MODERN VARICOSE VEIN SURGICAL PROCEDURES
MODERN VARICOSE VEIN SURGICAL PROCEDURES CAN BE DIVIDED INTO TWO GROUPS:
One of them is the group of procedures performed in local, in the so-called tumescent, anaesthesia: laser surgery and radiofrequency surgery (endothermal ablation). During these operations, we puncture the vein through the skin, apply laser or radiofrequency energy: the vein is being closed by the heat. The methods have been continuously developed and the results in the modern period of endothermal ablation (since 2006) have shown a long-term success rate, above 97%.
The other group comprises of the interventions not requiring anaesthesia: foam sclerotherapy (to treat smaller veins, side branches and spider veins), and the two, more recent surgical methods: mechano-chemical ablation (ClariVein) and closing of the vein with glue (VenaSeal).
Below we describe the painless methods (mechano-chemical and glue) performed without anaesthesia.
WHY SHOULD WE CHOOSE MODERN VARICOSE VEIN PROCEDURES?
During traditional varicose vein surgery few surgical incisions are made to expose to the main vein trunks (great saphenous vein and small saphenous vein). At the groin or the popliteal, where the blood flows into the deep vein, the side branches are tied (crossectomy), then the vein is removed with a stripper. During this procedure we cause relatively severe tissue damage and the side branches also tear which explains the significant post-operative pain and bleeding. The incision at the groin is not favourable either, because it might imply the risk of infections and encumber the daily cleaning routine. Not tying down the side branches around the junction does not increase recurrence rates; this has been proven by several examinations. Moreover, if crossectomies are performed along with modern operations (laser, radiofrequency) the re-formation of blood vessels is (neovascularization) is more likely to occur.
The minimally invasive surgical procedures without incisions, inside the vein (endovenous), have been applied for more than a decade. Based on international follow-up the efficiency of the operation and the recurrence rates are the same as the late results of the traditional varicose vein operations, however, the burden of the surgery is significantly lower, the occurrence of complications can be minimised and the improvement of life quality is clearly faster than at traditional operations. In the countries where new methods receive adequate support from insurance companies, almost exclusively the new vein surgery methods are used.
The endoluminal (laser surgery, radiofrequency ablation) surgical methods, which have spread over the past decade, apply a new, costly technique for patient comfort. The advantages of the new methods as compared to the traditional open surgical procedure
- no surgical incision in the groin
- minimal post-operative haemorrhage among the tissues therefore minimal wound pain
- patients may get up and stand on their feet immediately after the operation, no need for hospital observation, the surgical procedures may be performed as ambulatory procedures
- the operation can be performed in local anaesthesia, no need for epidural or other anaesthesia
- due to the lack of major punctures or incisions, the aesthetical results are better
- the patient can return to work a few days after the surgical procedure, no prolonged sick-leave period
- long term results do not differ from the results of traditional operations
The disadvantage of modern surgical methods is their need for special devices and their relative expensiveness; however, these are compensated by the benefits described above. Currently the Hungarian National Health Insurance Fund Administration does not finance radiofrequency and laser interventions, therefore patients shall cover the total costs of the operation. If we not only take the price of the operation into consideration, but also the time lost at work, the discomfort and pain accompanying the operation, as well as the aesthetical results, the balance is in the favour of the modern surgical procedures.
Each varicose vein treatment is preceded by a detailed vascular surgery examination thus no subsequent complications may be caused by a wound healing disorder resulting from an undiagnosed atherosclerosis; by detecting the cause of the varicose vein disease or the chronic venous insufficiency, not only the visible skin lesion is treated but also the underlying disease.
The treatment of varicose vein diseases is a complex vascular surgery task, not only cosmetology!
