Varicose veins are one of the most common diseases in Poland and in the world. They can be treated conservatively and surgically, the latter being more effective.
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Varicose veins are balloon-like extended, winding surface veins of the legs
The formation of balloony and twisted venous forms disrupts the way of blood from the legs to the heart. In expanded veins, the diameter of which does not return to the normal size, venous valves become leaky. Such a changed venous network is useless, because physiological "muscle-valvular pump" is supposed to work, which pumps blood "up" to the heart.
Fig. 1
In widened varicose veins venous valves become leaky, because the petals of the valves visible in the fig can not grow. Hence blood falling down under its own pressure is more likely to flow downwards than up - to the heart.
The inflammation of the veins destroys the venous valves
Varicose veins easily undergo thrombosis and inflammatory processes. The inflammation of the surface veins may increase and initiate deep vein inflammation. Then a serious problem arises. Inflammation destroys the valves of the deep and stabbing veins, and this significantly worsens the outflow of blood from the legs to the heart. Damaged venous valves no longer control the flow of blood so that it flows only towards the heart - so blood flows back down the leg and accumulates there causing skin changes. In the area of the ankles, swelling occurs, the subcutaneous tissue becomes fibrous, the skin darkens, aches and bakes. Anything, even minor wounds (eg scratches, abrasions) can cause an unhealthy ulcer - a wound that is very difficult to heal, recurrent and painful.
Can surgical removal of varicose veins be harmful to health for some reason?
It is not harmful. After removal of varicose veins, blood flows through numerous "spare" lines. This happens if even complete removal of varicose veins occurs. The blood begins to flow in a different direction, but in the right direction. In the combined calculation, the removal of vein-affected veins is beneficial for health. Finally, it eliminates the source of venous stasis conducive to inflammation, thrombosis and edema.
Diagnosis before surgery
The recommended examination of the venous system is imaging - USG Doppler with colored visualization. This test allows precise viewing of veins due to their possible damage. It is also non-aggravating for the patient. These tests allow for a comprehensive assessment of veins, pathology diagnostics and making the right decision regarding the strategy of therapeutic treatment.
The goal of surgical treatment is:
- restoration of the condition in which the blood flows smoothly upwards towards the heart.
- preventing blood stagnation, inflammation of varicose veins, swelling and skin symptoms of the legs.
- elimination of the source of inflammation and thrombosis of leg veins
The immediate goal of the surgical procedure is:
1. Removal of reflux from the deep veins connected with stabbing veins (fistula) with damaged valves with a system of varicose veins. (Fig 1)
2. Removal of varicose veins
Removal of reflux from the deep vein system
The correct direction of blood flow is the path from the surface veins - to the deep veins and further "upwards" to the heart. A reflux is a reverse blood flow - to the correct one. Venous reflux is the reverse direction of blood flow - from deep veins to superficial - and down the leg. Reflux causes venous stasis, phlebitis, clots and varicose veins.
Lynx.1 Schematic diagram of deep and surface veins in the leg - connected by stitching veins (venous fistula) with damaged valves. The arrows indicate the pathological direction of reflux - down the leg.
Removal of varicose veins - restores blood flow "up" to the heart
Removal of varicose veins (tortuous vein line in Fig. 1 above) - closes the stitching vein (fistula) and blocks venous reflux. Blockage of reflux from the deep vein system through the stabbing vein (fistula) to varicose veins restores blood flow "up" to the heart. The procedure is most often related to sapheno-femoral or scleral-popliteal connections, perforating veins (perforators) of the thighs and lower legs, and pelvic veins.
Removal of varicose veins - winitial condition of the operation
The condition for performing varicose vein surgery is the full patency of the deep vein system.
Blood from the lower limbs flows away from two systems, including 90% deep and 10% superficial. Deep veins are the most important for blood transport. In order for the operation to have a therapeutic meaning, the deep veins must have healthy valves and be able to participate efficiently in a mechanism called a "valvular-muscular pump".
Removal of varicose veins is done by two main methods:
- obliterative treatment - injection with obliterating agents, so-called sclerotization of "varicose veins.
- surgery
ed. Edward Ozga Michalski, MA
drug consultation med. Michał Wojtyczka
Literature:
1.Chronic venous insufficiency. From the symptom and diagnosis to treatment dr med. Tomasz Zubilewicz, dr med. Jacek Wroński, prof. zw. dr hab. med. Jerzy Michalak from the Chair and Clinic of Vascular Surgery, Medical University of Lublin Head of the Department and Clinic: prof. dr hab. Jerzy Michalak; Medycyna Rodzinna - notebook 18 (2/2002) 2. Compensated and decompensated hemodynamics of venous circulation in the lower extremities Author: Dr hab. n. med. Zbigniew Rybak, prof. dr hab. n. med. Piotr Szyber, dr hab. n. med. Andrzej T. Dorobisz, MD Maciej Karasek, MD Mariola Oleszkiewicz, Esculap, 2005. 3. Troublesome varicosity; bow. med. Marek Durakiewicz from the Department of Vessel Surgery SPSW im. Pope John Paul II in Zamość Branch Office: dr n. Med. Zbigniew Waga; Medycyna Rodzinna, issue 10 (2/2000) 4. Chronic venous insufficiency; dr Waldemar Jankowiak http://www.wizaz.pl/images/med_estet/medycyna_zylaki_leczenie.php 5. Prophylaxis of thrombosis and treatment of thrombosis in various clinical conditions. Oral Anticoagulants, Antiplatelet Drugs - VI Guidelines of the American College of Chest Physicians. (2000) Medycyna Praktyczna ONLINE 2005 6. Varicose veins - prevention and treatment; Dr. Diner Reinharez, ed. WAB, 1993 / p. 58 /
