Endovasal laser coagulation of varicose veins is a modern, highly effective, safe and simple method of laser surgical treatment of early stages of varicose veins. The technique is popular all over the world, but is used only in vascular surgery centers equipped with special laser equipment. Laser removal of varicose veins on the legs is easier for patients compared to classical surgery and contributes to quick recovery.
Despite all the positive aspects, laser coagulation, like any other method, has its drawbacks. It is very important to consider the therapeutic possibilities of the operation, using it only in those cases when it is really indicated and will help the patient. It is unacceptable to laser treat all patients with varicose veins according to the template principle, obeying exclusively commercial interests and fashion.
Indications and possibilities of the method
Only by dilating the superficial veins (large and small saphenous) of the lower extremities of 1 and 2 degrees, it is possible to remove them with a laser. This means that laser coagulation surgery can be effective only in the early stages of varicose veins.
More precise indications for surgery:
- Direct or slightly winding flow of varicose veins, when they do not have sharp bends.
- Lack of large varicose veins.
- Vein lumen dilation is less than 1 cm.
- The main type of varicose veins, when the expansion spreads along the central trunk of the small or large saphenous vein and does not include a large number of small tributaries in the process.
Laser coagulation of varices enlarged by more than 2 degrees is inappropriate due to the high risk of disease recurrence in the long postoperative period. If the process extends not only to the trunks of small or large veins, but also to their main branches (tributaries), combined surgery can be reported. It involves laser coagulation of the main trunk and surgical removal of varicose veins of small branches through separate small punctures. Such an intervention is also low-traumatic and combines all the advantages of laser and traditional surgery.
Contraindications
Even in patients with a small degree of varicose veins, laser treatment cannot be performed if there are contraindications for surgery. They are absolute - categorical, in which coagulation of varices can worsen existing changes in tissues, and relative - temporary, in which the risk of postoperative complications increases. All contraindications are listed in the table.
| Absolutely | Relatively |
|---|---|
| Blood clotting disorders in the form of an increased tendency to form blood clots or bleed | Purulent-inflammatory processes of the skin in the lower extremities, especially at the sites of future incisions |
| Severe general condition of the patient | Worsening of existing chronic diseases of internal organs and tissues |
| Signs of chronic venous insufficiency in the legs due to prolonged or severe course of varicose veins (severe swelling, brown spots, induration and ulcers on the skin of the legs) | Acute infectious diseases (colds, viral, intestinal infections) |
| Thrombophlebitis - inflammation of varicose veins | Immunity problems |
In pregnancy and the early postpartum period, it is better to refrain from laser coagulation surgery for varicose veins, although it does not have a negative effect on the fetus. This is due to the inability to predict the course of the postoperative period, high loads on the lower extremities, hormonal and immune changes in the body.
Stages of operation
The principle of laser coagulation of varicose veins of the legs is based on the thermal action of laser beams. Acting on the tissue, they heat them, destroy them and beautiful (close, cause sticking) the walls of the vessel. As a result, the vein loses its lumen, leaves and turns into scar tissue.
Laser surgery is performed in a sterile operating room with the help of special equipment:
- A laser coagulator is a device that is a source of radiation.
- Laser fiber optic - a tubular electrode by which a laser beam acts on a vein.
- An ultrasound device capable of visualizing superficial veins, which will make it possible to assess how well they are treated during the operation.
Main stages of the intervention:
- Vein labeling.
- Anesthesia (pain relief).
- Direct laser vein removal.
The duration of surgery on one leg is from 15-20 minutes if only one vascular tree is needed, to an hour when laser coagulation of the central venous tree is combined with the classic removal of small dilated branches through punctures (miniphlebectomy). ).
Vein labeling
The success of laser removal of varicose veins on the legs depends on how well the affected vessels are marked (marked). To do this, they draw with a special marker or brilliant green paint how and where the varicose veins pass on the leg. They also perform preoperative ultrasound Doppler examination of veins and additionally mark the characteristics of their branching, if they are not indicated before the ultrasound.
Anesthesia
Anesthesia during surgery can be local or regional or general. In the first case, the sites of punctures and incisions are infiltrated (injected) with local anesthetics - if only the central vein is treated with a laser.
If the intervention is prolonged (with miniphlebectomy), spinal anesthesia or short-term intravenous anesthesia may be required. In any case, the procedure will be painless.
Direct execution of the intervention
Laser coagulation surgery for varicose veins in the legs is as follows:
- After anesthesia in the upper third of the thigh along the anterior-inner surface below the inguinal fold, a puncture or skin incision no longer than 2 cm is performed.
- Under visual or ultrasound supervision, the great saphenous vein is located at its junction with the femoral vein.
- The saphenous vein is cut and ligated, separated from the deep one, and a long (about 1 m) flexible light guide is inserted into its lumen, which leads to the beginning of the vein at the level of the foot.
- Successively pulling the light guide to the site of the sting on the thigh, the beam acts on the walls of the vein, causing its burns, devastation of blood and obliteration (sticking) of the lumen.
- The fiber is removed, checked for bleeding, and the wound on the skin is sutured or bandaged.
- It is impossible to remove small varicose branches with a laser. They are removed with additional punctures that do not require suturing.
- On the operating table, immediately after the laser treatment of the veins on the legs, the limb is wrapped with an elastic bandage or an individually selected compression stocking (sock) is placed on it.
Laser coagulation should take place under ultrasound guidance, which allows you to see how the lumen of the vein collapses and dose the intensity of the laser radiation.
Advantages and disadvantages
Laser coagulation is a good and radical method of treating varicose veins, but it is not a cure for this disease either. Its advantages and disadvantages compared to traditional surgery are described in the table.
| Laser surgery | Traditional surgery |
|---|---|
| Anesthesia is often local | Local anesthesia is not effective |
| No big cuts, no scars | I need cuts, there will be scars |
| The operative trauma is minimal, the vein was not removed, but burned from the inside | The vein was removed, the tissue was injured |
| The procedure is fast (less than an hour) | The duration of the operation is more than an hour |
| Low risk of postoperative complications | Complications are more common than laser coagulation of varicose veins |
| Quick recovery and discharge from the clinic (even on the day of surgery) | Prolonged recovery, discharge after a few days |
| Laser treatment is only possible for mild varicose veins | You can remove veins affected by varicose veins of any degree |
| There is a risk of venous lumen recurrence if not treated well | The veins are removed surgically, so they will never renew their lumen |
| It requires special equipment, so the price is high | The price is twice lower compared to laser varicose vein removal and does not require special equipment |
Risks
The speed and minimal traumatization of surgical treatment of varicose veins with a laser minimizes the operational risks of the intervention. Negative consequences and complications occur in 1% of operated patients. They are usually local and are represented by inflammatory processes along the coagulated vein. Recanalization (lumen renewal) 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 patients is the prevention of negative consequences after laser treatment of varicose veins. You can walk on the day of the operation. Compression products (bandages or socks) should not be removed for 2-3 days. After that period, they can be removed at night and when they are moved to a horizontal position. You need to wear compression stockings for at least a month, put them on before getting out of bed. Heavy loads and insufficient physical activity for the legs are also contraindicated.
Laser coagulation of varicose veins of the legs is a highly effective and safe method of radical treatment of the early stages of this pathology, which surpasses and even surpasses the efficiency of traditional surgery. But the expediency of its use should be decided only by an expert, taking into account the individual characteristics of each individual patient.