Removal of a vein is called. Surgery to remove veins on the legs: price, methods, consequences and rehabilitation. Traditional phlebectomy or laser

From this article you will learn: what is miniphlebectomy, for what diseases this operation is performed, how to prepare for its implementation. Technique of miniphlebectomy and the course of the postoperative period.

Article publication date: 06/19/2017

Article last updated: 05/29/2019

Miniphlebectomy is a minimally invasive surgical procedure in which surgeons remove varicose veins through small incisions or punctures in the skin.

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Compared to traditional phlebectomy, this surgical intervention is characterized by a better cosmetic effect and the absence of large scars, the possibility of being performed on an outpatient basis and under local anesthesia. Sometimes this operation is called an outpatient phlebectomy.

Miniphlebectomy is performed by vascular and general surgeons.

Indications for outpatient phlebectomy

Miniphlebectomy is performed to eliminate varicose veins. This operation is used specifically to remove the most varicose veins, and not to remove all saphenous veins.

Contraindications and limitations of outpatient phlebectomy

Miniflebectomy is performed to remove varicose veins, with its help it is impossible to eliminate the cause of this disease - venous insufficiency and increased pressure in the superficial saphenous veins. Therefore, miniphlebectomy is often combined with other methods of treating varicose veins - with, subcutaneous veins.

With caution, this operation is carried out with the localization of varicose veins on the dorsum of the foot, ankle and in the popliteal region. These places are more sensitive to trauma, the veins located in them are harder to remove.

Contraindications for miniphlebectomy include:

• Infectious process at the site of the operation.
• Severe peripheral edema.
• Severe general health condition of the patient, for example, decompensation of diseases of the cardiovascular or respiratory systems.
• Patients with poor blood clotting, for example, due to the use of anticoagulants (warfarin, xarelto) or the presence of certain diseases (hemophilia).
• Patients with increased blood clotting who have an increased risk of developing venous thrombosis.
• Deep vein thrombosis.
• Pregnancy.

Preparing for the operation

Before performing an outpatient phlebectomy, a detailed examination of the venous system using ultrasound methods is necessary. A minimal laboratory and instrumental examination is also carried out, which allows assessing the general state of health of the patient. Commonly recommended tests by doctors include:

• general blood analysis;
• general urine analysis;
• coagulogram (blood clotting test);
• electrocardiography.

Instructions for proper preparation for a miniphlebectomy:

1. If you are taking blood thinners (warfarin, plavix, xarelto, brilinta, aspirin), tell your doctor. You may need to stop taking them 5 to 7 days before surgery.
2. If you have an allergy to any medicines (especially local anesthetics), you should tell your doctors about it.
3. Since this surgery is not performed under general anesthesia, a light breakfast should be taken in the morning before the operation.
4. Wear loose clothing and comfortable shoes on the day of surgery.
5. Sometimes doctors give special recommendations - for example, the use of ointment or tablets before surgery. You need to follow these instructions exactly.
6. Arrange with a relative or friend to drive you home after surgery. Although the pain syndrome after miniphlebectomy is not very pronounced, it can slightly interfere with free movement and driving.
7. Shave the surgical area in the evening, the day before the miniphlebectomy.
8. Take a hygienic shower in the morning before the operation.
9. On the day of surgery, do not apply any oils, lotions, creams, or ointments to the surgical area.

Execution technique

Miniphlebectomy is often performed on an outpatient basis. Despite the minimally invasiveness, this surgical intervention is carried out in operating rooms equipped with all the tools necessary to provide emergency care in case of complications.

Immediately before the operation, surgeons often mark with brilliant green or a marker all the varicose nodes that need to be removed. In this case, the patient should stand so that they can be better seen.

The skin at the site of the operation is treated with antiseptic solutions, then covered with sterile linen. Then local anesthesia is performed, after which, with a small scalpel or a thick needle, surgeons make incisions or punctures of the skin over the varicose veins. With the help of special surgical hooks, doctors separate the vein from the surrounding tissues and bring it out through the incision. Using a clamp, the surgeon “winds” the vein around it, slowly pulling it out of the subcutaneous tissue, after which it crosses both ends of the vessel. With miniphlebectomy, the ends of the removed vein are not bandaged, bleeding is stopped by squeezing during and after the operation. After removing one varicose vein, move on to the next.

