Surgery for varicose veins in the legs: what to consider before the operation
The surgical procedure is recommended when the veins are moderately or markedly dilated (at least three to five millimeters apart). Generally, these veins are tortuous, easily perceived under the skin because they appear to be embossed, and can not be otherwise treated. This type of varicose vein is the one that most worries and needs to be treated as soon as possible to avoid complications.
In the procedure, the vascular surgeon can only remove the varicose veins located on the thighs and legs of the patient. Removal of the saphenous vein is only necessary when it is also not functioning properly. In this case, vein extraction is done through two small cuts: one in the groin area and the other at the ankle. The vascular surgeon uses the vents to introduce a thin steel cord that assists in withdrawing the vein.
Today, doctors prefer to use an intravenous laser to treat the saphenous vein. Thus, it is not necessary to extract the vessel. It is only necessary to perforate a small hole in the skin with the help of a needle, so that the doctor inserts an optical fiber with a laser on the tip into the vein. Upon being released along the vessel, the energy of the laser causes the vein to close and promotes the disappearance of the varicose veins, making removal of the saphenous vein unnecessary.
Even if it remains in the body, the blood circulates no more for it, but for the other vessels. This disuse of the saphenous vein, the main vein of the leg, can be done in two ways. In the first, the laser light is directed only at the front, while in the second, there is also a direction to the sides, so that the application occurs evenly. The latter is the most used today.
Understand how removal of the saphenous vein
The surgery for saphenous vein removal, known as saphenectomy, requires preparation of the patient before the operation. The first prerequisite is preoperative examinations, which may include a surgical risk assessment with a cardiologist.
If the exams show that surgery for varicose veins in the legs can be performed, the procedure is scheduled by the vascular surgeon. At this time, the patient should be aware of the location where the saphenous vein will be removed. The correct thing is that it is performed in a hospital or clinic with adequate infrastructure to meet any complications that may occur during surgery.
Hospitalization does not need to be done in advance. Providing it a few hours before the scheduled time for the operation is the default behavior. The time spent in the hospital or clinic after the procedure is that it may vary. Depending on the size of the surgery and the method used, the patient can be released to recover at home on the same day or only after 24 hours.
Identification of the veins to be treated is done by the vascular surgeon moments before the operation. The doctor marks each of them with a special pen so that the varicose veins become more apparent and none be forgotten at the time of surgery. In this process, light emitting devices and ultrasound may also be used.
Upon arrival in the operating room, the patient receives anesthesia. There are three possibilities:
local anesthesia
It is done when only a few collateral veins are drawn and when the saphenous vein is treated with endolaser in most cases.
Spinal or general anesthesiaSpinal anesthesia is the same as that of pregnant women receiving cesarean delivery. This type of anesthesia, like the general one, is administered in cases where there are several veins to be removed or when the saphenous vein must be withdrawn.
After the anesthesia, the doctor starts the surgery making small cuts, close to the markings made previously. It uses them as a way of accessing the veins that will be removed, with the exception of the saphenous vein, which is extracted in another way, when necessary.
Two utensils are used to remove the vessels. One is similar to a crochet hook. The other is a forceps, with which the vascular surgeon gently directs the vein out, to prevent it from breaking in the process.
The action is repeated with each vein that needs to be removed. Surgery is completed when all vessels are removed.
The technique is different when it is necessary to extract saphenous vein. In patients whose only solution is the removal of this vessel, the physician begins the operation with an incision in the skin of the groin. The next step is to differentiate the saphenous vein from the femoral vein and undo the connections with the deep and superficial venous systems. An important care at this time is with the possibility of bleeding.
The surgeon then performs the procedure by cutting close to the foot or near the knee to locate the saphenous vein at the other end of the body. And, through a small opening in the vessel, a long, thick wire, called a phlebextractor, is carried to the groin. He is tied to the vein to take it out of the leg as the doctor pulls it back in one of the directions (the groin or the foot).
The accumulation of blood is controlled by compression. Only after that, the skin is sutured and the dressings are made with masking tape. The operated leg is bandaged to prevent possible bleeding, to prevent blood from accumulating and bruising. Approximately one day after surgery the dressings are removed.
For a while, the patient may need to take pain medications and anti-inflammatories. Rest should occur with your legs up. It is important to follow the recommendations of the vascular surgeon and go back to walking slowly. In some cases, the use of compression stockings is also indicated after surgery.
What you need to know before having surgery for varicose veins in the legs
Surgery for varicose veins in the legs is a safe and decisive procedure, provided that the patient remains attentive to the postoperative care during the recovery process. The doctor may advise the patient to remain on a rest day, legs up, and wear compression stockings when walking again.
