowledge of the individual characteristics of the operated patient is used as efficiently as possible.

Stripping

Using a short strip- gentle surgery for varicose veins allows you to remove only the affected area of ​​the vein. Since it is also performed through a puncture in the skin, it can be classified as a miniphlebectomy with all the advantages of this method.

Laser phlebectomy

Laser phlebectomy- a new word in this area of ​​vascular medicine, when the operation is performed without surgical instruments due to laser coagulation inside the vessel. During the operation, a laser light guide is inserted into the vein through a puncture under local anesthesia under Doppler ultrasound control. A burn to the vein walls produced by a laser pulse leads to its overgrowth. The insertion site is a puncture of minimal size, sealed with a special plaster. In fact, laser phlebectomy as laser therapy for varicose veins is becoming an alternative to surgical intervention in our opinion.

Radiofrequency obliteration

Radiofrequency obliteration (RAO) equipment has an even more precise effect on the walls of blood vessels. It uses disposable catheters, and the heating and extraction temperature is controlled by feedback. This procedure minimizes pain, allows you to perform the entire volume of vein reconstruction on both legs in one go, makes recovery after phlebectomy quick and is excellent in terms of the aesthetics of the result.

Video: preparation and progress of the operation

What should you know to feel armed?

In what cases is phlebectomy necessary?

Clear indications for phlebectomy are:

• Visual determination of the pattern of saphenous veins that appear as swelling.
• Varicose veins cover the legs up to the knee and above.
• Stagnation of blood in the legs when standing.
• Feeling tired and constantly swollen in the legs.
• The appearance of non-healing (trophic) ulcers on the legs that cannot be treated.
• Constant pain in the legs.
• Burning sensations along the veins.
• Varicothrombophlebitis types II, III and IV.

Who is not allowed to have surgery?

Contraindications to surgery are:

1. Persistent increase in blood pressure, hypertension.
2. Cardiac ischemia.
3. Uncontrolled infectious processes.
4. Old age, reduced immunity.
5. Late pregnancy (II–III trimester).
6. Inflammatory processes on the legs such as erysipelas, eczema, etc.

Undiagnosed diabetes mellitus, stroke, heart attack, hypertension during phlebectomy and in the postoperative period can provoke thromboembolism, renal failure and even gangrene in the patient!

Phlebectomy is the stage of treatment of varicose veins following the therapeutic one. For many, it suddenly becomes a growing problem, since the period of medical conservative treatment was missed due to inattention to their constant ailments and frivolity in assessing the seriousness of the disease. If we are guided by folk wisdom about caring for a drowning person, then it is important, having special knowledge about varicose veins, to prevent the development of this insidious disease.

Video: is surgery always necessary?

• Proper nutrition, rich in pectins and fiber, without overeating.
• Preferences for stairs over elevator.
• Bicycle rides.
• Swimming in any body of water.
• Preferences for comfortable shoes.
• Categorical cessation of smoking.
• Controlling your own weight.
• Cocktails made from herbs, such as acacia, St. John's wort and nettle.

But, if you did undergo a phlebectomy, continue to follow these rules. It is necessary to follow the recommendations after phlebectomy to prevent the disease from returning. The norm of life for the person undergoing surgery should be walks in the air, exercise therapy, contrast showers, a thoughtful diet, compression garments, elevated position of the legs during rest, and taking phlebotropic medications. Otherwise, unpleasant and difficult to eliminate complications await him.

Possible complications of the operation

Complications of phlebectomy can occur immediately after surgery or after some time. Complications of the postoperative period include:

1. Decreased sensitivity due to damage to cutaneous nerves.
2. Numbness in the ankle or inner calf.
3. Suppuration at the site of the hematoma.
4. Bleeding.
5. The appearance of new varicose veins above the scar or far from the incisions.
6. Bruising and discoloration of the skin area (with laser phlebectomy).
7. Slight pain at surgical sites.

Therefore, as rehabilitation after phlebectomy, patients are prescribed hydroprocedures for up to 9 days, massage and exercise therapy (gymnastics after phlebectomy), which ultimately normalize venous outflow and prevent the formation of new blood clots. For another 2 months, it is recommended to take venotonic drugs, wear compression garments and be observed by the treating phlebologist.

Is phlebectomy a paid service?