Usually, small incisions or skin punctures through which surgeons remove varicose veins do not need to be sewn up.

An experienced vascular surgeon performs a miniphlebectomy on two lower limbs in 1-2 hours. At the end of the operation, the leg is washed from the remnants of blood, a sterile bandage is applied to the incisions or puncture sites. After that, the lower limb is bandaged with an elastic bandage, which provides sufficient compression of the tissues and prevents possible bleeding.

Postoperative period

Even if the miniphlebectomy was performed on an outpatient basis, you will have to stay in a medical facility for about 2 hours, after which you can go home. In the postoperative period, you should carefully follow the recommendations of the doctor and the schedule of control visits to the medical institution.

Physical activity after surgery:

• On the day of the surgery, it is important to start walking a little. To do this, every hour you need to get up for at least 5 minutes. On the second day, take short walks of 15 minutes 2-3 times. This will help reduce the risk of deep vein thrombosis and improve blood flow in the legs.
• For the first 48 hours while the bandage is on, raise your legs in a sitting or lying position at least 3-4 times a day. If you stand for a long time in the first days after the operation, this can lead to swelling and discomfort.
• Over the next few days, gradually return to daily activities.
• You can resume moderate-intensity aerobic exercise (walking, jogging, yoga, Pilates) 4-5 days after surgery if you feel comfortable doing so.
• You can fly by plane or make long trips (more than 2 hours) after 1 week.

Care of the bandage and wounds after surgery:

• During the first 48 hours, the bandage should not be removed and wetted. If it feels too tight, elevate your leg to reduce swelling. If discomfort persists, call your doctor.
• After 48 hours, the bandage should be removed, after which you can wash in the shower.
• You will need to wear compression stockings for 2 weeks after surgery, taking them off just before going to bed.
• Within 2 weeks after the operation, you can not immerse the operated leg in water - that is, no baths, pools, etc. You can only take a shower.

Possible postoperative problems:

1. Bruising and discomfort is normal after a miniphlebectomy. They disappear 3-4 weeks after the operation.
2. You can take pain medication, such as ibuprofen, to relieve discomfort or pain. Continue taking this drug for 5 to 7 days after surgery to reduce inflammation.
3. Usually, with a miniphlebectomy, there are no stitches on the skin, small incisions or punctures in the skin heal completely within 2 weeks.
4. After the procedure, you may notice a few lumps that may be tender to the touch. Don't worry, they occur in a third of patients after miniphlebectomy. These are segments of residual veins with superficial blood clots that are not dangerous and disappear over time. Massage them and apply warm compresses to them several times a day. If these lumps hurt, take ibuprofen for 1 to 2 weeks.
5. If you notice blood oozing under the bandage, apply pressure with two fingers and lie down with your leg up. If bleeding continues, call your doctor or call an ambulance.
6. If you have significant bleeding, fever, signs of an infection, or any other problem, contact your doctor or go to the nearest emergency room.

Prognosis and results of miniphlebectomy

If the miniphlebectomy was performed according to the correct indications, the long-term results of this operation are excellent. Success rates for this surgical intervention reach 90% or more. Such good results are usually associated with the elimination of venous insufficiency before miniphlebectomy. It is widespread to first perform radiofrequency or laser ablation of large superficial saphenous veins, and only then perform miniphlebectomy.

As with any treatment, new varicose veins may develop over time, especially in patients with a genetic predisposition to the condition.

Varicose veins are a disease in which there is a narrowing of the walls of the vessels of the deep veins and slows down the flow of blood.

This disease has become much younger in our time. This is due to a sedentary lifestyle (although constant work on your feet can provoke an outbreak of the disease), movement only by transport, excess weight, the ecological situation in the world, a generic predisposition to blood diseases, etc.

