Varicose vein removal
Varicose vein removal refers to various medical procedures aimed at treating swollen, twisted veins that primarily occur in the legs due to valve incompetence. While often not harmful, many individuals seek removal for cosmetic reasons. Initial treatment typically involves compression with support stockings, but more invasive options are available, such as sclerotherapy, which entails injecting a solution into the affected veins to irritate and close them, often requiring multiple sessions. The traditional surgical method involves stripping the vein through small incisions, a procedure generally performed on an outpatient basis.
There are also less invasive alternatives, such as radio frequency ablation and ambulatory phlebectomy, which offer quicker recovery times and less trauma. In radio frequency ablation, heat is used to collapse and seal off the problematic vein, while ambulatory phlebectomy involves removing the vein through small punctures. Laser surgery and intense pulsed light therapy are additional options that minimize damage to surrounding tissues. Postoperative care usually includes walking and wearing compression bandages, with nonabsorbable sutures removed within a week. Preventative measures, such as maintaining a healthy weight and exercising, are encouraged as a way to avoid the development of varicose veins, which affect both men and women but are more prevalent among women.
Varicose vein removal
Anatomy or system affected: Blood vessels, circulatory system, legs
Definition: A surgical procedure that is used to rid the body of swollen blood vessels.
Indications and Procedures
Varicose veins are caused by an expansion of a superficial vein that is associated with incompetence of the valves within the vein. Conditions such as pregnancy and tumors that increase intra-abdominal pressure contribute to varicose vein formation. Initial treatment involves compression with support stockings.
Sclerotherapy is a more invasive treatment option. In this technique, several injections of a small amount of a solution are made into the affected vessels over an extended period of time. This solution irritates and destroys the inner lining of the blood vessel. The vein subsequently ceases to carry blood, and circulation is improved by the elimination of this diseased blood vessel. Each vessel usually requires one to six treatments at intervals of three to four weeks. Although the procedure is relatively painless, the fading of vessels is a slow process that can take one to six months.
The traditional method of treating varicose veins is surgery, which is usually performed on an outpatient basis. The most common site of varicose veins is in the lower extremities. The varicose veins are marked out on the surface of the leg. The leg is prepared with iodine and draped from the groin to the toes. A local anesthetic is injected in the skin overlying the ends of the varicose veins. A transverse incision is made over each end. The most distant (distal) end is freed, and a suture is tied around the vein. The surgeon must take care to avoid nearby sensory nerves. The near (proximal) end of the vein is similarly located and tied off. The vein is then cut, and a thin wire is passed from the distal to the proximal incision. A bullet-shaped stripper is tied to the wire; the vein is secured to the stripper. The stripper is slowly pulled out, removing the varicose vein. If a branch prevents the vein from moving, an incision is made, a suture is placed around the branch, and the branch is cut.
After the stripper passes through the entire vein, the varicosity has been removed. The path of the vein is then compressed with warm towels for several minutes to stop small branches from bleeding. Other marked branches are removed. The incisions are closed with sutures or tape. Dressings are placed over the path of the vein, and the leg is wrapped from the toe to groin with rolled, soft gauze and elastic bandages. The patient is instructed to walk but not to sit for prolonged periods of time for at least two days.
Several newer and less invasive techniques for treating varicose veins include radio frequency ablation, ambulatory phlebectomy, laser surgery, and intense pulsed light therapy. Radio frequency ablation or closure is a nonsurgical technique that uses heat in the form of radio frequency energy to collapse and seal varicose veins. The problem vein is essentially shut down, and other healthy veins take over the blood flow. This procedure is much less invasive than vein stripping. In the closure technique, a thin catheter (flexible tube) is inserted into the vein through a small opening. The catheter delivers the radio frequency energy to the vein wall, causing it to heat up and seal shut. The vein is eliminated by placing the catheter in the lower portion of the vein and then advancing the catheter up the vein using ultrasound guidance. There is no bleeding. After this one-day procedure, patients with little trauma can ambulate more quickly and wear compression dressings for a shorter period of time than in traditional vein stripping.
Ambulatory phlebectomy is a minimally invasive technique in which a varicose vein is removed through small punctures or stab incisions along the path of the vein. Through these tiny holes, the surgeon uses a surgical hook to remove the varicose vein.
In laser surgery, a high-intensity laser beam focuses a single wavelength of light at a tiny point on the vein. The light heats the vein but passes through the skin with only minimal surface damage. The underlying vein, however, is damaged by the heat and is then slowly reabsorbed by the body over a period of a few weeks. As opposed to laser surgery, intense pulsed light therapy focuses a broad spectrum of light in a range of wavelengths that are adjustable through the use of filters and computer-guided parameters of energy delivery. This adjustability allows the physician to customize precisely the characteristics of the light energy according to the needs of each patient, thereby minimizing damage to surrounding tissue and reducing recovery time.
Uses and Complications
Nonabsorbable sutures are removed after a week during a postoperative visit to the surgeon; elastic bandages are used for at least two weeks. Medication for pain may be needed for two to four days. The patient is instructed to walk increasing distances over the next few weeks. Patients who walk rarely experience complications.
Perspective and Prospects
The prevention of varicose veins is preferable to surgical removal. Removing excess weight, exercising, and avoiding articles of clothing that constrict the top of the thighs will help. Varicose veins affect men as well as women, although they are more common among the latter.
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