From this article you will learn: what is miniflebectomy, under what diseases is this operation performed, how to prepare for its implementation. Technique for the mini-phlebectomy and post-operative period.
Indications for outpatient phlebectomy
Miniflebectomy is called a minimally invasive surgical procedure by which surgeons remove varicose veins through small incisions orskin punctures.
Click on photo to enlarge Compared with traditional phlebectomy, this surgical intervention is characterized by the best cosmetic effect and the absence of large scars, the possibility of carrying out on an outpatient basis and under local anesthesia. Sometimes this operation is called ambulatory phlebectomy.
Vascular and general surgeons perform miniflebectomy.
Indications for ambulatory phlebectomy
Miniflebectomy is performed to eliminate varicose veins. This operation is used to remove the most varicose nodules, and not to remove all subcutaneous veins.
| indication for ambulatory phlebectomy | With miniflebektomii can |
|---|---|
| Asymptomatic varicose veins and reticular veins( vascular net, telangiectasia) | Enhance the legs look as large varices most people seem ugly |
| symptomatic varicose veins and reticular veins | relieve pain, spasms andfatigue in the leg muscles that may be associated with varicose veins |
| Complications of varicose veins | Reduce skin problems that can developas complications of varicose veins. These include chronic eczema, trophic ulcers, increased skin pigmentation |
| Reduce the risk of thrombophlebitis |
Varicosity is the cause of mini-phlebectomy. Contraindications and limitations of ambulatory phlebectomy
Miniflebectomy is performed to remove varicose veins, with its help to eliminate the cause of this disease - venous insufficiency and increased pressure in the superficial subcutaneous veins - is impossible. Therefore, often miniblebectomy is combined with other methods of treating varicose veins - with radiofrequency or laser ablation, sclerotherapy of the subcutaneous veins.
With caution, this procedure is performed when the varicose nodules are located on the back surface of the foot, ankle and in the popliteal region. These places are more sensitive to traumatization, the veins placed in them are harder to remove.
Contraindications to miniblectomy include:
- Infection at the site of surgery.
- Pronounced peripheral edema.
- Severe general health of the patient, for example, decompensation of diseases of the cardiovascular or respiratory systems.
- Patients who have 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 are at increased risk of developing venous thrombosis.
- Deep vein thrombosis.
- Pregnancy.
Preparation for operation
Before performing ambulatory phlebectomy, a detailed examination of the venous system using ultrasound methods is necessary. Also, a minimal laboratory and instrumental examination is performed to assess the overall health of the patient. To frequently recommended by doctors tests belong:
- the general analysis of a blood;
- general urinalysis;
- coagulogram( blood clotting assay);
- electrocardiography.
Instructions for proper preparation for miniblectomy:
- If you are taking blood-thinning medications( warfarin, plavix, xarelto, brilith, aspirin), tell your doctor. You may need to stop taking them 5-7 days before the surgery.
- If you are allergic to any medications( especially local anesthetics), you should tell the doctors about it.
- Since this surgery is not performed under general anesthesia, it is easy to have breakfast before the operation in the morning.
- Put on your day of operation loose clothing and comfortable shoes.
- Sometimes doctors give special recommendations - for example, the use of ointments or tablets before surgery. You need to follow these instructions clearly.
- Arrange with a relative or friend to take you home after the operation. Although the pain syndrome after miniblebectomy is not expressed strongly, it can slightly interfere with free movement and driving.
- Shave the area of surgery in the evening, the day before the mini-uberectomy.
- In the morning before the operation, take a hygienic shower.
- Do not apply any oils, lotions, creams or ointments to the surgical site on the day of surgery.
Technique for performing
Miniflebectomy is often performed on an outpatient basis. Despite the low invasiveness, this surgical intervention is performed in the operating rooms, equipped with all the instruments necessary to provide emergency care in the event of complications.
Immediately before surgery, surgeons often mark with green or marker all the varicose nodes that need to be removed. Thus the patient should stand, that it was better visible.