The early stage lends itself well to conservative methods of treatment. But if the disease has already gone far and continues to progress, then you should think about an operational way to solve the problem.

Correctly performed by a qualified surgeon, an operation to remove a vein is a guarantee of a complete cure for a debilitating debilitating disease.

Today, such operations are carried out by highly qualified specialists in medical centers equipped with the most modern equipment, and do not pose any danger to the life and health of the patient.

Indications for surgery

Vein removal is used in the following cases:

• extensive, covering a large area of ​​\u200b\u200bthe vein;
• improper expansion of the saphenous veins;
• severe swelling and fast;
• pathological violation of the outflow of blood in the veins;
• and blockage of veins.

Restrictions and contraindications

The operation is not assigned in the following cases:

• advanced state of varicose veins;
• hypertension of the 3rd degree and coronary heart disease;
• severe inflammatory and infectious processes;
• old age;
• 2nd and 3rd trimesters of pregnancy;
• skin diseases in the acute stage (eczema, erysipelas, dermatitis, etc.)

Before the operation, a thorough examination of the patient's venous system is carried out, as well as a wide one. An emergency operation is prescribed for blockage of the veins, recurrent thrombophlebitis and non-healing trophic ulcers.

Methods of surgical intervention

The operation to remove the veins on the legs can be performed using several modern techniques.

Phlebectomy is popular

In the early stages of the disease, they are carried out. Preparation for this type of operation is the most elementary. The patient takes a shower and completely shaves his leg and groin.

It is very important that before the operation the skin on the leg is completely healthy and the skin is not broken. Before the operation, the patient's intestines are cleaned and tests are carried out for allergic reactions to medications.

The operation lasts up to 2 hours under local anesthesia. Removal of the saphenous vein is absolutely safe for the human body. During the operation, an extravasal valve correction may be performed to restore blood flow.

The operation begins with an incision up to five cm long in the groin and two cm long at the ankle. The remaining incisions are made under large venous nodes. The cuts are shallow and narrow.

A venous extractor (in the form of a thin wire with a round tip at the end) is inserted into the vein through an incision in the groin. With this tool, the surgeon removes the affected vein. The incisions are then sutured and the operation is considered completed.

Of course, the leg is covered with a sterilized bandage and an elastic bandage is applied on top. After 1-2 days, the patient can already move independently.

After a phlebectomy, the patient wears (or) for 2 months, and also takes to restore the work of the veins.

In some cases, they are prescribed, in this case, small incisions are made on the leg (under local anesthesia), through which the damaged parts of the vein or even the vein are completely removed.

Sclerotherapy - painless removal of varicose veins

Today, the treatment of varicose veins with injections has gained particular popularity. In this case, a substance is injected into the vein - a sclerotant, which destroys the inner layer of the vessels, after which the middle layers coalesce and form a vein collapse.

This method is the most gentle, but to obtain a lasting effect, several procedures should be carried out and it will take about six months for rehabilitation.

This type of surgical intervention, and can also be used only for damage to veins of small diameter and with a large number of "". A foaming sclerotant is injected into the vein, the effectiveness of which increases due to a large increase in the area of ​​interaction with the inner side of the vessel.

And besides, due to its special consistency, the foam lingers in the vessel for a long time, increasing the time of exposure of the drug to the affected vessels. Therefore, with foam sclerotherapy, the number of sessions is reduced significantly.

Laser in phlebology

The most modern method of removing veins - with a laser, is intravascular. The surface of the vein is treated from the inside with a laser through a barely noticeable puncture. From the high temperature of the laser, the blood instantly boils and seals the wall of the problematic vessel along its entire length.

A huge advantage of this operation is the impossibility of infection, the speed of execution and the rapid healing of venous ulcers. But such an operation requires sophisticated equipment, highly qualified specialists, which are not available in every medical center.

The newest method of seamless technology is very interesting. With the help of micropunctures, the affected areas of veins and blood vessels are removed. In this case, even suturing is not required. In this case, a sterile elastic bandage is applied to the leg and after five hours the patient can walk independently.

