Nonsurgical treatments are suitable for ALL patients with varicose veins
Surgical treatment of varicose veins has been widely used all over the world for more than a hundred years. However, with the widespread application of non-surgical methods developed in the early 2000s, its popularity has decreased. Surgical procedures performed in varicose veins can be examined in two groups:
1. Interventions for venous insufficiency that cause varicose veins:
These are ligation&stripping surgery in great saphenous vein insufficiency and ligation surgery (SEPS) in perforating vein insufficiency. In ligation&stripping operation, incisions are made at the groin and various parts of the leg and the great saphenous vein is removed in pieces. Against the risk of injury to the saphenous nerve, usually only the upper part of the great saphenous vein is removed from groin to the knee, leaving the lower part intact. In SEPS, the perforating veins under the skin are closed by laparoscopic method using endoscopy.
Both ligation&stripping and SEPS operations have been performed in medicine for decades and have proven successful. However, both have the disadvantages such as general anesthesia, hospitalization, late return to normal life, and the risk of wounds, sutures and infections that apply in every surgical operation. Furthermore, there is a risk of deep vein thrombosis (clotting) up to 5%, especially after ligation&stripping surgery, and even after the most successful operations, venous insufficiency recurs in about half of the patients. The reason for this high recurrence rate is a phenomenon called neovascularization, which is the formation of new tiny tortuous veins in the bed of the removed saphenous vein as a reaction to the trauma created by the surgery. Since neovascularization consists of tiny vessels without valve, the venous blood flows back through these vessels and thus incompetence recurs causing varices to reappear. In such patients, neovascularization sites can be successfully treated with ultrasound-guided foam sclerotherapy if these veins are properly detected on color Doppler ultrasound.
2. Treatment of varicose veins caused by venous insufficiency:
These are varicectomy or phlebectomy surgeries, which are the removal of the varices. In these surgeries, large varicose veins are removed by making incisions from the skin and the incision sites are closed by suturing. In this method, the patient is immediately free of large varices, but permanent scars appear at various parts of the leg.
Today, this method is still in use, but the mode of application has changed completely. Large varices can now be taken out of the pinholes without cutting the skin under local anesthesia. In this method called miniphlebectomy, firstly, local anesthetic fluid is injected around the large varices and the varices become collapsed and the blood inside them is transferred to normal vessels. Then, the emptied varicose veins, which have turned into 1-2 mm small veins, are removed from the pinholes. Miniflebectomy is performed in our clinic with ultrasound guidance and foam sclerotherapy so that the procedure can be performed more effectively, easily and without blood.
Removal of varicose veins with large incisions causes permanent scarring and deformation (arrows) on the skin. For this reason, large varicose veins should be taken out through the pinholes at the skin without any incision by using a procedure called miniphlebectomy.