Phlebectomy today is a very common type of care for those suffering from varicose veins. It is performed both by public clinics with vascular surgery departments and by plastic surgery centers whose priority is solving aesthetic problems.

This branch of medicine is very well equipped with diagnostic and surgical equipment, highly qualified specialists practice in it, it is considered resource-intensive, which, of course, affects the cost of medical services of this kind.

The amount of costs for the patient consists of the method of performing phlebectomy, the forecast of its postoperative traces, care in the preoperative period, including diagnostics, and the postoperative period, including rehabilitation.

There are differences in the cost of this type of surgery and the regions in which they are performed. Thus, in Moscow clinics, the estimated price of phlebectomy ranges from 15,000 in an ordinary vascular center to 270,000 rubles for the services of a VIP clinic. In St. Petersburg, the average price range is still lower and these services are already offered for 3,900 – 38,000 rubles. Being high-tech at their core, operations to remove varicose veins on the lower extremities are still not subject to federal quotas provided for citizens of the Russian Federation.

It's always good to listen to someone else's opinion.

Bad things, unfortunately, are remembered for a long time, and the state of acquired lightness and health seems so natural that it is reflected much less.

Therefore, among the few patient reviews on the Internet, those healed as a result of phlebectomy are unanimous that:

• “I couldn’t decide for a long time”;
• “I learned about laser phlebectomy as less traumatic”;
• “The operation was quick and painless, in a friendly atmosphere, the doctors talked about what was happening and joked”;
• “They gave me a light guide as a souvenir!”
• “An hour and a half later I went home. On your own feet!”
• “For the first few days there was pain, I wore compression stockings”;
• “I did all this IN THE SUMMER, which has never happened before. I was told that such operations are not performed in the summer.”

So, if you work as a hairdresser, bartender, teacher, waiter or surgeon, like or don’t like to carry excessive weights, drink a glass of wine or smoke at frequent parties, take hormonal drugs or contraceptives without a doctor’s prescription, hang around the clock at your desk or computer desk, it’s worth it think about the problem of varicose veins and its consequences! Examine your tireless legs in the sunlight, take care of the bruises, stars and purple veins that you see on them - maybe it’s time to take action before it’s too late?

sosudinfo.ru

What it is

Phlebectomy is a type of surgery that specializes in removing veins affected by severe varicose veins. At this stage, neither medication nor compression garments can help stop the development of the disease.

Currently, this problem is felt by almost half of the world's population. The cause of thrombophlebitis can be anything - tight clothing, an ill-conceived diet, heredity.

There is no need to consider all stages in the development of phlebectomy. Interesting in modern technologies in medical practice. The choice of the optimal method of intervention depends on highly qualified diagnostics. In some cases, it is more reasonable to perform a combined phlebectomy.

First of all, a duplex ultrasound scan is performed, which marks the areas with affected veins. In difficult cases, phlebography is necessary.

The choice of operating method is based on data on the patient’s condition, as well as the degree of damage to his veins:

• Stripping. During the operation, the surgeon makes a puncture in the skin, through which a section of the affected vein is removed for subsequent removal. This method is quite gentle, as it makes it possible to save the vein itself.
• Laser phlebectomy. This method takes place without the use of surgical instruments. The skin is punctured under local anesthesia. A laser light guide is inserted into the vein. Laser coagulation is performed from inside the vein. The burn site in the vein heals over time. The size of the puncture does not need to be sutured, it is so minimal. It is sealed with a special plaster. This method shortens the patient’s recovery time.
• Radiofrequency obliteration This type of phlebectomy makes it possible to precisely target the damaged area of ​​the vein using disposable catheters. In this case, the restoration of the vein section is performed at one time, which can significantly reduce pain and reduce rehabilitation time.

Phlebectomy is not always prescribed for varicose veins. First of all, attention is paid to conservative treatment.

It must be remembered that thromboembolism can be caused by various diseases (hypertension, heart attack, stroke, diabetes). If you do not pay attention to the signs of this disease, the outcome may have a tragic end.

There are certain indications for prescribing phlebectomy:

• With severe swelling of the protruding saphenous veins;
• With stagnation of blood in the legs;
• With extensive damage to the leg by varicose veins (up to the knee);
• For chronic swelling of the legs;
• For constant pain in the legs;
• With the development of trophic ulcers;
• With varicothrombophlebitis (except type I);
• With a clear burning sensation manifested along the venous lines.

