Varicose veins of the lower limbs is long since known to humanity. Approximately 30% of the world population suffer from varicose veins on the legs. In 25% of patients without treatment develop serious complications (thrombophlebite ulcers and trophic). The patient it is important to understand that varicose veins is a degeneration of the wall of the vein and without the intervention of a doctor to a disease, unfortunately, only progress!
There are methods of conservative operations and is not operational for treating varicose veins. It methods of operation which belongs to the sclerotherapy. Today, it is the surgical treatment of varicose vein disease is one of the main. However, it should be noted that the surgical treatment is indicated not to all patients with the disease. The surgical methods of treatment include: tubal ligation (ligation of the vein), Stripping, microphlebectomy.
Varicose veins of the lower limbs can be called "popular disease". More than 40% of women and 20% of men have signs of this disease. In 20% of cases, the varicose veins causes ulcers trophic, more than 25% of patients have thrombophlebitis of varicose veins.
A hereditary predisposition – varicose veins is a consequence of the weakness of the connective tissues. These patients may also have hernias, hemorrhoids, etc
Excessive load – to long-term static loads (standing on feet), or a sedentary job, lifting and transfer of heavy loads, high-heeled footwear, physical inactivity (idle) – are the main factors contributing to the development of varicose veins.
Amorage varicose veins comes a strong physical stress, pregnancy and childbirth. When the excess load occurs a sharp increase of the pressure in the veins of the lower limbs and the damage of the valve of the device.
Chronic venous insufficiency – a typical complication of varicose veins in which the deterioration of the flow venous causes a medical condition called chronic venous insufficiency. The disease is progressive, but is continually evolving. The swelling can become permanent, appears to be a dark color of the skin in the ankle area.
Thrombophlebitis varicose veins – in telae venarum thrombosis called the inflammation of the venous wall, with the formation in the lumen of the vein blood clots. Varicose veins thrombophlebitis occurs in 25% of patients and sometimes complicated thromboembolism of the pulmonary artery.
Varicose ulcer trophic a wound does not heal for a long time, which occurs when serious violations of the outflow of venous by a deep and superficial veins. They are marked 1% of the total population and 20% of patients with varicose veins. Ulcers trophic appear during the execution of the stages of varicose veins.
Original varicose veins – varicose veins of lower extremities – occurs in 20% to 40% of the population of the developed countries of the world. Long varicose veins of the legs is the only mirror of the fault, but the progression of the disease leads to the onset of pain, edema of the feet and legs, and in advanced stages to the browning of the skin of the feet, of the inflammatory changes and venous ulcers.
Secondary varicose veins – post-thrombotic disease. Develops after suffering a deep vein thrombosis or the result of a congenital disease (arteriovenous fistula, congenital venous dysplasia). Post-thrombotic disease – heavy progressive in the disease process in the venous system of the lower limbs. Due to valve insufficiency, which develops as a result of a thrombosis, the blood on the deep veins starts to move from top to bottom, appears secondary varicose veins and arise from conditions to the venous stasis, especially in the lower in the feet and shins.
The indications for sclerotherapy:
Sclerotherapy can be applied as a method of treatment of varicose veins, as a complement to surgical methods.
Contraindications to sclerotherapy
The duration and the technique of performing the sclerotherapy
The procedure of sclerotherapy lasts from 5 to 30 minutes, depending on the number of varicose veins, which need to eliminate.
The procedure of sclerotherapy is performed with the patient in a horizontal position. Before administration of the drug, the patient should lift the foot to the blood in the veins of glass. The objective of this reception – reduce the amount of blood in the container for sclerosant not dissolved in it, and acted directly on the wall of a vein.
During a session of sclerotherapy physician can do 5 to 10 keys. The number of introduce a drug determined by the weight of varicose veins and the dose of sclerosant. On average, the rate of healing can take from 3 to 5 sessions.
The effectiveness of sclerotherapy
The advantage of sclerotherapy it is considerably lower cost compared to the operation, the absence of the need to be in the hospital (that is to say, the patient can go back home), as well as the more rapid the recovery period.
The effectiveness of sclerotherapy to the resolution of the manifestations of varicose veins reaches 85%.
Indications for the surgical treatment of varicose veins
The surgical treatment use cases where conservative treatment and lifestyle changes do not eliminate the symptoms.
Usually Stripping is conducted during the removal of varicose veins. In addition, as the method of intervention applies to the prevention of the changes on the part of the skin in the form of ulcers.
