Miniflebectomy (vein crocheting) - surgical treatment of lower limb varicose veins

Miniflebectomy (vein crocheting) - characteristics

Miniflebectomy (vein crocheting) is a technique used in the treatment of dysfunctional vessels located superficially under the skin of the shins. With a small invasiveness of the procedure allows you to quickly and effectively treat the failure of venous lines.

Varicose veins are a common condition. They can be easily recognized by characteristic, piercing and visible through the skin on the legs pronounced, and even balloon-like tumors. Undertaking treatment at an early stage of disease development is important not only for aesthetic but also for health reasons. One of the therapeutic options is the miniphotectomy operation also commonly referred to as vein crocheting. After removal of fragments of vessels in which surgically damaged stasis occurs, the ends become shrunk and healed, while the remaining sections of inefficient veins grow in the subcutaneous layer of the calf, as a result of which the body searches for new routes for blood transport. After miniflebectomy - the surgical treatment of varicose veins of the lower limbs, the flow of blood in inefficient vessels is stopped, and the blood is diverted to these channels, which can flow freely and return up the body.

Miniflebectomy (vein crocheting) - benefits

Benefits gained thanks to miniflectomy are first of all getting rid of the body of inefficient venous vessels and allowing the stream of blood to be directed to properly functioning vessels. Thanks to this treatment we get improvement in the circulation of the lower limb. The surgical treatment of lower limb varicose veins reduces the risk of vasculitis in the supine and related complications and pain. In addition, the risk of shin ulcers is reduced, especially in older patients, with poor blood supply in the distal parts of the body and numerous additional loads that heal poorly and can often result in complications in the form of infections and others. The benefits of miniflebectomy also improve the appearance of the skin of the shin and increase the comfort of the patient. The symptoms accompanying venous insufficiency in the leg are reduced or even completely eliminated. First of all, it concerns swelling of the shins and around the ankles (especially after a long standing patient in the standing position, legs down which further hinders the return of the venous blood), pain, burning sensation, itching, distraction or discomfort in the lower limb. In addition, after vein crocheting, the appearance of the skin improves, the risk of new discoloration is reduced and the chance of undoing spots, efflorescence and ulceration created in the past increases.

Indications for the procedure

The indication for the miniflebectomy - the surgical treatment of varices of the lower limbs is, above all, the inefficient venous vessels that cause the patient's symptoms. We perform the miniphotectomy in recurrent inflammation of varicose veins, which are associated with unpleasant sensations like pain, burning sensation, and numbness. In addition, the indication for the procedure is superficial vein failure resulting in the formation of ulcers (early removal of varicose veins can prevent further changes and difficulty in healing of tissues), repeated haemorrhage from hemorrhage, haemorrhagic diathesis, the formation of swollen edema, as well as ineffectiveness and failure of conservative treatment. Patients often report on the operative treatment of varices of the lower limbs for cosmetic reasons, and they are mainly disturbed by unsightly changes in the shin surface. At the early stage of development of venous insufficiency and subsequent dilatation of blood vessels with blood clots, the complaints are not so onerous, and the patient's discomfort is associated with swelling and swelling of the legs, especially around the ankles. Besides, before serious tissue damage and ulcerations occur on the surface of the skin of the shins, unsightly teleangiectasias appear, the increased drawing of the venous mesh begins to translate through the skin, or even modify its surface creating a bulge with residual content. Diarrhea changes pigmentation on the surface of the body, and the skin becomes earthy-gray to sino-brown. The earlier treatment of venous insufficiency is taken by vein crocheting, the greater the chance of achieving a good cosmetic effect, although complete reversal of pigmented lesions on the skin may be difficult to perform. After miniflebectomy, the feeling of tiredness and heaviness in the leg also decreases.

Contraindications for the procedure

Contraindication to miniflectomy is a poor general condition of the patient, when first of all treatment of the underlying disease and restoration of stable health is required. Subsequently, it is not advisable to perform isolated miniflebectomy in the event of a significant venous insufficiency reaching the saphenous vein (in this situation it is recommended to use the Babcock method with striping and removal of the vein in its course from the inguinal canal to the popliteal region). It is contraindicated to perform the operative treatment of varicose veins in the case of a generalized infection or localized superficially in the form of, for example, abscesses on the skin of the shin if there is a risk of transferring microbes to deeper tissues during the procedure. The procedure is not performed in the case of significant clotting disorders (until the parameters are equalized and confirmed in the laboratory results). It is not advisable to perform the procedure if effective conservative treatment of varicose veins is possible or the patient does not consent to the therapy with the miniflectomy method.

Before the surgery

Before the miniflebectomy procedure, additional tests are necessary. It is important to assess the source of the problem. There are special tests that help to examine the condition of deep veins (if they turn out to be efficient, we can assume that we are dealing with varicose veins described as primary) and perforating and superficial veins. In case of deep venous insufficiency, one should carefully search for a cause in the form of thrombosis or arteriovenous fistula. Once the patient is qualified for the mini-cardectomy procedure, the surgeon performs tests to check the efficiency of the thyroid veins and legs of the operated leg. For this purpose, special diagnostic tests are used, among others the Trendelenburg and Perthes test. It is also worth performing ultrasound examination. Applying the head of the ultrasound device will help visualize the vessels, possible thrombi, and also indicate the location of the stasis.
Before the miniflebectomy, the surgeon examines the patient standing upright. There are places on the skin of the legs in which veins of the veins are visible, which indicate the insufficiency of valves in this place and the presence of blood. This will help to make incisions and crocheting with the extraction of appropriate vein fragments during surgery. After placing the patient on the treatment table, the blood can go back to the deeper cords, and the inefficient vessels will cease to be visible, which will make it difficult to locate the problem correctly.