Contraindications

There are times when surgery is not advisable or contraindicated. If, nevertheless, an operation is performed despite contraindications, complications, including death, are possible.

Phlebectomy is prohibited if:

• hypertension;
• last stage of varicose veins;
• coronary heart disease;
• elderly patient;
• severe infectious diseases;
• erysipelas;
• purulent skin lesions (pyoderma);
• eczema;
• in the second half of pregnancy.

Before performing phlebectomy surgery, therapy is necessary. If you seek medical help late, the opportunity for medication treatment may be missed. Then surgery is prescribed.

Preparation

Surgery is not as scary as it is made out to be. You just need to tune in to a positive wave and prepare yourself for the operation. This can not only get out of a stressful situation, but also make the surgeon’s task easier.

When preparing for surgery, you need to follow some recommendations:

• Take a shower;
• Check the operated limb for the presence of rashes (pimples or pustules);
• Remove hair from leg;
• Talk with your doctor about the operation, the planned type of anesthesia, and drug treatment;
• If it is necessary to use general anesthesia, cleanse the intestines;
• Prepare soft, comfortable shoes and loose clothing;
• Talk to the surgeon about possible allergies to medications used during surgery.

There is no need to refuse preoperative ultrasound examination. Based on the results of the ultrasound, you can assess the condition of the veins at the current moment. This can be triplex or duplex scanning.

You should stop taking certain medications before surgery. If during this period any deviations in health occur, you must inform your doctor.

Phlebectomy involves the complete removal of damaged sections of the vein. Let's consider the approximate course of the operation. The use of general anesthesia is currently not relevant. The surgeon performs all manipulations under local anesthesia. The person being operated on is aware of everything that is happening, but there is no pain. It will be necessary to fix the body on the operating table. This precaution helps to avoid involuntary movements of the person being operated on the table, which can lead to disruption of the operation.

There is no need to describe the entire course of the operation in detail. The surgeon makes a skin incision in the distal and proximal areas of the limb - where varicose veins are projected. The damaged venous trunk is removed through the incisions. The final stage of the operation is suturing the incision sites. In particularly advanced cases, combined phlebectomy is required.

When a patient seeks medical help in the late stages of varicose veins, the doctor may prescribe a combined phlebectomy to save the situation.

The whole process consists of several stages, the order of which must be strictly adhered to:

• At the first stage (crossectomy), blood flow in the damaged vein is stopped. This is done by ligating the superficial veins. The site of this procedure is the femoral inguinal fold or popliteal region.
• The next stage is stripping. The affected areas of the veins identified using duplex scanning are removed. Varicose veins mainly affect large longitudinal veins. And the legs remain unaffected. Most often, a short stripping is used (the vein is removed through a puncture in the lower leg and an inguinal incision). There are several operating techniques, including Bebocca probe, cryoscripping, inversion and PIN stripping.
• The next step, cutting off the communicating veins, makes it possible to avoid the formation of unsightly scars and reduces the postoperative recovery period. This manipulation can be performed in two ways, depending on the depth of the veins. If the communicating veins are shallow, then the entire procedure can be performed through skin punctures and is less traumatic. If significant changes have occurred in the vein, if the veins are deep, it becomes necessary to make deep incisions, which previously left unsightly scars on the leg. Endoscopic equipment allows you to avoid this.
• Miniphlebectomy, as a type of surgical intervention, is both highly effective and effective from a cosmetic point of view. Punctures in the skin are made under local anesthesia. From them, sections of the vein affected by varicose veins are extracted. For these purposes, a special hook is used. With a miniphlebectomy, there is no need for sutures and the scars are almost invisible.

Postoperative period

Combined phlebectomy for varicose veins involves being under medical supervision for a week after the operation. It is at the end of this period that the sutures in the groin area are removed. In the popliteal area, the sutures are removed after 10 days. It is necessary to wear compression stockings around the clock for one month. A little physical activity will be of great benefit in rehabilitation. At the end of the month, knitwear is allowed to be removed at night.