The skin at the site of operation is treated with solutions of antiseptics, then covered with sterile underwear. Then a local anesthetic is performed, after which a small scalpel or thick needle surgeons make incisions or puncture of the skin above the varicose veins. With the help of special surgical hooks, the doctors separate the vein from the surrounding tissues and outward through the incision. Using the clamp, the surgeon "twists" the vein, slowly pulling it from the subcutaneous tissue, then crosses both ends of the vessel. With miniblebectomy, the ends of the vein being removed are not bandaged, bleeding is stopped by squeezing during and after surgery. After the removal of one varicose node, proceed to the next.
Usually, small incisions or skin punctures, through which surgeons remove varicose veins, can not be sewn.
An experienced vascular surgeon performs miniflebectomy on the two lower limbs in 1-2 hours. At the end of the operation, the leg is laundered from the remnants of blood, a sterile bandage is applied to the sites of incisions or punctures. After that, the lower limb is bandaged with an elastic bandage, which ensures sufficient compression of the tissues and prevents possible bleeding.
post-operative procedure
postoperative period Even if a mini-phlebectomy was performed on an outpatient basis, you will have to stay in the medical institution for about 2 hours, after which you can go home. In the postoperative period, the doctor's recommendations and schedule of visits to the clinic should be carefully followed.
Physical activity after surgery:
- On the day of the surgery it is important to start walking a little. For this, every hour you need to get up at least 5 minutes. On the second day, take short walks for 15 minutes 2-3 times. This will help reduce the risk of deep vein thrombosis and improve blood flow in the legs.
- In the first 48 hours, while the bandage is on your feet, 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, it can lead to swelling and discomfort.
- Over the next few days, gradually return to daily activity.
- On the 4th-5th day after the operation, you can resume aerobic exercises of moderate intensity( walking, jogging, yoga, pilates), if you feel comfortable at the same time.
- You can fly in an airplane or make long trips( more than 2 hours) in 1 week.
Bandages and wounds after surgery:
- During the first 48 hours, the bandage should not be removed and wetted. If it seems too squeezing, raise your foot to reduce swelling. If discomfort does not go away - call a doctor.
- After 48 hours, the bandage should be removed, after which you can wash yourself in the shower.
- Within 2 weeks after surgery, you need to wear compression stockings, removing them just before bedtime.
- Within 2 weeks after the operation, it is impossible to immerse the operated leg into water - that is, no baths, swimming pools, etc. You can only take a shower.
Possible postoperative problems:
- The formation of bruises and a feeling of discomfort is normal after miniblectomy. They disappear 3-4 weeks after the operation.
- To eliminate discomfort or pain, you can take an anesthetic drug, for example, ibuprofen. Continue taking this medication for 5-7 days after surgery to reduce inflammation.
- Usually, with miniblebectomy, no stitches are applied to the skin, small incisions or punctures in the skin completely heal within 2 weeks.
- After the procedure, you may notice several seals that may be sensitive when touched. Do not worry, they occur in a third of patients after miniblebectomy. These segments are residual veins with superficial thrombi, which are not dangerous and eventually disappear. Massage them and apply warm compresses to them several times a day. If these seals hurt, take ibuprofen for 1-2 weeks.
- If you notice that blood drains under the bandage, push it down with two fingers and lie with your leg raised. If bleeding continues, call a doctor or call an ambulance.
- In case of significant bleeding, fever, signs of infection, or any other problems, contact your doctor or the nearest emergency department.
After actual mini-phlebectomy, there are no visible traces from operation . Forecast and results of mini-phlebitomy.
. If the mini-phlebectomy was performed according to the right indications, the long-term results of this operation are perfect. The success rates of this surgical intervention reach 90% or more. Such good results are usually associated with the elimination of venous insufficiency before undertaking miniblectomy. It is widespread to perform first radiofrequency or laser ablation of large superficial subcutaneous veins, and only then to perform mini-phlebectomy.
As with any method of treatment, over time, new varicose nodules may appear, especially in patients with a genetic predisposition to this disease.