Used in Pickling, generally:
If You have as small and large varicose veins may need more than one treatment method. Usually, Stripping large varicose veins of varicose veins is complemented by sclera therapy more small venous branches.
Most of the surgical methods of treatment of varicose veins on the legs pass in an outpatient setting. That is, the patient should not be in the hospital, and may, after a transaction to the time you go home.
Contraindications to treatment by methods such as ligation and Stripping
Before the operation, You must do the following survey:
You have preferably at least 2 weeks before surgery do not take medications that affect blood clotting (e.g., aspirin, cough). Stop smoking 2 weeks before surgery, because smoking is harmful to the healing process. Refrain from consuming alcohol.
For the indications proposed additional surveys – developed for the biochemical analysis of blood, ULTRASOUND of internal organs, advice from specialists, etc, the Patient receives the recommendations of the physician, who must perform.
The operation expoliantes can be performed under local or general anesthesia. The duration and the technique of realization of the operation – Stripping.
Stripping is a minimally invasive intervention, in which struck vienna is removed with the help of a small fine probe. This is usually two small cup, a in the region of an end of varicose veins, and the other on the other end. After that vienna is selected, it intersects in two places, but in the light of the probe is introduced. The head of the probe is fixed (thread) to the end of vienna (that is to say, the place vienna, from where came out of the probe. Then, the surgeon removes the reason of this probe of vienna.
Usually Stripping is conducted to remove the veins of the region of the groin to the patella of the pit or ball pit, down to the bone.
The benefits of the exuere' is that it is not carried out along the dissection along the vein, but only an incision at the beginning and at the end of the vienna. The first cuts will be in the region of the groin, where it will be completely the rim of the underwear cloth.
Now, apply the method of short-exuere'. Short Stripping different, this is for suppression only affected by segments of varicose veins. And vienna with, normal valve remains without change. This allows to reduce the duration of the surgery, trauma and improve cosmetic effect.
Among the benefits in the short exuere' are the faster the recovery time and the almost total absence of pain in the postoperative period.
Previously, doctors were of the view that the holding of exuere' is not desirable in the sense that, if all of a sudden the patient will ever need heart surgery (coronary bypass), vienna on the leg to be used as a shunt during this operation will not. However, to date, it is estimated that varicose veins may not be good shunts for such an operation. In addition, in most cases for such an operation role of shunt may play the thoracic artery, and in addition, for these purposes, you can take the veins with the hands.
Ligation is the ligation of varicose veins. Usually, ligaturam methods do not apply separately, but only as a supplement to the other – phlebectomy, expoliantes.
microphlebectomy is a procedure in which the varicose veins is collected by puncture in the skin. The operation miniphlebectomy is a minimally invasive operation which requires a minimum of anesthesia.
miniphlebectomy is done with the particular help of the hook, which is inserted under the skin in the area of varicose veins through a small incision – puncture. This hook varicose veins is drawn to the outside, after which it bandaged and cross. Then, the same method takes place the removal of other veins.
It is also important to note the fact that the removal of veins such as Stripping or ligation, leads to the formation on the location of varicose veins, bruising (haematomas). But not worth worrying about, because they disappear after 2-3 weeks after the application of ointments. On the site of the puncture remain almost invisible scars.
Among the advantages of miniphlebectomy it is important to note a high efficiency, a small traumatic and almost complete preservation of the integrity of the patient, and, of course, stunning cosmetic effects.
After the operation of removal of the veins of the recommendations will be different for every patient – it depends on the degree of varicose veins, the volume of the operation, the presence of chronic diseases.
Since the first hours after the surgery, it is recommended to roll, fold the legs, etc, And simple lifting of the edge of the bed 8-10 cm improves the blood circulation.
The day after the operation is done ligation with the application of the compression shirt or band lastique on the two legs of the tip of the fingers to the groin. Are allowed to walk after the ligation. Also, after the removal of the vein it is recommended that physical therapy and massage for the prevention of thrombus formation.
7-10 days after the surgery is not worth it to exercise and access to the steam room or sauna. 8-9 days, the wires are removed, and affected the course of the therapy. Elastic band compression requires at least 2 months after the withdrawal of points.
Are particularly important when the exercise varicose veins for patients aged. It is the ideal prevention of post-operative complications – the slowing down of the flow of venous blood and postoperative thrombosis. For the prevention of thrombosis also prescribe medications.