Enlarged leg veins surgery
Varicose – Enlarged leg veins – Leg varicosity
Method of atraumatic stripping in removing enlarged leg veins. The main advantages of atraumatic stripping compared to standard methods are a significantly shorter recovery period and sick leave.
Varicose or enlarged veins are a problem that occurs to a lot of people. It is manifested by a swelling in the ankle area, an enlargement of superficial veins, which are usually the first symptoms of this disease, a feeling of heaviness and numb pains in the shin. Besides the already listed symptoms, patients that suffer from these problems complain about tingles and itching in the legs.
If the problem of enlarged veins is neglected, it may come to complications such as ruptures and bleeding from the enlarged vein, an inflammation of the superficial veins (tromboflebitis), chronic vein insufficiency characterized by swelling of the shin, inner ankle callosity, hyperpigmentation and, in the end, an open wound which is usually very resistant to treatment!
The most important natural factors in developing varicosity are weakly developed or undeveloped vein valves of the superficial veins (this is where the heredity factor plays the most important role), lack of physical activity, long sitting and/ or standing, prior leg injuries.
However, it is important to point out that the function reduction (insufficiency) of valves has the most important role in developing varicosity. Because of the insufficiency of the so called safeno-femoral valve a safeno-femoral reflux is developed and the blood column from the deep veins effuses to the superficial veins. This is how the pressure of the blood column is transferred through the superficial venous system towards the feet leading to vein enlargement.
The leg venous system anatomy
We differentiate two venous systems: the superficial and the deep one. They are interconnected by perforant veins. Two big superficial veins take the blood from the inner ankle area to the groin (saphena magna vein) and from the outer ankle area to the knee pit (saphena parva vein), where they pour into the deep veins. Vein valves (lat. valvulae) are an important part of the venous system. They work as a one-way vent and release blood from the periphery to the heart.
Neglect of enlarged veins leads to complications!
Possible complications of long-term enlarged veins are: ruptures and bleeding from the enlarged varices, an inflammation of the superficial vein (tromboflebitis), chronic vein insufficiency characterized by swelling of the shin, inner ankle callosity, hyperpigmentation and, in the end, an open wound (very resistant to treatment)!
Besides the examination with a vascular surgeon or angiologist, when the anatomic position of the enlarged veins and the presence of inflammatory changes or clogs in the superficial veins is determined, the basic examination (especially before making the decision to do the surgical procedure or not) is an ultrasound (Doppler) of the leg veins. With it we determine the porosity of the deep venous system, the level of valve insufficiency and the flow of the superficial veins. A deep and superficial vein Doppler is an examination that must be done before any leg vein procedure.
In the first stage of enlarged veins the operation treatment can be postponed by the usage od elastic-compressive bandages or stockings.
Enlarged veins that have a diameter less than 2-4 mm can be treated with sclerosation. That is a method of injecting a solution of a sclerosing agent into the enlarged vein.
Such and larger veins are also suitable for surgical removal under local anesthetics (mini flebectomy). This method consists of applying a local anesthetic in the area of the enlarged vein, small incisions in the skin (2-3 mm) and removing the enlarged vein with the help of special hooks. A compressive stocking is put on post operatively.
In the case of insufficient sapheno-femoral or safeno-popliteral valve, one of the methods that is indicated is used to remove one or two big superficial leg veins, the saphena magna vein and the saphena parva vein. We use so called atraumatic stripping of the superficial leg veins in our clinic. This procedure is performed by an experienced surgical team led by a renowned vascular surgeon.
Enlarged leg vein operation in this case consists of implementing a special sonde into the previously tied superficial vein through a small incision in the groin area and its removal just under the knee joint, also through a small incision. Through small (2-3 mm) separate incisions left over enlarged vein offsets are removed. Atraumatic vein stripping in our clinic is performed in local anesthesia under sedation, and the patient is discharged a few hours after the procedure for home care.
After this type of anesthesia, the recovery is a lot faster and easier in comparison to general anesthesia. It also brings fewer risks. The procedure is entirely painless for the patient and lasts about an hour with the preparation.
Preparation for the procedure
Although operation of enlarged veins is a routine procedure for our surgical team, a professional approach demands of us to dedicate special attention to preoperative preparation of the patient. The first step is the examination and consultation with a vascular surgeon in our clinic, during which we set an indication for a surgical treatment of enlarged leg veins and an operation date, as well as all other details concerning the surgery.
After the examination and consultation, before the procedure, it is necessary to make an ultrasound (Doppler) leg vein examination, which will determine the porosity of the deep venous system, the level of valve insufficiency and the flow of the superficial veins.
We arrange the dates for the preoperative Doppler directly with our expert assistants for all of our patients. It is also necessary to do certain blood tests before the procedure.
Before any surgical procedure, especially before enlarged leg veins surgery, patients need to stop with the usage of pain killers and nonsteroidal anti-inflammatory drugs, containing acetylsalicylic acid like Aspirin, Andol or Acisal. This is a very important factor in a patient’s preparation for surgical procedure, as this way we prevent possible bleeding and hematoma during and after the procedure. Following this instruction makes the recovery quicker and more successful, and the result of the operation is improved.
Recovery and sick leave
The main advantage of atraumatic stripping in comparison to standard methods is the significantly shorter recovery period. Elastic bandages are to be worn for 10 days following the surgery and after that it is sufficient to wear firm, elastic stockings for a period of two weeks.
The final result of this operation depends on the course of the operation, the experience of the vascular surgeon and his team, it also depends on conscientious and detailed postoperative monitoring and control. To be sure of that we insist on regular check ups and everyday contact with the patient for our patients’ safety, successful recovery and postoperative monitoring.
Ten days following the surgery the stitches from the small (2-3 mm) incisions, through which the procedure was done, are removed. In their place are left minimal, almost unnoticeable scars. After atraumatic stripping the advised sick leave and absence from work is a lot shorter than after a standard method, and they last from ten days to two weeks. The patient needs to rest a couple of days following the surgery.