Endovasal laser treatment of varicose veins is a modern, highly effective, safe and simple laser surgery method in the treatment of early stage varicose veins. This technique is popular worldwide, but it is only used in vascular surgery centers equipped with special laser equipment. Laser leg vein removal is more acceptable to the patient than classical surgery and contributes to a quick recovery.
Despite all the positives, laser coagulation, like any other method, has its limitations. It is very important to take into account the therapeutic possibilities of surgery, to use it only in cases where it is really indicated and will help the patient. Laser treatment for all varicose veins patients cannot be accepted according to stereotypical principles, only following commercial interests and fashion.
Indications and possibilities of the method
Only with dilation of the superficial veins (large and small) of the lower extremities 1st and 2nd degree can they be removed with a laser. This means that only in the early stages of varicose veins can the action of laser coagulation be effective.
More precise indications for surgery:
- The direct or slightly tortuous paths of the vessels dilate, when they do not have sharp bends.
- Lack of large veins.
- The dilatation of the vessel lumen is less than 1 cm.
- Primary type of varicose veins, when the dilation is widespread along the central trunk of a small or large hemispheric vein and does not involve a large number of small branches in the process.
Laser coagulation is not suitable for varicose veins of more than 2 degrees due to the high risk of recurrence in the long postoperative period. If this process extends not only to the trunks of the small or large hemispheric veins, but also to their main branches (tributaries), then a combined operation can be performed. It consists of laser coagulation of the main trunk and surgical resection of the veins of the small branches through separate small perforations. Such an intervention is also less traumatic and combines all the advantages of traditional and laser surgical approaches.
Contraindications
Even patients with mild varicose veins cannot be treated with laser if surgery is contraindicated. They are categorical in absolute, where coagulation of the varicose veins can exacerbate existing changes in the tissue, and relatively - transiently, in which the risk of postoperative complications increases. . All contraindications are listed in the table.
| Absolute | Relation |
|---|---|
| Coagulation disorders in the form of increased propensity to clot formation or bleeding | Purulent inflammatory skin processes in the lower extremities, especially in the places of future incisions |
| Serious general condition of the patient | Exacerbation of existing chronic diseases of internal organs and tissues |
| Signs of chronic venous insufficiency in the legs due to prolonged or severe varicose veins (visible swelling, brown spots, calluses and ulcers on the skin of the legs) | Acute infectious diseases (colds, viral infections, intestinal infections) |
| Thrombophlebitis - varicose veins | Immune problems |
During pregnancy and the early postpartum period, it is better to limit yourself from laser varicose veins treatment operations, even though it does not adversely affect the fetus. This is due to the unpredictability of the postoperative period, high load on the lower extremities, and hormonal and immune changes in the body.
Stages of activity
The principle of operation of the laser for varicose veins treatment is based on the thermal effect of the laser beam. Acting on tissues, they heat them, destroy and adhere (seal, cause stickiness) the vessel walls. As a result, veins lose lumen, desertify, and turn into scar tissue.
Laser surgery is performed in a sterile operating room using special equipment:
- A laser condenser is a device that is a source of radiation.
- Laser light guide - a tubular electrode that the laser beam acts on the vein.
- An ultrasound machine has the ability to see superficial veins, making it possible to assess how well they are handled during the operation.
The main stages of the intervention:
- Vein marking.
- Anesthesia (analgesia).
- Directly remove the veins with a laser.
One-leg procedure takes 15–20 minutes if only one of the two vascular tubes is needed, up to one hour when laser ablation of the central venous body is combined with classical perforation resection of small dilated branches. (mini ablation surgery).
Vein marking
The success of laser removal of leg veins depends on the extent of marking (marking) of the affected vessels. To do this, they draw with a special marker or brilliant green how and where the variation moves on the leg. They also performed a preoperative Doppler ultrasound to examine the veins and further mark their branching features, if they were not indicated prior to ultrasound.
Anesthetize
Anesthesia during surgery can be local or regional, or general. In the first case, the sites of the puncture and the incision are injected (injected) with preparations of a local anesthetic - if laser treatment is only in the central vein.
If the intervention is prolonged (with minor ablation), a short-term spinal or intravenous sedation may be required. In any case, the procedure will be painless.
Directly performing the intervention
The operations of the varicose vein coagulation laser in the legs are as follows:
- After anesthesia in the upper third of the thigh along the anterior - medial aspect below the inguinal fold, make an incision or incision of the skin no more than 2 cm.
- Under imaging or ultrasound guidance, a large hemispheric vein was found at its junction with the femoral vein.
- The hemispheric vein is cut and reattached, disconnected from the deep vein, and a long flexible light tube (approximately 1 m) is inserted into its lumen, leading to the vessel tip at leg level.
- Sequentially pulling the light leads to the puncture site on the thigh, they act on the vein wall with a beam, causing burns, melting the blood and wiping (gluing) the lumen.
- The light guide is removed, examined for bleeding, and the skin wound is sutured or bandaged.
- Small varicose veins cannot be removed with a laser. They are removed through additional punctures without stitches.
- On the operating table, immediately after laser treatment of the leg veins, the limb is bandaged with an elastic bandage or ordered individually selected compression knitwear (socks).
Laser coagulation must take place under ultrasound guidance, allowing you to see how the vein is flattening and quantify the intensity of the laser radiation.
Advantages and disadvantages
Laser coagulation is a good and radical method in the treatment of varicose veins, but it is also not a panacea for this disease. Its advantages and disadvantages compared with traditional surgery are described in the table.
| Laser surgery | Traditional surgery |
|---|---|
| General anesthesia is local | Local anesthetic is not effective |
| No large incisions, no scars | Need cuts, there will be scars |
| The surgical trauma is minimal, the vein is not cut off but burned from the inside | Veins removed, tissue injured |
| Quick procedure (less than an hour) | The duration of the operation is more than an hour |
| Low risk of complications after surgery | Complications are more frequent than varicose vein laser coagulation |
| Fast recovery and hospital discharge (even on the day of surgery) | Long recovery, discharge after a few days |
| Laser treatment is only possible for mild varicose veins | You can remove the veins affected by varicose veins of any degree |
| There is a risk of vascular restoration if not treated well | The veins are surgically removed, so they will never restore the lumen |
| Requires special equipment, so the cost is high | Twice the price of laser vein ablation and no special equipment |
Risk
The speed and minimal trauma of laser varicose vein surgery minimize the operational risks of the intervention. Negative outcomes and complications occur in 1% of patients undergoing surgery. They are usually local and are manifested by inflammatory processes along the coagulation vein. Recanalization (recovery of the lumen) and disease recurrence may occur in 5%, possibly in association with surgery without the use of ultrasound equipment or in patients with severe varicose veins.
Post-operative period
Early patient activation is the prevention of negative consequences after laser varicose vein treatment. You can walk on the day of the activity. Compression products (bandage or stock) are not removed for 2-3 days. After this period, they can be removed at night and when moved to a horizontal position. You need to wear compression knitwear for at least a month, before you get out of bed. Contraindicated both carrying heavy loads and not doing enough physical activity for the legs.
Laser coagulation for varicose veins of the legs is a radical treatment of the early stages of this pathology that is safe and highly effective, rivaling and even surpassing the effectiveness of traditional surgical methods. But the effectiveness of its use should be decided only by a specialist, taking into account the individual characteristics of each particular patient.