From this article you will learn: what is a crossectomy, for what indications is this operation performed, when its performance is contraindicated. Preparation for a crossectomy, the course of its conduct and maintenance of the postoperative period.
Description of the article:
- Indications for operation
- Contraindications to cross -ectomy
- Preparation for operation
- Progress of operation
- Possible complications
- Postoperative period
- Results
Cross -ectomy is a surgical intervention during which the dressing and crossing of the large saphenous vein and the vasculature into itfoot. Another name is the operation of Troyanov-Trendelenburg.
Click on the picture to enlarge This operation is one of the oldest surgical interventions used for diseases of superficial veins of the lower extremities. The effectiveness of its implementation depends on what indications it is being made. Isolated crossectomy is currently rarely performed, most often if there is a need for emergency care because of severe thrombophlebitis. As a treatment for varicose veins on the legs, the Troyanov-Trendelenburg operation is rarely used, as it is accompanied by a high risk of recurrence of the disease. To reduce the risk of re-emergence of varicose nodules, a crossectomy is combined with other surgical procedures - miniblebectomy, stripping or sclerotherapy.
A cross -ectomy, like other operations on the venous vessels of the legs, is performed by vascular or general surgeons.
Indications for operation
Cross -ectomy is performed according to the following indications:
- Ascending thrombophlebitis of superficial veins of lower limbs.
- Thrombophlebitis above the knee.
- Purulent thrombophlebitis on the legs.
- Recurrent thrombophlebitis of the lower extremities.
- Conservative treatment of thrombophlebitis of the lower extremities.
The goal of the Troyanov-Trendelenburg operation is to eliminate the danger of the transition of the thrombosis process from the superficial veins system through the large subcutaneous vein that connects to the femoral vein into the system of deep veins of the lower limbs.
The fact is that thrombophlebitis of the superficial veins practically does not become a source of development of pulmonary artery thromboembolism - a life-threatening disease in which thrombi overlap the lumen of the pulmonary vessels. The main cause of thromboembolism is deep vein thrombosis of the lower extremities, the risk of developing it with thrombophlebitis and trying to reduce through crossectomy.
Contraindications to cross -ectomy
In urgent cases, when it is necessary to stop the spread of thrombosis to the deep veins of the lower extremities, there are no contraindications to the operation of Troyanov-Trendelenburg.
In the case of planned indications, cross -ectomy, like other operations with varicose veins, is not performed in the following cases:
- During pregnancy and for 3 months after childbirth( as in most cases, varicose veins disappear after birth).
- The presence of an acute infectious disease.
- Violation of the patency of deep veins on the legs.
- Infection at the site of surgery.
- Severe obliterating disease of peripheral arteries.
- Recently suffered deep vein thrombosis.
- Poor overall health, decompensation of cardiovascular and other systemic diseases.
Preparing for operation
Before conducting a cross -ectomy, the doctor conducts an examination of the patient and prescribes an appropriate examination, which helps to establish the correct diagnosis and determine the method of surgical intervention. Usually, a general clinical examination is scheduled, including general blood and urine tests, coagulogram, electrocardiography. Ultrasound examination of the superficial and deep veins of the lower extremities is carried out with the help of which the presence of indications to the procedure, the localization of the vessels and the prevalence of the pathological process are established.
For successful preparation for cross -ectomy, it is advisable to adhere to the following recommendations:
- Read the information on what kind of operation is planned, ask about its risks and benefits.
- Tell the doctor about all the medicines that you take. Some of them may increase the risk of bleeding or affect anesthesia.
- If you are taking a blood-thinning medication( eg, warfarin, aspirin or Plavix), be sure to tell your doctor. He must tell you whether you should stop taking them before the operation.
- For several days before the intervention, do not shave the skin on the leg where the operation will be performed. Shaving can lead to skin irritation, which increases the risk of infectious complications.
- Take a shower or bath in the morning before the operation.
- If the operation is planned under general anesthesia, you should not eat or drink anything 6-8 hours before the intervention.
Course of operation
Cross -ectomy is performed under local, regional or general anesthesia.
Stages of the operation of Troyanov-Trendelenburg:
- Treatment of skin with solutions of antiseptics and covering the operating field with sterile underwear.
- The surgeon determines the location of the femoral artery, probing her pulse in the groin, the medial of which is the large saphenous vein.
- Having determined the location of the large saphenous vein, the surgeon makes above it a small incision( 3-4 cm long) of the skin.
- In a blunt way, pushing the subcutaneous tissue, doctors are selected to a large subcutaneous vein, and then secrete it to the point of confluence in the femoral vein.
- Immediately before confluence in the femoral vein, surgeons are bandaged and cross a large subcutaneous vein.
- Then the doctors excrete the vessels that flow into the large subcutaneous vein, bind them and cross them.
- The incision is sewn layer by layer, after which a sterile bandage is applied to the wound.
Click on photo to enlarge Possible complications of
The operation of Troyanov-Trendelenburg is a safe surgical intervention. But, as with any medical procedure, there are certain risks, including:
- Allergic reactions to anesthetics.
- Infections in the incision site.
- Bleeding and formation of bruises.
- Deep vein thrombosis.
- Damage to nerves that run close to the large superficial and femoral veins.
Postoperative period
After a crossectomy, patients may feel pain at the incision site. To alleviate it, doctors prescribe pain medication.
On the second day after surgery, the patient needs to be activated - that is, he is forced to get up and walk. This helps to improve blood flow in the lower limbs and prevent the formation of blood clots. For 2 weeks, intense physical activity should be avoided, including running, cycling and lifting large weights.
Drink and eat is allowed either immediately after surgery( if it was performed under local or regional anesthesia), or on another day( if it was performed under general anesthesia).When developing nausea, it is better to eat low-fat food.
After operation for several weeks, it is necessary to wear a properly selected compression knitwear, especially if a crossectomy was performed in combination with other surgical methods of treating varicose veins. This helps improve blood flow in the lower limbs and reduces the risk of blood clots in deep veins.
You can wash yourself in the shower after 48 hours, but you should protect the wound from water ingress. The bath should not be taken within 2 weeks after the operation.
In addition to anesthetics, doctors can prescribe other drugs, including antibiotics and anticoagulants, which you need to take, adhering to the recommendations.
You should seek medical help immediately if:
- There are violations of movements in the foot or foot - these are signs of nerve damage.
- A serious bleeding started from the wound.
- The leg became hot and painful, increased in size - this could be a sign of deep vein thrombosis.
- Suddenly, chest pain, shortness of breath or a cough with blood in the sputum - this may be a sign of life-threatening thromboembolism of the pulmonary artery.
- There was severe pain and numbness in the leg, it became pale and cold to the touch - these are signs of an impaired arterial blood supply, which can lead to the need for limb amputation.
Results of
A cross -ectomy can be performed according to various indications, which affects its short-term and long-term results. When this operation is performed to eliminate the risk of thrombosis spreading to the deep veins of the lower limbs, its effectiveness is high enough. The prognosis for a crossectomy performed for the treatment of varicose veins is not as favorable - in two thirds of patients within 5 years there is a relapse of the disease and the need for repeated intervention. Therefore, the Troyanov-Trendelenburg operation is currently very rarely used as an independent treatment for varicose veins, most often it is supplemented by other techniques - stripping, miniflebectomy or sclerotherapy.