Both of these methods are considered low-traumatic and painless. The patient, if desired, can go home on the same day on their own feet.

Possible consequences

After any, even the most sparing operation to remove veins on the legs, bruises, hematomas and other consequences will remain that will bother you for some time.

For some time after surgery, it is better to sleep with your legs elevated to improve blood flow.

A fairly common complication after surgery is re-developmentif the patient has a birth predisposition, and he has not changed his lifestyle.

It is extremely rare for an adjacent vessel or nerve to be injured during surgery. But this complication is completely excluded from a qualified specialist. After a phlebectomy, subtle small scars will remain on the legs.

Thromboembolic complications are very dangerous

Thromboembolic complications are the most terrible consequence of the postoperative period. And to warn them take a number of preventive measures:

• it is mandatory to wear;
• rather long wearing of elastic bandages with insufficient interaction of the valvular apparatus of deep veins;
• evenly alternate physical activity, exclude the possibility of blood stagnation;
• the use of special drugs that thin the blood to reduce blood clotting.

For a long time I was afraid to perform the operation, although varicose veins were very disturbing and for a long time. On the right leg hung a whole bunch of venous cones. The leg hurt a lot, it twisted, especially at night, it quickly got tired under stress.

The doctor suggested right away. Seeing no other way, I agreed. And now I do not regret it at all and even wonder why I hesitated and suffered for so long. The operation was performed by an experienced specialist under local anesthesia.

Seven incisions were made on the leg from the groin to the ankle. Then for two days my leg hurt very badly, but soon the pain subsided and after a week I was discharged from the hospital in good condition.

For a month, I smeared my leg and wrapped it with an elastic bandage, and also took it. Now five years have passed since the operation and my leg does not bother me at all. New venous nodes are not formed. I advise you not to hesitate in such an important matter, but to agree to surgical intervention.

Yuri V, 49 years old

From the age of 13 I was engaged in shaping, and at the age of 26 a whole bunch of venous nodes formed on my leg. My leg hurt incredibly. Nothing helped. When I came to see the doctor, he told me that the disease was in a state of neglect and recommended surgery. There was nothing to do and I agreed.

The operation lasted more than an hour under local anesthesia, it was difficult, but the surgeons supported me, distracted me with conversation. The next day I was discharged from the clinic. A month later, after several appointments with the doctor, the leg became completely healthy, without any signs of illness.

The only thing I regretted was that I had not done this operation earlier. The leg does not bother me at all, although I have completely removed a large vein. By the way, the stitches from the operation are not visible at all. To everyone who is recommended such an operation, I urge you to do it and not to think for a long time.

Anna B, 27 years old

Rehabilitation after surgery

Recommendations for the recovery postoperative period will be strictly individual for each patient and will depend on the severity of the disease, the general condition of the patient, the presence of other chronic conditions, etc.

But there are some general tips for everyone:

Vein removal operations are well developed and carried out by qualified specialists. Very often, ordinary fear does not let us decide on an operation, but is it better to endure pain and prolong the disease?

If you listen to the advice of your doctor, follow all his appointments, then the postoperative period will pass without complications, and you will part with your disease forever.

There are various ways to remove veins:

• phlebectomy (surgery to remove veins);
• miniphlebectomy (microphlebectomy), destruction and removal of damaged veins through small openings;
• endovenous laser coagulation (modern method of laser removal of varicose veins);
• compression sclerotherapy.

All of them are suitable for getting rid of a serious illness, however, the proven and best way out in such a situation is leg vein surgery.

Many are afraid of this operation, but they understand the need for such a responsible step. Removal of veins on the legs conducted by an experienced angiologist. Before the operation, he marks the protruding sections of the veins on the patient's leg with a special pencil. The marking is done in a standing position, since in this case the sections of the veins will be easier to recognize. After the marking procedure, the patient is placed on the operating table.

By prior arrangement, local or general anesthesia is administered. Under general anesthesia, the patient does not feel anything, and after the operation to remove the veins, he can immediately go to his home. However, the abuse of general anesthesia is contraindicated for all people, and for some it is generally prohibited.