Type of anaesthesia

Miniflebectomy (vein crocheting) - surgical treatment of lower limb varicose veins is carried out under local anaesthesia. Locally, a lidocaine solution is applied around previously marked cut point

How does the procedure work?

The miniflectomy operation starts with placing the patient on the surgical table and cleaning, and proper disinfection of the skin surface. Then the patient is anesthetized by injecting a lidocaine solution into the area previously marked by the doctor of the largest changes associated with varicose veins. With a scalpel, the surgeon makes a small, several millimeter incision to the depth that allows to visualize the blood vessels. A sterile crochet-like device, the doctor wraps an inefficient vein with a quick pull and pulls a fragment of the vessel. It ends spontaneously to shrink the rest of the leg. Holes in the skin are closed with a single, straight seam made of specialized thread. Very small incisions made while crocheting veins may not require a thread supply.

Time and course of convalescence

The time required to return the patient to full efficiency after is short. Usually, after three to four days, the patient may return to normal activity. However, it is recommended that after the miniflebectomy the prevention of new changes should be used. Preventive actions improving the circulation and return of venous blood from the leg, which are aimed at preventing the formation of new varicose veins are not troublesome and do not extend the time of recovery, but only help to keep them for longer. Appropriate methods of prophylaxis of relapse after surgical treatment of lower limb varicose veins will certainly be indicated by the doctor.

Effects after surgery

The effects of miniflebectomy (vein crocheting) are noticeable almost immediately after the treatment to improve the appearance of the skin of the limb. Shaving is deprived of ugly bulging and ballooning widening in the course of the vessels. In addition, the operational effects of treating lower limb varices is an improvement in health. The risk of congestion and related complications is reduced.

Recommendations after the procedure

It is recommended that after miniflebectomy (crocheting veins) - the patient as soon as possible to get out of bed and return to daily activities. Crocheting venous shins is a minimally invasive procedure, and the short time needed for convalescence allows you to return to daily activity in a short time. Patients after vein crocheting should avoid prolonged staying in a standing position, and if it is necessary to try to move their legs and through calf muscle tension, they should increase the work of the limb press and stimulate the blood pushing to the upper body parts. Miniflebectomy surgery is a procedure that treats symptoms but not the cause of varicose veins. For this reason, it is necessary to use probilactic blood stasis in the legs to prevent the development of new lesions on the failing valves. Patients should sleep with their legs raised at a slight angle up. In order to prevent the recurrence of the disease and improve the effects after the procedure, it is recommended that patients undertake regular physical activity with intensity adjusted to their health. Particularly recommended are exercises in water, followed by general exercise, cycling and running. One should not carry heavy weights or undergo heavy gym training (increased abdominal muscle tension during weight lifting causes tension of the abdominal press and pressure on the vena cava which results in obstruction of blood drainage from the lower limbs). It is also worth taking advantage of additional treatments after the miniflebectomy operation, which are helpful in improving leg muscles and preventing the creation of new changes.

How long do the effects last after the treatment last?

The duration of the effects of miniflectomies (vein crocheting) is largely dependent on the patient. It is worth remembering that the operation of miniflectomy does not cure the disease in the form of venous insufficiency which is the essence of the problem, but only removes the symptoms in the form of varicose veins. Their removal during miniflebectomy (vein crocheting) brings good results, however, it does not exclude recurrence in the future. The duration of the effects depends largely on the patient's compliance with medical recommendations and appropriate prophylaxis to improve venous return from the lower limbs, in order to prevent stagnation in the area of inefficient valves, stretching of the vessel walls and the formation of new varicose veins.

How to avoid complications after the procedure?

Miniflebectomy surgery is an uncomplicated and quite safe procedure. The procedure is short and the risk of complications related to coagulation disorders or the formation of blockages due to immobilization is not high. However, it increases the disease associated with valve insufficiency and blood stasis in the limbs. It is recommended that after the surgical treatment of varicose veins, the patient would like to start up as soon as possible and not limit the activity until healing the lesions in the leg to a greater extent than necessary. In addition, patients receive appropriate medications. It is recommended to use compression therapy and other physical methods to improve venous return. They counteract the emergence of complications after miniflebectomy (crocheting veins) and counteract the development of new changes. Other possible complications of Miniphlebectomy (crocheting veins) infection in skin wounds. They are prevented by proper hygiene of the legs and cleaning and disinfection of the shin surface, especially in the area of surgical cutting. It is also important that the dressings are changed as often as required to keep wounds clean and dry to promote healing.

Possible complications after the procedure

During mini-cardectomy (vein crocheting), we are primarily concerned about damage to the tibial nerve. Therefore, the so-called stripping, i.e. removal of the saphenous vein on the longer segment, is performed only in its course from the groin to the popliteal region. Below, i.e. on the shin, the vein runs very close to the tibial nerve and an attempt to extract the whole could lead to serious neurological complications. After a miniflebectomy operation, in which the inefficient vessels are removed in small fragments by several millimeter incisions on the skin of the shin, a complication may also occur in the form of damage to the tibial nerve, but this happens less often. In addition, possible complications after vein crocheting include infection in places of incisions, pain and impaired wound healing.

Recommended additional treatments after the procedure

After the miniflebectomy (vein crocheting), additional procedures are recommended to improve venous circulation in the leg vessels. Compression is recommended, consisting in the use of appropriate stockings with graded pressure or dressings, this helps to increase venous return of the limb and reduces the risk of new stasis. In addition, physical therapy is recommended. Good effects on counteracting the development of varicose veins give exercises on the lower limbs. The work done by the calf muscles is conducive to the creation of a pump that pushes blood out of the shin up the body.

Author: Anna Kołodziejska, MD
Literature:
"Surgery" edited by Wojciech Noszczyk, PZWL

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