Despite the diversity, high efficacy and priority of minimally invasive procedures (radiofrequency ablation, «VenaSeal»), surgeons still have to perform traditional operations. This is due to a range of reasons, when performing a minimally invasive procedure is impossible either technically of because of medical contraindications.
✔ technical reasons:
– thrombosis of a varicose vein in the past medical history
– excessive tortuosity of a varicose vein trunk
– big varicose nodes along the vein trunk
– injection drug use
✔ medical reasons:
– acute thrombosis of a varicose vein trunk
– allergy to local anaesthesia
In these cases, a surgeon has to perform crossectomy and stripping of a varicose vein trunk with varictomy (phleboectomy) of its tributaries through separate incisions.
Crossectomy is evacuation of the terminal fragment of the great saphenous vein with ligation of the base of the deep vein (Picture 1).
Stripping is evacuation of the varicose vein trunk with the help of stripper (Picture 2).
Crossectomy and stripping are performed simultaneously and are stages of one and the same surgical operation.
Before the operation, the patient is admitted into hospital for at least one day, where they undergo laboratory tests and additional examinations. The operation is usually performed on the admission day.
Peculiarities of the operation
The operation is performed under spinal or general anaesthesia. There are usually from 2 to 10 incisions, depending both on the stage of the disease, and on the technical peculiarities of the surgery. The operation is usually from 1 to 1,5 hours long. The surgeon makes the main incision along inguinal fold, singles out the vein, performs crossectomy (evacuation of the terminal fragment of the vein trunk with tributaries), and then introduces a flexible metal probe into the vein lumen, and evacuates the diseased vein fragment through separate incisions. Afterwards, varicose tributaries of the trunk are evacuated through separate additional incisions. Then wounds are sutured and aseptically bandaged. Compression stocking is put on the extremity.
Specialists of clinic «Lekar» perform evacuation of varicose veins by means of the most modern and least traumatic method, which is PIN-stripping (perforating invagination stripping) designed by A. Oesch, M.D. The operation is performed with German-built devices. Owing to this, post-operation pain, swelling of foot and ankle, and bruises are minimal.
A patient can stand up, walk and eat the day when the operation has been performed. There is swelling of the lower third of ankle and of foot, moderate pain, and bruises on site of varicose veins evacuation. This requires prescription of a short course (usually 3-5 days) of injectable anti-inflammatory, pain-relieving, and antiedemic medications, as well as of venomotor pills and elastic compression (wearing compression stockings during 1-4 weeks). Besides, after the operation the patient is bandaged during 10 days, and sutures are removed on the 7th-10th day after the operation. It is prohibited to wet the wounds before the sutures are removed. After the operation the patient needs to be on sick leave for two weeks on average.
After the operation, some restrictions should be introduced for about a month:
– to doing sports
– to thermal procedures (sauna, hot bath, etc.)
– to massage of the operated lower extremity
– sunbathing and visiting sun parlour
– swimming in open waters
As a rule, patients return to their work and home routine within a month after the operation.
This method of treatment is practised by Professor Dmytro Riazanov, Doctor of Medicine, who is extensively experienced in treating patients with lower extremity varicose vein disease.
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