Surgery to remove varicose veins begins with an incision in the groin (about five centimeters long) along the line where the bottom edge of the trunks passes. Then an incision is made near the ankle, on the inside of the leg (the length of the incision is about two centimeters). All other incisions are made over varicose veins. The incisions should be shallow, just enough to reach the saphenous vein.

Previously, all varicose nodes were removed. Today, it is enough to remove the largest ones, and the rest will disappear by themselves. The surgeon inserts a venous extractor through an incision in the groin, which looks like a thin wire with a round head at the end.

The extractor reaches the ankle, after which air begins to flow into it. The head of the extractor is inflated, and the doctor brings it back along with the affected vein. The communicative veins are pulled over, the incisions are sutured, and the surgical removal of the veins can be considered complete.

The operated leg is covered with sterile gauze and tightened with an elastic bandage on top. After this procedure, the patient needs to lie down.

Laser vein removal - intravascular laser coagulation, an alternative method of surgical operation.

The inner surface of the varicose vein is treated through an inconspicuous puncture with a laser beam. The blood, receiving the energy of laser radiation, immediately boils. High temperature instantly welds the wall of the problematic vessel throughout the entire thickness. The laser allows healing of venous ulcers. leg vein surgery laser treatment requires complex equipment, qualified personnel, which leads to an increased cost of laser treatment for the removal of veins.

Consequences of removing veins on the legs can develop according to two scenarios: unsuccessful and successful.

Unsuccessful consequences will provide you with bruises and hematomas, and in case of successful completion of the operation, the doctor will prescribe individual recommendations for you.

You should raise your legs and turn your torso, this will provide better blood flow. The next day, you need to be ready to bandage it with a bandage or put on compression stockings. After that, you are allowed to walk and exercise. After nine days, the patient is released from the stitches and personal rehabilitation courses are prescribed after the removal of the veins.

Rehabilitation includes:

• complete rest;
• walks in the open air;
• physical education;
• dietary compliance.

Cost of leg vein surgery. The cost of treating varicose veins varies significantly, depending on the quality and quantity of services provided. The price for the operation is estimated in tens of thousands of rubles: from 11 000 rub. up to 70-80 000 rubles. True, the total cost includes the price for laser light guides and other auxiliary products.

In some cases, the treatment of varicose veins requires the use of radical methods of treatment. One of them is a phlebectomy procedure (surgery to eliminate varicose veins in the legs).

Radical therapy can be used in cases where medical and alternative methods of treatment do not have the desired effect and the disease continues to progress. The essence of the method is the complete or partial removal of the affected vein. During the procedure, the following therapeutic effects can be achieved:

• Normalize the outflow of blood.
• Eliminate cosmetic defects.
• To remove not only the vein affected by the disease, but also to eliminate pathological discharges of blood in the leg area.

Carrying out such a procedure is not considered a serious operation. Modern techniques allow you to perform the necessary manipulations quickly and minimize the risk of postoperative complications.

Removal of veins for varicose veins is required in severe cases of the disease:

• The formation of trophic disorders, the development of thrombophlebitis.
• With violations of the sensitivity of the lower extremities.
• With the development of extensive varicose veins.
• With intense manifestations of the disease: a constant feeling of fatigue (even at rest), the development of intense pain, swelling.
• With pathological expansion of the saphenous veins.

Patients should be aware that if proper treatment is not carried out in a timely manner, the consequences can be serious and irreversible.

Preparing for the operation

Before performing surgery, it is imperative to consult with doctors of the following specialties: angiosurgeon or phlebologist. The doctor prescribes a preliminary examination: ultrasound, blood test.

Before the operation, you should stop using drugs, the active substance of which is acetylsalicylic acid. This precaution minimizes the risk of hematoma or bleeding during or after the procedure.

The patient's further task is simple: take a shower and get rid of hair in the area of ​​the operated limb.