Therefore, when it is possible, it is interesting to plan before surgery, since after doing so, the patient will have to stay between one and seven days away from routine activities and will need help to perform some tasks of the day at day.
The ideal is to have no appointment or leisure activity scheduled for the post-surgical rest period, as it is prohibited to expose the skin to the sun, especially if it is stained. It is also not allowed to shave, massage, among other beauty treatments.
After surgery for varicose veins in the legs, the woman should leave some habits behind, such as taking the contraceptive pill as a contraceptive method. In contrast, despite the long and careful recovery period, only one surgical procedure is necessary, provided that the patient takes proper care even after the post-surgical period.
There are treatments for varicose veins that do not require rest, such as new laser techniques, but need to be indicated by the specialist.
Find out if laser treatment is right for you
Surgery for varicose veins that uses endolaser is usually indicated to treat cases where the saphenous veins and perforating veins undergo changes in functioning because of varicose veins. The patient undergoing this technique receives local anesthesia and light sedation, most of the time.
After the surgery, you have to rest for just one day. There is no scar formation and the chance of bleeding is almost nil.
In the treatment for varicose veins with transdermal laser, the patient does not need any rest, with immediate return to normal activities ..
Recovery is faster, in this case because it is not necessary to pierce the skin to apply the laser. For this reason, too, the procedure is considered minimally invasive.
The way laser warms blood to the skin to promote vein contraction and vessel closure is more effective in eliminating telangiectasias and varicose veins considered to be smaller.surgery for varicose veins in the legs: what to consider before the operation
Dilated veins with a thicker appearance should not be treated with transdermal laser, because the method is not very resolute in these situations. That is, its action is insufficient to cause dilated veins to cease to be harmful to the blood circulation.
The only people for whom the use of any type of laser is not recommended as a treatment option for varicose veins are those who are pregnant, those who have had thrombosis in some cases have vitiligo or need to make use of photosensitizing medicines.
The vascular surgeon may suggest for patients with any of these limitations other treatments for varicose veins, such as those using dense foam or sclerotherapy.
Factors that favor the appearance of varicose veins
The major cause of varicose veins is linked to genetics, a factor that is not changeable. People whose father and / or mother have varicose veins are more likely to suffer from dilatation of the veins.
The chances of this happening, however, are also related to living habits. The adoption of a poorly recommended lifestyle greatly facilitates the development of varicose veins. However, knowing what they are, you can avoid them:
Sedentary lifestyle
Staying long periods of standing or sitting in the same position without moving the legs is one of the situations that most favors the formation of varicose veins. Circulation requires that the legs be moved so that the calf muscles contract, as this will help the blood return from the lower limbs to the heart.
Obesity
Being overweight is harmful because it exerts too much pressure on the vessels through which the blood circulates. In that way, a greater effort of the veins for the conduction of the blood is required. This can damage them to the point of preventing them from exercising their work properly.
Hormonal variations
Hormonal changes are a problem that affects women more. The level of hormones, such as estrogen, above normal can damage the structure of the veins and, consequently, compromise the proper functioning of blood circulation.
How to know if you have varicose veins
Technological advances have facilitated the diagnosis of varicose veins. Image examinations, such as ultrasound with Doppler, for example, that emits ultrasound waves and allows to see the images of the veins and to evaluate if the blood flow is normal, is one of the most used to confirm the existence of varicose veins.
Along with clinical examination, imaging examinations are two of the ways for the vascular surgeon to assess the existence and perform accurate mapping of the varicose veins. By observing and analyzing the exams, the doctor can obtain the necessary information to define the method that will be used in the treatment of each case.
What the vascular surgeon observes is whether the blood reaching the legs through the arteries is returning to the heart, through the veins, as it should. Augmented reality equipment enables the visualization of the veins inside the skin and allow this observation more precisely.
In general, the test is noninvasive, easy to perform and has no contraindications. In addition, it allows the visualization of veins that are not evident to the naked eye.
One of the analyzes that is done is whether the valves, which function as a sort of blood vessel, are performing their function as expected.
In short, when the blood wants to pass through the vessel to reach the heart, the valves open. Soon after the passage, they close, in an attempt to avoid blood flow. However, when the valves, for some reason, fail to work properly, this backflow is almost inevitable.
There are situations in which, from the examinations, the vascular surgeon can identify secondary causes of varicose formation and act to reduce the return of varicose disease.
The symptoms that report that the veins are suffering from the dilation are the sensation of pain, perceived sometimes, when touching the affected region, and the sensations of weight and swelling.
Going to the doctor when any of these symptoms appear, even if it is considered too early to have a complaint regarding varicose veins, is crucial to avoid the progression of the condition.
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