Is it possible to remove varicose veins permanently? And if they don’t hurt, do you need to do something? And what will happen to the blood that previously flowed through the removed vein?
It is widely known that modern methods of treating varicose veins do not involve the removal of the main saphenous veins, as was the case in the recent past, when the “gold standard” for the treatment of this disease was considered combined phlebectomy – removal of a vein in the literal sense of the word.
Today, surgical interventions have the same effect as phlebectomy, but the trunk of the varicose vein is not removed, but is reliably “closed” in various ways under ultrasound control directly during the operation.
These can be thermal techniques, when the lumen of the venous trunk is “soldered” or “brewed” under the influence of high temperature; or non-thermal – when a substance is introduced into the vessel that causes the vein to “stick together”.
Relapse in surgery for varicose veins of the lower extremities is considered to be so-called recanalization, that is, the re-occurrence of a lumen inside a previously closed vein. This is what any phlebologist surgeon who has taken responsibility for treating a patient is primarily afraid of. But one way or another, unfortunately, relapses happen.
Currently, modern methods have a high efficiency profile, which, according to various scientists, ranges from approximately 92 to 96% for up to 3 years. This means that a vein closed by a surgeon will remain so for the next 3 years with a prognostic probability of 92–96%; and this also means that in 4–8% of cases a relapse may occur within the specified period of time.
As we know, a vein is like a tree: there is a trunk and there are its branches – tributaries.
It is the presence of varicose veins that is one of the indications for surgical treatment.
As for the long-term period, according to statistics, when using any surgical technique, the probability of relapse within up to 10 years after surgery is approximately 50%. This recurrence rate may include both the recanalization mentioned above and the progression of tributary varices.
The specificity of varicose veins is such that, despite all the scientific and technological progress, we still do not reliably know the cause of the development of this disease. And if we don’t know the cause, then we cannot influence its trigger, so often the treatment consists of surgeons removing the “tops”, but the “roots” remain.
Varicose veins are not a problem of just one or several veins, by removing which the surgeon cures the patient.
Unfortunately, everything is much more complicated. Therefore, patients with varicose veins need to be constantly monitored by a doctor, and visits to a phlebologist should be similar to preventive examinations at the dentist, that is, have a certain regularity. And the scientific community can continue to think about improving approaches to the treatment of varicose veins and search for its exact causes.
2. If the veins in the legs don’t hurt, then everything is fine, nothing needs to be done?
Phlebologist, surgeon at SM-Clinic Dmitry Blinov answers:
In the initial stages of varicose veins, the veins may not hurt, but varicose veins will still exist. And you still need to make an appointment with a doctor to accurately determine the stage of the disease, understand the prognosis and further treatment, if necessary. There are 6 stages of varicose veins in total, let’s look at them in more detail.
Stage C1 is characterized by vascular “webs” and reticular (slightly dilated, visible) veins. This is exactly the stage when nothing bothers a person, only in the evening heaviness in the legs may appear. Wreaths can grow and spoil the appearance, so treatment at this stage is rather aesthetic.
At stage C2, varicose nodes and tortuous veins with a diameter of more than 4 mm already appear. Here we can talk about valve incompetence of the main great and small saphenous veins. In this case, blood flows through the vein in the opposite direction, which increases venous pressure and expands the venous walls. From this stage it’s already a stone’s throw to more serious problems and complications. In this case, the treatment is no longer only aesthetic in nature.
Next, stage C3 begins, which is characterized by persistent swelling of the legs. It is associated with chronic venous insufficiency and venous blood stagnation.
In the absence of treatment, it comes to stage C4, when decay products penetrate the venous wall, getting under the skin and causing trophic disorders. The patient may complain of itching, eczema and hyperpigmentation of the skin.
If a person continues to do nothing, then the disease develops to the last two stages – C5 and C6, when trophic ulcers form on the legs , healing (at C5) and not (at C6). A serious complication may also develop – thrombophlebitis, which often leads to pulmonary embolism (PE).
Therefore, varicose veins should be treated at the earliest stages, when they are not yet very bothersome. This only takes an hour of your time and does not require any incisions or general anesthesia. Immediately after the operation, you can return to normal life.