• Immediately after the operation, you can and should turn and perform flexion actions with your legs. It is recommended to elevate one side of the hospital bed to improve blood circulation.
• Compression hosiery and elastic bandages can be used on the recommendation of the attending physician one day after surgery. Only then is it permissible to get out of bed.
• To facilitate the rehabilitation period and prevent the formation of blood clots in the postoperative period, preventive massage and physical therapy are recommended.
• There are intensity limits for physical activity. Aerobics and gymnastics are not recommended. It is prohibited to heat the feet (taking hot baths and visiting the sauna).
• After removing the stitches, you need to take care of yourself.

Are complications possible?

The objective possibility of postoperative complications, according to doctors, is minimal, but one hundred percent absence of complications cannot be guaranteed. Phlebectomy for varicose veins is still a surgical intervention, and not a simple cosmetic procedure. A significant portion of complications can occur immediately after surgery.

Types of complications after phlebectomy:

• severe bleeding;
• weakening of sensitivity (if the saphenous nerves were damaged during the operation);
• suppuration (occurs at the site of a hematoma);
• numbness (in the lower leg and ankle);
• bruises (result of laser surgery);
• pain (at the operated area);
• deep vein thrombosis (quite rare).

Phlebectomy is currently quite common and is performed either in a public or private medical institution, in the department of vascular surgery. The price for phlebectomy in Moscow clinics depends on several factors, in particular the level of the clinic, the complexity of the surgical intervention and the qualifications of the surgeon. Phlebectomy is cheaper in clinics in St. Petersburg.

sostavkrovi.ru

Varicose veins and ways to combat the disease

The beauty of a woman’s legs is an important component of her emotional and psychological health. The real tragedy is the development of painful forms of the lower extremities, which are difficult to hide under clothing. One of these ailments is varicose veins. Modern medicine offers many solutions to overcome negative symptoms. For example, change your lifestyle, force yourself to move more, give up bad habits.

Today, specialists provide drug therapy and surgical intervention. Phlebectomy is not a type of plastic surgery; it is a responsible intervention in the functioning of the body, which is subject to serious pathological changes. The purpose of the operation is to normalize the passage of blood flow through the deep veins, so the shorter the delay period, the better for further rehabilitation.

The operation is not performed if:

• chronic varicose veins;
• hypertension;
• cardiac ischemia;
• complex infections, eczema.

Intervention in old age and in the second half of pregnancy is undesirable. The procedure for removing saphenous veins is simple - it lasts no more than 2 hours. The surgery does not disrupt normal blood circulation in the legs, since up to 10% of the blood flows through the subcutaneous capillaries.

Postoperative scars are invisible and are no more than 0.5 cm in size.

Complications after phlebectomy

Negative consequences are minor and unlikely, but they do happen. Their degree depends on the initial state of the venous system before surgery, some associated ailments and factors. At the initial postoperative stage, the appearance of bruises and bleeding from small capillaries that were not tightened during the procedure is possible. Bruises disappear within a week, after a maximum of 10 days, and bleeding is harmless and gradually stops as it heals.

Very rarely, blockage of arterial vessels occurs due to the detachment of a blood clot - thromboembolism. Its cause may be low blood pressure in the artery, wound infection, or prolonged bed rest. Recommendations for preventing blockage of deep vessels are as follows:

• getting up on the first day after the procedure;
• the use of appropriate medications that improve blood characteristics;
• compression therapy.

An undesirable complication may be a relapse, since only the affected areas of the capillaries are removed. If preventive measures are not followed, previously healthy vessels begin to hurt. To prevent the recurrence of the disease, be sure to follow the advice of the treating staff. It is possible that tissue numbness in the incision area may develop, pus and pain may appear. The postoperative cosmetic condition of the veins largely depends on the individual predisposition to pigmentation, scarring, healing and the general immune background of the body.

The restoration of normal functioning is ensured by a complete change in the approach to one’s previous lifestyle, if it included inactivity, poor nutrition, alcohol abuse, smoking or very hard physical work. Often the latter concerns men and women who live in rural areas. Pregnancy is also possible after phlebectomy, but not earlier than six months later. Carrying a child is accompanied not only by internal changes in the entire female body, but also by an increase in the load on the entire system of the lower extremities. Therefore, to avoid the return of varicose veins, it is worth delaying the birth of a child. If pregnancy has occurred, then the operation cannot be a reason to terminate it.

