The treatment of varicose veins in the lower extremities is usually a combination of one or several surgical procedures. The procedure that is well established in Chaoyang Hospital and the one I personally perform most often is transilluminated spinotomy (transilluminated direct vision spinotomy) + small incisional inversion stripping with the possibility of combining treatment modalities such as sclerotherapy, laser or electrocoagulation. This procedure is available to a wide range of people and can be used for all varicose veins except for C0 patients who do not need surgery. I will briefly describe how this procedure is performed as follows.
First, regardless of the surgical approach, the main trunk of the vessel (also known as the saphenous vein) is stripped. The stripping technique may vary from hospital to hospital, from normal stripping to inversion stripping. The procedure I use is a small incision with internal stripping, which minimizes the damage.
The main difference between the various procedures is in the management of the varicose vein masses and branches in the legs. Traditional surgery requires removal of the varicose mass, which involves making a long incision or multiple incisions at the mass and finally removing the varicose mass, which is not the case with transilluminated spinotomy.
The procedure of transilluminated spinotomy has the following general steps.
(a) Before surgery, the patient is first asked to stand and mark the location and extent of the patient’s varicose vein mass, the root of the saphenous vein, etc., to determine the portion to be removed for surgery (Figure 1).
Figure 1: Preoperative marking of the varicose range
Then after administering anesthesia to the patient, the patient’s part to be operated on is exposed, the patient’s affected limb is disinfected, and then the patient’s saphenous vein is stripped; after the saphenous vein is stripped, preparation of the transilluminated rotary cutter for excision of the varicose mass is started (as in Figure 2).
Figure 2: Preparing for saphenous vein stripping after administering anesthesia to the patient
During the procedure, a small incision (1-2 mm) is made at the proximal and distal ends of the preoperatively marked varicose mass, and a rotary cutter tip is inserted at each of the two incisions, along with a reagent injection device with a cold light source (Figure 3), which separates the varicose mass from its surrounding tissue.
Figure 3: Injection of reagents into the varicose mass and start of spinotomy
After injecting the reagent into the varicose mass, the spin cutter head is used to spin and break the varicose mass (Figure 4), and the procedure is completed by suction or clamping out the mass that has been spin cut. Because of the small incision, a medical band-aid can be applied to the wound after surgery.
Figure 4: The rotary cutter head suctioning and rotary cutting the vein masses
Although I do not agree that “transilluminated spinotomy is a minimally invasive procedure” and it does not have a significant advantage in terms of speed of recovery, after the inflammatory response to the procedure (1-2 weeks), its recovery is better than that of traditional surgery, especially because it has only two tiny incisions, which is especially important for patients.
I would also like to correct some patient misconceptions here: some patients believe that removing the leg veins will cause a lack of blood supply to the leg, which is not the case. It is the arteries that are used to supply blood, and the veins are primarily responsible for sending blood back to the heart. But the varicose saphenous vein has lost this function, so keeping it will only make the circulation worse and involve other vessels. By removing these veins, the other veins can do a better job of getting blood back to the heart.