Intravascular laser coagulation of varicose veins is a modern, highly effective, safe and simple method of laser surgical treatment of the early stages of varicose veins. The technique is widespread all over the world, but is used only in vascular surgery centers equipped with special laser equipment. Removal of varicose veins on the legs with a laser is more easily tolerated by patients than with classical surgery and contributes to a quick recovery.
Despite all the positive aspects, laser coagulation, like any other method, has its drawbacks. It is very important to take into account the therapeutic possibilities of the operation, using it only in cases where it is really indicated and will help the patient. It is unacceptable to treat all patients with varicose veins with a laser according to the model principle, obeying only commercial and fashionable interests.
Indications and possibilities of the method
Only with the expansion of the superficial veins (large and small saphenous) of the lower limbs by 1 and 2 degrees it is possible to remove them with a laser. This means that only in the early stages of varicose veins, the laser coagulation operation can be effective.
More accurate indications for surgery:
- Direct or slightly tortuous course of dilated vessels, when they do not have tight curves.
- Lack of large varicose veins.
- The expansion of the lumen of the vein is less than 1 cm.
- The main type of varicose veins, when the expansion extends along the central trunk of the small or large saphenous vein and does not involve a large number of small tributaries in the process.
It is inappropriate to perform laser coagulation of varices enlarged by more than 2 degrees due to the high risk of disease recurrence in the long-term postoperative period. If the process extends not only to the trunks of the small or large saphenous veins, but also to their main branches (tributaries), a combined operation can be performed. It involves laser coagulation of the main trunk and surgical removal of varicose veins of small branches through small separate punctures. This surgery is also not very traumatic and combines all the advantages of the laser and traditional surgery.
Even in patients with a minor degree of varicose veins, laser treatment cannot be performed if there are contraindications to surgical intervention. They are absolute - categorical, in which the coagulation of the varices can aggravate the existing changes in the tissues, and relative - temporary, in which the risk of postoperative complications increases. All contraindications are listed in the table.
|Blood clotting disorders in the form of an increased tendency to form blood clots or bleed||Purulent-inflammatory skin processes in the lower limbs, especially in the places of future incisions|
|Severe general condition of the patient||Exacerbation of existing chronic diseases of internal organs and tissues|
|Signs of chronic venous insufficiency on the legs due to the prolonged or severe course of varicose veins (pronounced swelling, brown spots, induration and ulcers on the skin of the legs)||Acute infectious diseases (colds, viral, intestinal infections)|
|Thrombophlebitis - inflammation of the varicose veins||Problems with immunity|
During pregnancy and the early postpartum period, it is better to refrain from laser coagulation of varicose veins, even if it does not have a negative effect on the fetus. This is due to the inability to predict the course of the postoperative period, high loads on the lower extremities, hormonal and immune changes in the body.
Stages of the operation
The principle of laser coagulation of varicose veins of the legs is based on the thermal effect of laser beams. By acting on the tissues, they heat them, destroy and glue (seal, adhere) the walls of the vessel. As a result, the vein loses its lumen, becomes deserted and turns into scar tissue.
Laser surgery is performed in a sterile operating room using special equipment:
- A laser coagulator is a device that is a source of radiation.
- Laser light guide - a tubular electrode with which the laser beam acts on a vein.
- An ultrasound machine can visualize the superficial veins, which will allow you to assess how well they have been processed during the operation.
The main phases of the intervention:
- Marking of the veins.
- Anesthesia (pain relief).
- Direct removal of veins with a laser.
The duration of the surgery on one leg ranges from 15 to 20 minutes if only one of the vascular trunks is needed, up to an hour when laser coagulation of the central venous trunk is combined with the classic removal of small dilated branches by puncturing (miniflebectomy ).
Marking of the veins
The success of laser removal of varicose veins on the legs depends on how well the affected vessels are marked (marked). To do this, they draw with a special or bright green marker how and where the varice passes on the leg. They also perform preoperative Doppler ultrasound of the veins and additionally mark the features of their branching, if they are not indicated before ultrasound.
Anesthesia during surgery can be local or regional or general. In the first case, the puncture and incision sites are infiltrated (injected) with local anesthetic preparations, if only the central vein is treated with a laser.
If the surgery is extensive (with miniflebectomy), spinal anesthesia or short-term intravenous anesthesia may be required. In any case, the procedure will be painless.
Direct execution of the intervention
The laser coagulation operation of varicose veins on the legs is as follows:
- After anesthesia in the upper third of the thigh along the anterior-internal surface below the inguinal fold, a puncture or skin incision of no more than 2 cm is made.
- Under visual or ultrasound guidance, a large saphenous vein is found at its junction with the femoral vein.
- The saphenous vein is dissected and tied, disconnected from the deep one, and a long (about 1 m) flexible light guide is inserted into its lumen, which is led to the beginning of the vessel at the level of the foot.
- By sequentially pulling the light guide to the puncture site on the thigh, they act on the walls of the vein with a ray, which causes it to burn, desolation of the blood and obliteration (gluing) of the lumen.
- The light guide is removed, checked for bleeding, and the wound on the skin is sutured or bandaged.
- It is impossible to remove small varicose branches with a laser. They are removed through additional punctures that do not require suturing.
- On the operating table, immediately after the treatment of the leg veins with a laser, the limb is bandaged with an elastic bandage or an individually selected compression stocking (stocking) is applied.
Laser coagulation should take place under ultrasound guidance, which allows you to see how the lumen of the vein collapses and measure the intensity of the laser radiation.
Advantages and disadvantages
Laser coagulation is a valid and radical method of treating varicose veins, but it is not a panacea for this disease either. Its advantages and disadvantages over traditional surgery are described in the table.
|Laser surgery||Traditional surgery|
|Anesthesia is often local||Local anesthesia is not effective|
|No big incisions, no scars||We need cuts, there will be scars|
|The operative trauma is minimal, the vein is not removed, but burned from the inside||The vein is removed, the tissue is damaged|
|The procedure is quick (less than an hour)||The duration of the operation is more than one hour|
|Low risk of postoperative complications||More frequent complications than laser coagulation of varicose veins|
|Quick recovery and discharge from the clinic (even on the day of surgery)||Prolonged recovery, discharge after a few days|
|Laser treatment is possible only with slight varicose veins||Veins affected by varicose veins of any degree can be removed|
|There is a risk of restoration of the lumen of the vein if not well treated||The veins are surgically removed, so they will never restore their lumen|
|It requires special equipment, so the cost is high||The price is twice as low as removing varicose veins with a laser and does not require special equipment|
The speed and minimal trauma of surgical treatment of varicose veins using lasers minimize the operational risks of the surgery. Negative consequences and complications occur in 1% of the operated patients. They are usually local and are represented by inflammatory processes along the coagulated vein. In 5%, recanalization (restoration of the lumen) and relapse of the disease are possible, which can be associated with the operation without the use of ultrasound equipment or in patients with severe varicose veins.
Early activation of patients is the prevention of negative consequences after laser treatment of varicose veins. You can walk on the day of the operation. Compression products (bandage or stocking) should not be removed for 2-3 days. After this period, they can be removed at night and when moving to a horizontal position. You must wear compression stockings for at least a month, putting them on before you get out of bed. Both heavy loads and insufficient physical activity for the legs are contraindicated.
Laser coagulation for varicose veins of the legs is a highly effective and safe method of radical treatment of the early stages of this pathology, competing and even surpassing the effectiveness of traditional surgery. But the expediency of its use should be decided only by a specialist, taking into account the individual characteristics of each particular patient.