Postoperative adaptation

Rehabilitation after phlebectomy has individual characteristics for each person and cannot be the same, although common elements exist. The main condition is strict adherence to doctors’ recommendations. Any ill-considered step can aggravate the situation and cause the condition to worsen. After phlebectomy, the postoperative period is almost the same for all patients with varicose veins. The majority of patients are confident that surgical intervention involves maintaining complete immobility. As for varicose veins, this is a deep misconception. After several hours, you should perform simple physical exercises, namely, begin to raise your legs above body level. This improves venous circulation.

The next step in rehabilitation will be correct turning over, bending and straightening the legs and other simple exercises. A prerequisite for accelerating recovery will be the use of special compression garments, elastic bandages, as well as therapeutic massage. Dressing is performed the next day after surgery. In this case, the toes are bandaged, gradually covering the ankle, lower leg, and up to the knee joint.

Physical inactivity is one of the main causes of the development of numerous modern diseases, including damage to the venous vessels of the lower extremities. After vein surgery, you should not continue a sedentary lifestyle to prevent the disease from reoccurring. Dosed physical activity will definitely help you adapt after surgery. But sports and related activities are completely excluded. During the first 10 days it is prohibited to take a steam bath, visit saunas, gyms, or swimming pools. Walking is allowed, and a little later - cycling. All classes must be conducted under the supervision of a physician. For older patients, the most effective way to speed up recovery after phlebectomy is light physical activity.

Exercises will help avoid the development of side effects due to increased drug effects and weakening of the immune barrier.

www.jlady.ru

Indications for surgery

Phlebectomy is not prescribed for all patients suffering from varicose veins. If you can get rid of the problem using traditional non-surgical treatment, the patient is not prescribed surgery.

Indications for phlebectomy are:

• extensive varicose veins;
• the presence of trophic ulcers caused by varicose veins;
• clear signs of impaired blood outflow, accompanied by a feeling of heaviness, swelling, increased fatigue of the legs, even without dilatation of the superficial veins;
• acute thrombophlebitis;
• blood stagnation in the lower extremities;
• a burning sensation along the venous lines of varicose vessels.

How is the operation performed?

Phlebectomy involves complete removal of the affected veins. The duration of this operation is only one to two hours. In most cases, local anesthesia is used - the patient does not feel pain and is aware of everything that is happening in the operating room. The patient's body is fixed on the operating table to prevent involuntary movements during surgery.

Through incisions, the surgeon removes the damaged venous trunk. After the operation, minor scars remain, only about 3-5 mm, which over time turn white and become completely invisible.

If emergency surgical intervention is necessary, combined phlebectomy is prescribed.

This operation consists of four parts:

• crossectomy - ligation and suppression of superficial veins, stopping blood flow. This is done either in the femoral inguinal fold or in the popliteal region;
• stripping - identifying affected areas of blood vessels using duplex scanning. The vein is removed through a puncture in the groin or calf area. There are several operational stripping techniques - cryoscripping, inversion, Bebocca probe, PIN scraping;
• suppression of communication veins. If the communicating vessels are localized close to the skin, surgeons use low-traumatic manipulations. When the veins are deep, the doctor uses endoscopic equipment. This method allows you to get rid of unaesthetic scars on the skin after surgery and shortens the postoperative period.
• microphlebectomy - this type of surgical intervention combines good performance and cosmetic effectiveness. Under local anesthesia, the doctor makes punctures in the desired areas of the skin, from which the affected veins are removed using a special hook. The advantage of this type of operation is that there are practically no scars left on the skin.

Contraindications for surgery

Phlebectomy is contraindicated in the following cases:

• the presence of severe infectious processes;
• inflammatory processes on the skin of the legs, such as eczema, erysipelas, pyoderma;
• pregnancy period, especially the second and third trimesters;
• late stage of varicose veins;
• old age of the patient (over 74-75 years);
• cardiac ischemia;
• hypertonic disease;
• impossibility of elastic compression (for example, obesity in a patient);
• the inability of a person to actively move after surgery;
• acute thrombosis of superficial or deep veins;
• atherosclerosis of the arteries of the lower extremities.

A relative contraindication is previous thrombosis. In this case, the possibility of surgical intervention is determined by the doctor individually.

