Endovascular laser coagulation of varicose veins is a modern, highly effective, safe and simple method of laser surgical treatment of varicose veins in the early stages. The technique is popular around the world, but is only used in vascular surgery centers with special laser devices. The removal of varicose veins on the legs with a laser is better tolerated by patients compared to classic surgery and contributes to a quick recovery.
Despite all the positive aspects, laser coagulation, like any other method, has its disadvantages. It is very important to consider the therapeutic possibilities of the operation and only use it when it is really indicated and helps the patient. It is unacceptable to use a template to treat all patients with varicose veins with a laser that only obeys commercial interests and fashions.
Indications and possibilities of the method
Only with the expansion of the superficial veins (large and small saphenus) of the lower extremities by 1 and 2 degrees is it possible to remove them with a laser. This means that laser coagulation surgery can only be effective in the early stages of varicose veins.
More precise indications for an operation:
- Direct or slightly tortuous course of enlarged vessels, if they do not have any sharp curves.
- Lack of large varicose veins.
- The expansion of the lumen of the vein is less than 1 cm.
- The main type of varicose vein when the extension spreads along the central trunk of the small or large trunk vein and not many small tributaries are involved.
Laser coagulation of varices with an enlargement of more than 2 degrees is not appropriate due to the high risk of recurrence of the disease 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 includes laser coagulation of the main trunk and surgical removal of varicose veins of small branches through separate small punctures. Such an operation is also less traumatic and combines all the advantages of laser and classic surgery.
Contraindications
Even in patients with mild varicose veins, laser treatment cannot be performed if there are contraindications for an operation. They are absolute - categorical, in which variceal coagulation can aggravate existing tissue changes, and relatively - temporary, in which the risk of postoperative complications increases. All contraindications are listed in the table.
| Absolutely | Relative |
|---|---|
| Blood clotting disorders in the form of an increased tendency to form blood clots or to bleed | Purulent-inflammatory skin processes on the lower extremities, especially in the places of future cuts |
| Severe 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 persistent or severe course of varicose veins (pronounced swelling, brown spots, indurations and ulcers on the skin of the legs) | Acute infectious diseases (colds, viruses, intestinal infections) |
| Thrombophlebitis - inflammation of varicose veins | Immunity problems |
During pregnancy and the early postpartum period, it is better to refrain from laser coagulation of varicose veins, even if it does not adversely affect the fetus. This is due to the inability to predict the course of the postoperative period, high loads on the lower extremities, hormonal and immunological changes in the body.
Phases of the operation
The principle of laser coagulation of varicose veins of the legs is based on the thermal effect of laser beams. They act on the tissue, heat it up, destroy and glue (seal, glue) the vessel walls. As a result, the vein loses its lumen, becomes deserted and turns into scar tissue.
Laser surgery is performed in a sterile operating room with special equipment:
- A laser coagulator is a device that is a source of radiation.
- Laser light guide - a tubular electrode that the laser beam uses to act on a vein.
- An ultrasound machine that can visualize superficial veins, which can be used to assess how well they are being processed during surgery.
The main phases of the intervention:
- Vein marking.
- Anesthesia (pain relief).
- Direct removal of veins with a laser.
The duration of the operation on one leg is 15–20 minutes if only one of the vascular trunks is required, up to an hour if laser coagulation of the central venous trunk is combined with the classic removal of small, dilated branches by punctures (miniflebectomy).
Vein marking
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 marker or bright green how and where the Varix goes by on the leg. They also perform a preoperative ultrasound Doppler examination of veins, in addition to marking the features of their branching, if they are not indicated before the ultrasound.
anesthesia
Anesthesia during the operation can either be local or regional or general. In the first case, the puncture and interfaces are infiltrated (injected) with preparations of local anesthetics - if only the central vein is treated with a laser.
If the procedure is extended (with miniflebectomy), spinal anesthesia or short-term intravenous anesthesia may be required. In either case, the procedure is painless.
Direct implementation of the procedure
The operation of laser coagulation of varicose veins on the legs is as follows:
- After anesthesia in the upper third of the thigh along the anterior inner surface under the inguinal fold, either a puncture or a skin incision of a maximum of 2 cm is made.
- A large saphenous vein is found at its confluence with the femoral vein under visual or ultrasound guidance.
- The saphenous vein is severed and ligated, separated from the deep one, and a long (approx. 1 m) flexible light guide inserted into its lumen, which is guided to the beginning of the vessel at foot level.
- You pull the light guide one after the other to the puncture point on the thigh and act with a beam on the walls of the vein, which causes it to burn, sclerosing blood and sclerosing (sticking) 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 veins with a laser. They are removed through additional punctures that do not require suturing.
- Immediately after the treatment of leg veins with a laser on the operating table, the extremity is connected with an elastic bandage or individually selected compression stockings (stockings) are put on.
The laser coagulation should be carried out under ultrasound control so that you can see the collapse of the venous lumen and dose the intensity of the laser radiation.
advantages and disadvantages
Laser coagulation is a good and radical method of treating varicose veins, but it is also not a panacea for this disease. The advantages and disadvantages compared to traditional surgery are described in the table.
| Laser treatment | Traditional surgery |
|---|---|
| Anesthesia is often local | Local anesthesia is not effective |
| No big cuts, no scars | Need cuts, there will be scars |
| The surgical trauma is minimal, the vein is not removed but burned out from the inside | The vein is removed, the tissue is injured |
| The procedure is quick (less than an hour) | The duration of the operation is more than an hour |
| Low risk of post-operative complications | More common complications compared to laser coagulation of varicose veins |
| Fast recovery and discharge from the clinic (even on the day of the operation) | Longer recovery, discharge after a few days |
| Laser treatment is only possible for mild varicose veins | You can remove veins affected by varicose veins of any grade |
| There is a risk of rebuilding the lumen of the vein if not treated well | Veins are surgically removed so they never restore their lumen |
| Requires special equipment, so the cost is high | The price is twice lower compared to removing varicose veins with a laser and does not require special equipment |
Risks
The speed and minimal trauma of surgical treatment of varicose veins with a laser minimize the surgical risks of a procedure. Negative consequences and complications occur in 1% of the operated patients. They are usually local and presented by inflammatory processes along the coagulated vein. Recanalization (restoration of the lumen) and relapse of the disease are possible in 5%, which may be associated with surgery without the use of ultrasound equipment or in patients with severe varicose veins.
Postoperative period
The early activation of patients is to avoid negative consequences after laser treatment of varicose veins. You can go on the day of the operation. Compression products (bandage or stocking) must not be removed for 2-3 days. After this time, they can be removed at night and when moving to a horizontal position. You must wear compression stockings for at least a month and put them on before you get up. 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, surpassing and even surpassing the effectiveness of traditional surgery. However, the advisability of its use should be decided only by a specialist, taking into account the individual characteristics of each patient.