Surgery always requires local, epidural or general anaesthesia, and often a few days in the hospital. It is used mostly in cases of advanced varicose disease and/or cutaneous complications.
A) AMBULATORY PHLEBECTOMY
With the help of ultrasounds, the location of varicose veins is pencilled on the skin with permanent ink. The surgeon thus knows the exact location of the veins to be removed. A local anaesthetics is injected along the varicose veins marked for removal; through tiny incisions 1 to 3 mm wide, the varicose veins are then extracted using special mini-hooks.
The incisions do not require stitching; small local dressings are held by elastic bandages for eight days, and then by compression stockings for two weeks. The surgery can last one to three hours, depending on the importance of varicose veins. The patient can walk immediately after the operation.
Classic or invaginated, stripping remains the surgical method of choice to remove the largest varicose veins and main points of reflux.
A cut is made in the groin or the back of the knee depending on whether the internal or external saphenous vein is involved. Another cut is made usually in the ankle or calf, the surgeon ties off and cuts the superficial vein near the crotch (i.e. near where it connects with the deep venous system), then by the ankle. After inserting a metal probe in the diseased vein, one end of the vein is attached to it and pulled from inside out like the finger of a glove (invagination method) as the probe is removed. This surgical method has many variations depending on the tools used.
Incisions do not exceed 2 or 3 cm in the groin or behind the knee, 1/2 cm at the ankle. General or epidural anaesthesia is required. Two or three days in the hospital are usually needed. The patient can walk one day after surgery but a compression bandage must be worn for three weeks.
C) CRYOSURGERY (cold surgery)
In this method, the varicose vein is frozen from the inside. It has both the inconvenience of surgery (hospitalisation, incisions, sometimes pain and nerve damage) and a very high relapse rate (30%). Cryosurgery is hardly ever used these days.
D) OTHER METHODS
Other methods have come up in recent years, hit the news and then fallen into oblivion just as fast as fads come and go, with unhappy patients or victims forced to resort to traditional surgery. There are hopes with the intra-vascular laser, its initial results are promising but it is too early to judge the quality or permanency of these results.
This does not mean that surgical protocols do not change over time and that techniques do not improve regularly. Hospital stays are shorter and shorter. Anti-clotting and anti-infectious treatments have all but eliminated the risk of serious complications. Surgical results are now excellent thanks to pre-surgery Doppler scanning which help guide the surgeonĀs hands.
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