Possible complications after surgery

After an incorrectly performed surgical intervention and poor quality care, the patient may experience the following complications:

• bleeding;
• suppuration of wounds;
• pain in the surgical area;
• numbness in the area of ​​the legs and thighs;
• lymphocele - the formation of cavities filled with lymph;
• decreased skin sensitivity.

A minor complication of phlebectomy, which almost always occurs, is the formation of hematomas - small bruises. These formations disappear within one to two weeks after surgery.

More serious complications, such as thromboembolism and deep vein thrombosis of the leg, are quite rare today, since doctors use modern treatment methods.

Improper rehabilitation can also cause healthy veins adjacent to the diseased ones that have been removed to become varicose veins. The postoperative period is a time when special attention should be paid to the health of the cardiovascular system.

Recovery after surgery does not require much expense or a long time.

A week after the operation, you can engage in physical therapy and massage. Rehabilitation in the form of physical exercises after phlebectomy is especially necessary for elderly people who have crossed the sixty-year mark. The intensity of training is determined by the doctor individually, depending on the patient’s condition and age.

A mandatory recommendation in the postoperative period of phlebectomy is to limit physical activity, namely, lifting heavy objects. Also, the operated person is strictly not recommended to drink alcohol and smoke.

ovenax.ru

After a phlebectomy operation (an operation to remove varicose saphenous veins), the patient must adhere to certain recommendations aimed at preventing possible complications, as well as speeding up the recovery process. Rehabilitation and its duration depend on the technique of performing phlebectomy and the degree of trauma of the operation for the patient.

Postoperative measures

The early postoperative period should take place in a hospital under constant medical supervision. Combined phlebectomy is performed under general or spinal anesthesia.

In the first few hours after the procedure, the patient recovers from the effects of anesthesia. During this period, pain may occur due to damage to soft tissues during surgery. To eliminate painful sensations, it is recommended to use painkillers and venotonic drugs.

After restoration of motor ability of the lower extremities, it is not recommended to be in an immobilized position. Within a few hours after surgery, you should move your legs, lift and bend them. To improve blood flow, the legs should be in a slightly elevated position. You can start walking the next day after surgery.

• degree of development of varicose veins;
• general condition of the patient;
• presence of chronic diseases;
• volume of surgical intervention;
• nature and technique of phlebectomy.

Stitches placed on the incision in the groin area are usually removed one week after surgery. In the popliteal area - after 10 days. The duration of hospitalization after surgical removal of dilated veins ranges from 3 to 5 days (depending on the patient’s condition). Constant compression of the lower extremities, necessary in the postoperative period, is carried out with elastic bandages.

Recovery process at home

At the end of the hospitalization period, in order to avoid relapse of the disease, the patient is prescribed round-the-clock wearing of compression stockings. After a month, round-the-clock compression is replaced by daytime compression, which is necessary until the venous insufficiency completely disappears (about 2-3 months).

To avoid complications in the postoperative period, special attention should be paid to the sutures. Scar formation takes several months, so after phlebectomy it is necessary to follow certain rules for caring for sutures:

• at first, you should not rub the seam area and use rough washcloths or aggressive detergents;
• It is forbidden to take a hot bath, visit a sauna or bathhouse, which leads to vasodilation. It is recommended to wash with warm water;
• You should not tear off the crust that has formed on the seams, so as not to disrupt the wound healing process;
• It is recommended to lubricate the suture area with antimicrobial agents to prevent infection.

Recovery in the first month involves limiting exercise and taking a gentle lifestyle. Walking and exercises that normalize blood flow are recommended. After this period, you can return to your usual physical activity.

The diet prescribed for a speedy recovery and prevention of varicose veins should include foods that help thin the blood and strengthen the vascular wall. You should limit your fat intake and increase the amount of vitamin-containing foods (fruits and vegetables) in your diet.

Preventive measures

Even when the rehabilitation period ends, to prevent relapse of the disease, you should lead a healthy lifestyle and adhere to certain recommendations, including:

• proper nutrition and weight control;
• giving up bad habits;
• walking in the fresh air;
• cycling, running, swimming;
• exercises to prevent venous insufficiency.

The most effective exercises for strengthening the veins of the lower extremities that can be performed in the period after surgery are listed below:

• an exercise that is performed while standing on the floor. Feet must be placed shoulder-width apart and tilted downwards. Your fingers should touch the floor and your legs should remain straight;
• sitting on the floor. Your legs should be spread wide and your arms folded across your chest. In this case, bends forward;
• kneeling. It is necessary to spread your arms to the sides and walk on your knees back and forth.