Possible contraindications

The procedure is not carried out with the development of deep vein thrombosis, with a persistent increase in blood pressure and coronary heart disease, the development of inflammatory diseases in the lower extremities (eczema, erysipelas, pyoderma).

A contraindication to the procedure may be the advanced age of the patient, the second half of pregnancy, the presence of infectious diseases in the progression stage.

If the patient develops trophic disorders that are not amenable to drug therapy and are not associated with varicose veins, the doctor may cancel the operation.

How is the operation

In modern medicine, the technique of combined phlebectomy is most often used. The procedure is carried out under anesthesia. The essence of the method is to carry out the following steps:

• Crossectomy procedures - in this case, the surgeon cuts the saphenous vein at the point where it flows into the deep vein.
• Stripping procedures (removal) of the great saphenous vein affected by the disease. Manipulation is carried out using a special device - a probe of small diameter. During the manipulation, veins can be removed only in the thigh area, or the great saphenous vein can be completely removed.

In order to minimize injury to the surrounding soft tissues, the affected vein may be removed through small incisions using a narrow probe. In this case, the process of postoperative scarring decreases and the risk of hematoma formation decreases.

In the event that the operation is performed in order to eliminate cosmetic imperfections, then the angiosurgeon performs punctures of no more than 5 mm, as a result of which almost imperceptible scars remain.

There are methods for removing veins, in which there are practically no scars.

If it is required to remove an extensive trunk of veins, including from both legs, then the doctor will most likely insist on a saphenectomy procedure, a traditional surgical intervention.

How is the rehabilitation period

The process of recovery of patients after surgery is very fast. After 2-3 days, the patient can be discharged home. The recovery period can take up to several weeks. At this time, the patient is issued a special sick leave. It is necessary to follow all the doctor's instructions in order to quickly return to the usual way of life and not provoke the development of possible complications.

During the first few days after the operation, the patient may find the formation of bruises and seals. To eliminate such phenomena, the use of Heparin ointment or Lyoton externally may be recommended.

Already 2-3 days after the operation, the patient can be discharged home

14 days after the removal procedure, the patient will be re-examined by the attending physician.

If the recovery process goes well, a follow-up examination will be recommended no earlier than 60 days later. In the future, a second ultrasound examination of the veins of the lower extremities will be scheduled to verify the effectiveness of the operation.

The doctor's instructions for each individual patient may differ. It all depends on a large number of factors: the presence of concomitant chronic diseases, the stage of development of varicose veins, the results of surgical intervention.

• During the first few hours, the patient is categorically not recommended to perform flexion and extension of the operated limbs.
• In order to normalize the outflow of venous blood, the doctor may advise you to raise the edge of the bed by 10 cm.
• 24 hours after the procedure, the patient will be assigned a dressing. In this case, the use of elastic bandages or compression stockings is required: both limbs are bandaged from the bottom up to the knees.
• The patient can get up and start moving only after the dressing has been performed.
• In order to reduce the risk of blood clots, a course of therapeutic massage and physical education may be prescribed.

During the recovery period, the patient must necessarily use compression stockings and take medications prescribed by the doctor. For at least 60 days, the use of an elastic bandage or elastic stockings is required around the clock.

After the operation, it is necessary to use an elastic bandage or compression stockings.

In the future, the patient will be recommended moderate physical activity: swimming, cycling, gymnastics. It is recommended to refrain from weightlifting and excessive power loads. The patient is also not recommended to visit the sauna, take a hot bath, baths, carry weights, abuse alcohol and smoke.

A positive therapeutic effect will have a contrast shower and baths with the addition of apple cider vinegar, sea salt and essential oils.

The cost of removing varicose veins of the lower extremities ranges from 24,000-26,000 rubles and depends on the degree of development of the disease and the clinic.

