Endovasal laser coagulation of varicose veins is a modern, highly effective, safe and easy method of early stage laser surgical treatment of varicose veins. This technique is popular around the world, but it is only used in vascular surgery centers equipped with special laser equipment. Removal of varicose veins in the legs with laser is more easily accepted by the patient compared to classical surgery and contributes to a speedy recovery.
Despite all the positive aspects, laser freezing, like other methods, has its drawbacks. It is very important to take into account the therapeutic possibilities of surgery, using it only in cases when it is really indicated and will help the patient. It is unacceptable to treat with laser all patients with varicose veins according to the principles of the template, only adhering to commercial and fashion interests.
Indications and possible methods
Only with the expansion of the superficial veins (large and small saphenous) at the bottom of 1 and 2 degrees is it possible to remove them with a laser. This means that only in the early stages of varicose veins, laser coagulation surgery can be effective.
More precise instructions for surgery:
- Direct or slightly winding flow on the dilated vessel, when it has no sharp bends.
- Lack of large varicose veins.
- The expansion of the venous lumen is less than 1 cm.
- The main type of varicose veins, when the expansion spreads along the central trunk of the saphenous vein is small or large and does not involve a large number of small tributaries in the process.
It is not appropriate to perform laser coagulation of enlarged varicose veins more than 2 degrees because of the high risk of recurrent disease in the long -term postoperative period. If the process extends not only to the trunk of the small or large saphenous vein, but also to its main branch (river branch), a combined operation can be performed. It includes laser coagulation on the main trunk and surgical removal of small branch varicose veins through separate small punctures. Such interventions are also low traumatic and combine all the advantages of laser and traditional surgery.
Contraindications
Even in patients with small levels of varicose veins, laser treatment should not be performed if there are contraindications to surgery. They are absolute - categories, in which the clotting of varicose veins can exacerbate existing changes in the tissue, and relative - temporary, in which the risk of postoperative complications increases. All contraindications are listed in the table.
| absolute | relative |
|---|---|
| Blood clotting disorders in the form of increased tendency to form blood clots or bleed | The process of purulent inflammatory skin in the lower part of the foot, especially in the place of future incisions |
| The general condition of the patient is severe | Exacerbates chronic diseases of existing internal organs and tissues |
| Signs of chronic venous insufficiency in the legs due to prolonged or severe varicose vein travel (obvious swelling, brown spots, induration and ulcers on the skin of the feet) | Acute infectious diseases (influenza, viruses, intestinal infections) |
| Thrombophlebitis - inflammation of the varicose veins | Immunity problems |
During pregnancy and early postpartum period, it is better to refrain from laser coagulation of varicose veins, even if it has no negative effect on the fetus. This is due to the inability to predict the course of the postoperative period, high load on the lower limbs, hormonal and immune changes in the body.
Operational stages
The principle of laser coagulation of varicose veins of the legs is based on the thermal effects of laser radiation. Acting on the tissue, they heat it, destroy and attach (seal, cause sticking) to the vessel wall. As a result, the vein loses its lumen, deserts and turns into scar tissue.
Laser surgery is performed in a sterile operating room using special equipment:
- A laser coagulator is a device that is a source of radiation.
- Laser light guide - a tubular electrode through which the laser beam acts on a vein.
- An ultrasound machine capable of visualizing superficial veins, which will make it possible to assess how well they are processed during operation.
The main levels of the intervention:
- Vein marking.
- Anesthesia (pain relief).
- Continuous removal of veins with a laser.
The duration of surgery on one leg is from 15–20 minutes if only one of the vascular trunks is required, up to one hour when laser coagulation on the central venous trunk is combined with the classic removal of a small branch extended through puncture (miniflebectomy). ).
Vein marking
The success of laser removal of varicose veins in the legs depends on how well the affected vessels are marked (marked). To do this, they draw with special markers or brilliant green how and where the varix passes the foot. They also perform a preoperative Doppler ultrasound examination of the veins and also mark the characteristics of their branches, if they are not shown before the ultrasound.
Anesthesia
Anesthesia during surgery can be either local or regional, or general. In the first case, the puncture site and incision are infiltrated (injected) with a local anesthetic preparation - if only the central vein is treated with a laser.
If the intervention is extended (with miniflebectomy), spinal anesthesia or short -term intravenous anesthesia may be required. In any case, the procedure is not painful.
Intervene directly
Laser coagulation of varicose veins in the legs is as follows:
- After anesthesia in the upper third of the thigh along the anterior-inner surface below the groin fold, either a puncture or a skin incision of no more than 2 cm is performed.
- Under visual or ultrasound guidance, a large saphenous vein is found at its junction with the femoral vein.
- The saphenous vein is transcribed and ligated, severed from the deep, and a long flexible light guide (about 1 m) is inserted into its lumen, leading to the beginning of the vessel at foot level.
- Sequently pulling a light guide to the site of the puncture on the thigh, they act on the wall of the vein with a beam, which causes its burning, destruction from the blood and destruction (adhesion) of the lumen.
- The light guide is removed, checked for bleeding, and the wound on the skin is sutured or bandaged.
- It is not possible to remove small varicose branches with a laser. It is removed through an additional puncture that does not require suturing.
- On the operating table, immediately after treatment of the veins in the leg with laser, the limb is wrapped with an elastic bandage or individually selected compression socks (stockings) are placed over it.
Laser coagulation should take place under the guidance of ultrasound, which allows you to see how the lumen of the vein collapses and the intensity dose of the laser radiation.
Advantages and disadvantages
Laser coagulation is a good and radical method of treating varicose veins, but it is also not a cure for the disease. Its advantages and disadvantages compared to traditional surgery are described in the table.
| Laser surgery | Traditional surgery |
|---|---|
| Anesthesia is usually local | Local anesthesia is ineffective |
| No large slices, no scars | Need a wound, there will be scars |
| The trauma of the operation was minimal, the vein was not removed, but burned from within | Veins are removed, tissues are injured |
| The procedure is fast (less than an hour) | The duration of operation is more than an hour |
| Low risk of postoperative complications | More frequent complications compared to laser coagulation of varicose veins |
| Quick recovery and exit from the clinic (even on the day of surgery) | Prolonged recovery, relief after a few days |
| Laser treatment is only possible with a few varicose veins | You can remove veins affected by varicose veins in any degree |
| There is a risk of venous lumen recovery if it is not treated properly | The veins are removed surgically, so they will not restore their lumen |
| Requires special equipment, so the cost is high | The price is twice as low as the removal of varicose veins with a laser and does not require special equipment |
risk
The speed and minimal trauma of varicose vein surgical treatment using lasers minimizes the risk of interventional surgery. Negative consequences and complications occurred in 1% of patients operated on. They are usually localized and are represented by inflammatory processes along the frozen veins. Recanalization (recovery of the lumen) and recurrence of the disease are possible in 5%, which may be associated with surgery without the use of ultrasound equipment or in patients with severe varicose veins.
Postoperative period
Early activation of the patient is the prevention of negative consequences after laser treatment of varicose veins. You can walk on the day of operation. Compression products (bandages or stockings) should not be removed for 2-3 days. After this period, they can be removed at night and when moving to a horizontal position. You should wear compression socks for at least a month, wear them before getting out of bed. Both heavy loads and insufficient physical activity for the legs are contraindicated.
Laser coagulation for leg varicose veins is a very effective and safe method of radical treatment in the early stages of this pathology, competing with and even surpassing the effectiveness of traditional surgery. But the appropriateness of its use should be decided only by a specialist, taking into account the individual characteristics of each particular patient.