As a disease based on morphological changes, varicose veins in the lower extremities are not strongly indicated for surgery, but the complete treatment is still surgical, and all treatments other than surgery are only to delay their development as well as to reduce the symptoms.
The surgical treatment of varicose veins in the lower extremities has been the subject of much exploration. Saphenous vein ligation + saphenous vein stripping has been the classic procedure for varicose veins in the lower extremities for more than 100 years and has been used for a century. Many improvements have been made to this procedure, such as changing the insertion of the stripper from the proximal to the distal end to the insertion from the distal to the proximal end (paracentral saphenous vein ligation and stripping), changing the incision for varicose vein stripping from a large incision to a smaller incision, then from a small incision to a tiny incision, to the current incisionless continuous subcutaneous suture method, laser treatment, and other minimally invasive The surgical approach.
First of all, almost all procedures require a high saphenous vein ligation.
It is undoubtedly the most classic procedure, and for more than 100 years, despite the various improvements that have been made to it, it has not fundamentally changed its status and is still used today as a classic procedure.
What is a high saphenous vein ligation?
As stated in the previous introduction to varicose veins, varicose veins are caused by the destruction of the valves and blood reflux (see the introduction to varicose veins in this platform). In this way, the biggest reflux factor is removed.
1.Saphenous vein stripping, saphenous vein stripping
In fact, it is to strip the saphenous vein out of the body by some medical methods, that is to say, this blood vessel has already broken down, so it will be removed.
What is the disadvantage of this method?
In most cases, only the main stem of the saphenous vein in the thigh can be stripped, while the main stem of the saphenous vein in the lower leg remains, and the saphenous vein is not stripped cleanly, so the whole process of stripping cannot be achieved. After the vessel is stripped, there will be traffic branches and branches will be pulled off and bleed, and a large hematoma will be formed under the skin. Due to the rough stripping, it is more common to cause nerve damage, which eventually leads to numbness and other symptoms in the lower limbs. The incision of stripping branch varicose veins is too much and the incision is also larger, which causes obvious postoperative pain and affects the aesthetics of the limb after surgery, especially for young patients.
2.Point stripping of saphenous vein
According to the preoperative markings, multiple small incisions of 0.5~1.0cm in size are made to strip some varicose veins in sections.
The advantage is that the surgery is less invasive than traditional surgery and the surgical scar is significantly smaller.
The disadvantage is that although the surgical incisions are small, they are more numerous and still have a more pronounced surgical scar. For patients with obvious varicose vein masses, there are still veins remaining, thus affecting the surgical results.
3.Venous varicose power removal surgery
The mechanism of varicose vein power removal system (TriVex) is to insert a planer knife close to the wall of the varicose vein, which is also known as “minimally invasive planer aspiration of varicose veins”, to fragment the varicose vein and aspirate it out of the body.
The advantage of this procedure is that the number of incisions is small and the wound is small, which significantly shortens the operation time compared to surgical excision and traffic branch ligation, and the intraoperative pressure filling solution is used to separate the varicose vein from the subcutaneous tissue while protecting the surrounding tissue.
The shortcomings of this procedure are that the subcutaneous tissues are more traumatic and prone to infection, the surgical operation interface is wider and prone to subcutaneous hematoma and saphenous nerve injury, and it is not suitable for patients with superficial venous dilatation only.
4.Laser treatment
The full name is endovenous laser therapy (EVLT). Laser therapy was first proposed by Spanish phlebologist Carlos Bone in 1998 and applied to the treatment of varicose veins in the lower extremities. The mechanism is that the laser is scattered in all directions through the end of the optical fiber, which is absorbed by the surrounding tissues and converted into heat energy through photothermal action, and the blood in the vein cavity boils and generates steam, which causes the vascular contraction and permanent closure to achieve the same effect as traditional surgery, while the laser treatment does not damage the normal tissues around the vessels and plays a role in leg aesthetics.
This method has the advantages of minimally invasive, simple, scarless and fast recovery, while making the operation time much shorter.
In terms of personal experience, we use the combined surgical method of “high saphenous vein ligation + laser treatment” to treat varicose veins in the lower extremities, which allows the disease to be treated satisfactorily while ensuring maximum minimally invasive and aesthetic appearance.
Although the surgical treatment of varicose veins can cure the disease, it is not suitable for every patient with varicose veins, and each patient should choose individualized treatment according to the various conditions described previously.