Surgical treatment of lower limb varicose veins

What are varicose veins of the lower limbs?

Varicose veins of the lower limbs are irreversibly dilated, elongated, and twisted venous vessels. Varicose veins form in the superficial veins (located just under the skin) and perforators, which are venous vessels connecting the superficial veins with the deep venous system.

We distinguish the following three types of varicose veins of the lower limbs:

• Telangiectasias (spider veins) – dilated small vessels located superficially in the skin, primarily a cosmetic defect
• Reticular varicose veins, which form a network of twisted vessels located under the skin. They most often appear below the knees or on the lateral surfaces of the calves or thighs. Such varicose veins are not painful and rarely cause limb swelling.
• Varicose veins of the main venous trunks – the great saphenous and small saphenous veins. They are most commonly located on the medial surface of the limb (varicose veins of the great saphenous vein) or on the posterior surface of the calf (varicose veins of the small saphenous vein). These varicose veins cause very unpleasant symptoms of chronic venous insufficiency.

Causes of varicose veins of the lower limbs

It is believed that the main cause of varicose veins of the lower limbs is genetic predisposition, causing abnormalities of the venous valves or disorders of the vein walls.

Valve abnormalities can cause backward blood flow into the superficial system, leading to its excessive stretching and overload. Consequently, this leads to dilation and elongation of the veins and the formation of varicose veins.

There are also many other factors that may accelerate the development of varicose veins. These include, among others:

• pregnancy, during which pressure on the veins by the enlarged uterus and the effect of hormones on the venous vessel walls may occur
• standing work
• age – the incidence of varicose veins increases with age
• lifting heavy weights
• overweight and obesity

Treatment of varicose veins of the lower limbs

If any concerning symptoms appear, you should see a specialist doctor as soon as possible. Early assessment of the venous system can prevent further progression of the disease and help avoid serious problems such as deep vein thrombophlebitis causing venous ulcers located on the lower legs. These ulcers are difficult to treat and represent very serious issues for patients, often for life.

The recommended examination of the venous system is an imaging test – Doppler ultrasound. This test allows precise visualization of the veins due to possible damage.

In situations where there is no risk of venous inflammation, treatment with pharmacological preparations can be considered. Unfortunately, this treatment is long-term, and the effects of these medications are often unsatisfactory.

Surgical procedures

The classic surgical procedure is the primary method for treating varicose veins of the lower limbs, as it is the only one without limitations regarding the size of veins that can be removed.

The surgical procedure involves complete removal of the main superficial vein of the lower limb (the great saphenous vein) along with its branches (the so-called stripping) and additionally removal of all visible dilated veins through numerous small incisions along the entire lower limb.

In the case of small varicose veins, a procedure is used in which all dilated veins are extracted through very small, almost invisible skin incisions using a special instrument.

Every referral for varicose vein surgery must be preceded by a surgical consultation during which the specialist surgeon will determine the possibilities and contraindications for performing the surgery. It should be emphasized that surgical operations must be adapted to the stage of disease progression, and each patient should be treated individually regarding the scope and method of treatment used. In some cases, in addition to the surgeon’s referral, a cardiological or internal medicine consultation is also required.

It is also necessary for the patient to sign consent for surgical treatment and anesthesia (anesthesiology interview). Varicose vein surgery is performed under epidural anesthesia. The duration of the surgery is about 2 hours. After the surgery, the patient usually stays one day in the clinic under individual nursing care, and then may go home. Two postoperative follow-up visits are scheduled at dates agreed with the specialist surgeon.