And It is known that the removal of the great saphenous vein is effective in reducing the frequency of recurrence of varicose veins. This procedure is performed mainly with the help of an extractor, which is a rather long flexible wire made of metal or plastic, which is inserted into the lumen of the vein. At one end of this wire, a tip is attached, the size of which significantly exceeds the lumen of the vein. The vein is fixed on the wire with a ligature. After dissecting the vein at both ends by hard traction (of course, in the direction opposite to the end to which the tip was previously attached), it can be pulled out of the subcutaneous tissue. However, the use of an extractor is believed to be the main cause of hemorrhage and postoperative pain, which can lead to a later recovery of mobility.
S. Khan et al. , staff at Clatterbridge Hospital in Babington/Wirrel, Merseyside, United Kingdom, conducted a prospective, randomized comparison of two techniques for removing the great saphenous vein. Method A is described above: making an incision directly under the knee, the extractor was inserted after the saphenofemoral anastomosis into the foramen ovale of the tributary; the great saphenous vein was ligated at the confluence with the femoral vein, ligated, and all lateral tributaries in this area were also crossed. After that, the whole leg was bandaged and the wound in the inguinal region was closed. This method was used to intervene in 40 patients. The other 40 patients, matched by age and sex, made up group B, in which the following methods were used: surgery of the saphenofemoral fistula, as well as removal of varicose veins in the region of the great saphenous vein (patients with varicose veins in the region of the small saphenous vein were excluded from this trial) were performed the same as in group A. Removal of the great saphenous vein was performed differently: from the inguinal region, the vein was pulled tightly stretched and bluntly separated (using the index finger) from the subcutaneous tissue; then, by means of small incisions, the vein was weakened below the knee, after which it was removed. Then they closed all the wounds and bandaged the leg.
Before the intervention, all patients gave informed consent to the operation using one of two methods of arbitrary choice. After surgery, they were usually allowed to go home 24 hours later and asked to complete a symptom record sheet that included a daily pain score ranging from 0 to 10, as well as daily activity data: walking in and around the house, climbing stairs, walking longer distances. and continuation of normal activities, including work. Patients did not know which operation they had undergone until a week later, when the bandages were removed. When measuring the area of ​​subcutaneous hemorrhage, the researchers found significant differences: in group A, the surface area of ​​the hemorrhage averaged 160 cm 2 in group B - 56 cm 2 .
Analysis of the symptom registration cards showed that the severity of pain during the entire first postoperative week in group A was significantly higher than in group B; after 1 week, the mean in group A was 3, while in group B it was 1.
13 out of 40 patients of group A who underwent saphenous vein extirpation could not climb stairs, in group B there were 6 such patients; however, activity scores did not differ significantly between the two groups during the first postoperative week. Comparative data on the resumption of work for both groups is not given; only found that 76% of 62 still working patients returned to work within 2 weeks.
Based on the obtained data, the authors prefer method B, i.e. removal of the vein by dissection instead of extirpation, as it is less painful and produces less hemorrhage.
Obviously, the publication only presents very short-term results, and we cannot judge the later recurrence of varicose veins. The authors are also silent about the fact that in many Western hospitals, the great saphenous vein is usually removed completely, and not just the part above the knee.
Complete removal, however, may be completely redundant when it comes to later recurrences; with partial, only proximal removal, a part of the vein is preserved, which can be used later for vascular operations, such as coronary bypass surgery. Finally, this publication does not mention arguments regarding the interruption of incompetent perforating veins that connect the deep venous system to the superficial one. Perhaps the authors share the opinion of other researchers that the indications for interruption of perforant veins can be very limited, since R. Bjordal showed back in 1972 that they make only an insignificant contribution to venous hypertension during walking: when retrograde blood flow is mainly the trunk of the great saphenous vein was disturbed by proximal venous occlusion, venous pressure at the level of the ankle remained normal.

Literature:

1. Khan SK, Greaney MG, Blair SD. Prospective randomized trial comparing sequential avulsion with stripping of the long saphenous vein.
2. Keeman JN. Varicosis: toch liever chirurgische verwijdering (? strippen?) van de vena saphena magna. NTvG 1996 Dec 14;140:2492.
3. Bjordal R.I. Circulation patterns in incompetent perforating veins in the calf and in the saphenous system in primary varicose veins. Acta Chir Scand 1972;138:251-61.