3. If you remove a varicose vein, where will the blood that used to flow through it go? This is life-threatening!
Answered by phlebologist, surgeon at SM-Clinic, Ph.D. Gevorg Mnatsakanyan:
The question of where the blood from the lower extremities will go is asked by approximately 8 out of 10 patients who learn that they are indicated for surgery to eliminate varicose veins. And only a thinking person can ask this question.
Indeed, if a vein is removed or closed, where will the blood that used to flow through it go? In addition, patients also ask, “How will the leg be supplied with blood if you remove my vein?”
To answer these questions, you need to understand a little about the anatomy and physiology of the cardiovascular system.
- Firstly, the veins do not supply blood to the lower extremities . Delivery of oxygen and other vital elements to tissues is carried out through arteries – vessels through which blood flows away from the heart. Through the veins, blood flows in the opposite direction, that is, to the heart: metabolic products are removed from the tissues and transferred to the excretory organs (carbon dioxide – from the tissues to the lungs, etc.)
- Secondly, in circumstances where intervention on varicose veins of the legs is indicated, these altered veins are usually no longer involved in transporting blood back towards the heart. Why? Due to varicose veins, veins dilate and the valves that allow blood to pass only from bottom to top stop working. Thus, in a varicose vein with non-functioning valves, the blood, at a minimum, stagnates or moves in the opposite (unnatural) direction – from top to bottom. This movement of blood most often leads to complaints of a feeling of fullness in the legs, a feeling of heaviness, fatigue, swelling, burning, etc.
- Thirdly, veins have another anatomical characteristic. Unlike arteries, most of which are highways, veins are almost always a network of vessels . If you close or remove any part of this venous network, the blood will be redistributed to other normally functioning vessels. The physical and mathematical justification for the laws of blood movement through venous vessels can be found in the works of the Swiss physicist Daniel Bernoulli. By the way, it has been established that the capacity of venous vessels is approximately 18 times greater than the capacity of arterial vessels.
Thus, having examined the issues of blood movement from different angles, we come to the conclusion that in the case where there are indications for eliminating a varicose vein on the leg, this can and should be done without fear or doubt for the further functioning of the vascular system at the local level.
4. Treatment of varicose veins is a complex and traumatic operation under anesthesia. Can’t this really be avoided?
Answered by phlebologist, surgeon at SM-Clinic, Ph.D. Dmitry Blinov:
There are some strong ideas about how varicose veins are treated – some of these are outright “horror stories”. For example, that combined phlebectomy is a good, proven method in which the anastomosis of the great or small saphenous vein is ligated, and the vein is literally pushed onto it with a special probe and pulled out from the groin to the ankle.
This happens under general anesthesia, with incisions made and stitches placed. As you already understand, the operation is quite traumatic, and rehabilitation takes quite a long time. By the way, this method is already 130 years old.
And thank God, it was replaced at the beginning of the 21st century by endovenous, low-traumatic techniques.
Currently, they can officially be called the “gold standard” for the treatment of varicose veins.
These are the “three pillars” – 2 thermal techniques: endovenous laser coagulation and radiofrequency coagulation of the vein, as well as the most modern non-thermal technique – adhesive obliteration (sealing veins with bioglue), which was born in the USA.
All these techniques are done without incisions, general anesthesia and hospitalization, through small punctures, after the procedure the patient can almost immediately get up and walk. The techniques are carried out under ultrasound control, which helps to close the entire affected vein as effectively as possible.
Early rehabilitation is the key to preventing postoperative complications. Indeed, according to national recommendations, the risks of postoperative thrombosis and infectious abnormalities are 10 times lower than after open surgery, not to mention possible complications and rehabilitation after anesthesia.
And even the risks of relapse are much lower. If relapse after open surgery for 10 years is approximately 25%, then after performing endovenous techniques it is approximately 5%. And if we talk about adhesive obliteration, then, in fact, it requires almost no anesthesia, as well as wearing compression garments, which is very convenient in the summer.
When performing thermal techniques (EVLT and RFA), we recommend wearing compression stockings for 10–14 days.
Thus, we see obvious advantages of modern minimally invasive techniques compared to outdated traumatic ones. But the main thing is to understand that it is important not to start the disease and not wait for its sudden complications. A modern procedure for treating varicose veins takes on average 30–40 minutes, and you don’t have to wait 30–40 years to get it done.