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Surgical treatment of varicose veins

Varicose vein surgery has been revolutionized by the contribution made by Doppler-ultrasound technology and the practice of a tumescent local anesthesia along the vein.

 

The technique of administering a tumescent local anesthesia has also assisted the development of endovenous laser treatment.

1. Mini-invasive varicose vein surgery

This varicose vein surgery is mini-invasive and tailored to the patient as it only concerns the diseased veins leaving the healthy or little-dilated ones unaffected (these could, one day, be useful as material for arterial bypass).

 

The vast majority of patients arrive in the morning and leave the same day (ambulatory surgery) with a leg free from hematomas, although some bruising may appear the following day.

 

It is no longer necessary to wear compression bandages on leaving the clinic. Patients are thus free to leave on the same day as the varicose vein surgery, wearing compression stockings to enable them to put on their shoes and walk normally from the moment they leave.

 

Our experience (over 15,000 varicose vein surgeries undertaken in ambulatory surgery with a tumescent local anesthesia) shows that time off work is reduced to 2-8 days.

 

The number of recurrences is reduced to less than 5% over 10 years on condition that the procedure is inspected by ultrasound scan on the 15th day and of course that the patient is monitored by his angiologist for additional sclerotherapy.

 

Varicose vein surgery must obey all the guidelines for cosmetic surgery (very fine resorptive suturing, no suturing on skin, only steristrips).

 

Lastly, recently (and we are one of the few teams to practice this regularly), the varicose vein surgery is inspected by a Doppler ultrasound scan on the 15th day after the operation to check that nothing has been omitted and this forms the basis for essential post-operative monitoring (of the patient by the angiologist).

Following this procedure fully means that the patient can be guaranteed that there will be no additional fees (excluding the fee for the surgery itself) will be charged for any, rare recurrences over time.

2. 2. Doppler ultrasound

This is carried out by a specialist angiologist:

  • Only this technique enables the varicose veins to be measured, the direction of the blood circulation to be determined, the leakage points to be located and the incontinence of the varicose vein to be confirmed.
  • Thus, only this can provide an indication of suitable, considered treatment based on the mapping of the varicose veins viewed as a diagram. This map shows the direction of blood circulation in the varicose veins (upwards or downwards) and the precise location of leakage points.

This mapping is essential and should be carried out on 3 occasions:

  • Before any decision is made on treatment in order to:
  • The day before treatment by endovenous laser or varicose vein surgery in order to:
    • guide the operation by producing a venous flow map,
    • ensure a good view of (highly frequent) anomalies in the position of varicose veins, which can lead to recurrence,
    • determine from what direction the surgery should be carried out,
    • avoid missing anything (varicose veins which are not visible to the naked eye),
    • ensure scarring is as cosmetically unobtrusive as possible and is punctiform due to good guidance.
  • After varicose vein surgery in order to:
    • monitor the effectiveness of the surgery, which means checking that all the varicose veins have been properly retracted

3. The Tumescent local anesthesia

Only this technique can ensure “non-traumatic” varicose vein surgery, with the least possible pain, whilst still being entirely complete.

 

With our team this has virtually replaced general or spinal anesthetic.

 

In fact both general and spinal anesthetic lead to a dilation of the varicose veins and increase bleeding during the operation, requiring several days’ hospitalization (hematomas – a source of pain and prolonged social and professional incapacity – are frequent). The level of recurrence is high at 30-50% over 5 years in published statistics).

 

It is essential not to confuse massive local anesthetic (spinal anesthesia or epidural) with tumescent local anesthesia along the veins. The latter allows highly localized anesthetic to be administered exclusively to the varicose vein being operated upon, which has the advantages of:

  • detaching the vein which does not need to be extracted,
  • closing the varicose vein, which will empty it of the blood it contains.

This means hematomas are unusual, though some bruising can appear after the varicose vein surgery.

 

This use of local anesthetic facilitates invagination where the vein is removed by turning it inside out. A thread inserted into the varicose vein enables it to be turned inside out like the finger of a glove.

 

This avoids trauma outside the vein (perivenous fat or the nerve’s satellite vein); hematomas and pain such as neuralgia are thus highly unusual.

 

The combination of perfect pre-operative mapping and surgery using local anesthetic administered to areas of tumefaction enable us to perform soft, more precise and more cosmetic varicose vein surgery (this is because the Doppler ultrasound scan carried out the day before for marking, enables the smallest, most deeply buried veins to be located immediately when under the scalpel, and without problems from bleeding).

 

The technique of the tumescent local anesthesia is always practiced by our team because of its accuracy (around the vein). However, at the patient’s request, a small “neuroleptanalgesia” may be administered so that they needn’t “see or hear anything,” if they so wish.

 

In any event, this soft varicose vein surgery under tumescent local anesthesia is always mini-invasive and cosmetic.


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Doppler ultrasound

Doppler ultrasound to produce…

varicose vein surgery

… pre-operative location

of varicose veins

varicose vein treatments

Surgery without bleeding

varicose veins surgery

Post-operative monitoring

varicose veins surgery

The patient remains awake

varicose veins surgery

The patient does not require an oxygen mask during the operation

varicose veins surgery

Marking to ”guide” the surgery

varicose veins surgery