Exercises with circular movements of the legs, standing on the toes, flexion and extension of the fingers on the lower extremities are also useful. Do not forget that physical activity should not be excessive. If fatigue occurs, you need to take a break and do breathing exercises.

After the patient has undergone phlebectomy, the postoperative period, the recommendations of doctors on which must be followed accurately and consistently, is an important stage of recovery. It depends on it whether a person will get rid of varicose veins or have a relapse.

Phlebectomy is a surgical procedure in which dilated varicose veins are surgically removed from the patient. The operation is performed in a hospital setting. During this procedure, the patient is given spinal anesthesia. Its exposure time can be from 2 to 3 hours. Therefore, after the operation is completed, the patient is left in the hospital ward under the supervision of the nurse on duty.

At this time, most patients almost completely lack any sensation in the lower extremities, and motor ability with their legs is extremely limited.

After the effect of spinal anesthesia wears off, no one limits the person’s movements; on the contrary, doctors give the patient recommendations on how to actively but measuredly walk during the first 24 hours after restoration of sensation in the legs.

Postoperative hospital stay

After surgery, doctors prescribe medications to the patient that are intended to eliminate possible pain. For this purpose, medications from the group of phlebotonics (for example) and antiplatelet agents are used for 1-2 days (Aspirin is most often used - it is needed to thin the blood so that blood clots do not form).

If complications arise due to infection of the operated area of ​​the leg, the patient may be prescribed antibacterial medications. At the same time, he is given compression therapy around the clock.

A person may be prescribed a diet, which may be limited by the presence of concomitant ailments in the patient.

While the patient is under the supervision of doctors in the hospital ward, he is given dressings, which are usually done on days 1, 3 and 6. Sutures are removed on day 7 if they are made in the groin area. If the patient’s popliteal part was sutured, then the threads are removed on the 10th or 12th day after surgery. Most often, the patient stays in a hospital ward (the so-called hospitalization period) for no more than 5-7 days.

During this entire period of time, he receives round-the-clock compression using special compression garments, which are selected for the patient before surgery. After 10-12 days after surgery, elastic bandages or hospital compression garments are replaced with compression tights or knee socks of the class that doctors recommend the patient wear.

Actions after discharge

After a person is discharged from the hospital, he will be monitored as an outpatient at the medical facility where he underwent surgery to eliminate varicose veins. Monitoring the patient is necessary in order to timely diagnose possible postoperative complications and quickly eliminate them.

The patient continues to receive round-the-clock compression in an outpatient setting using elastic bandages or compression stockings for 30 days. Then the patient is transferred to compression procedures only during daylight hours, usually during the day. This course of therapy continues until all negative manifestations of chronic insufficiency in the venous vessels completely disappear. If this is necessary, then to speed up the patient’s recovery, he may be prescribed courses of conservative therapy, which include taking recommended medications, using various physical therapy techniques, and courses of special gymnastics, etc.

If the patient has dilation of the venous channels in the second leg, then the second operation can be scheduled only after six months. If this is not the case and the first surgical intervention went well, then the patient should undergo a control ultrasound examination (Doppler ultrasound) six months after the operation.

Treatments at home

After a person has undergone a radical surgical operation and all the negative effects of chronic varicose veins have been stopped without complications, in order to avoid recurrence of varicose veins, the attending physician gives the patient the following advice:

1. If a person was sedentary or had a sedentary job (driver, office worker, etc.), then he should switch to an active lifestyle and, if possible, change jobs.
2. The patient is recommended to switch to a balanced diet, eliminating all fatty, spicy, fried, smoked foods. He should stop drinking alcohol and walk more in the fresh air.
3. At home, he can use (after consultation with his doctor) various methods and recipes of traditional medicine aimed at eliminating the symptoms of varicose veins. To do this, you can use natural apple cider vinegar (compresses, baths), sea salt and other methods.

A person should wear compression garments of the lowest class almost until the end of his life.

Most often these are knee socks with the first degree of compression. But it is best if the patient wears tights of this class or even a whole suit made of compression material (the kind produced for swimmers). The patient must undergo courses of medication to eliminate the threat of relapse and carefully follow all of the above advice.