Venous system surgery - phlebology

We want our legs to be forever healthy, beautiful, and attractive. Can varicose veins be an obstacle? Unfortunately yes, but now we have effective ways of fighting them! Let’s do something about it.

Varicose veins in the lower extremities are a serious problem, not only for aesthetic but also health reasons. Many people suffer from varicose veins, women more often than men. In Poland, a third of women suffer from varicose leg veins and over 40% of Polish women ignore the initial symptoms: leg pain, cramps and pain in the calves, swelling, or “spider veins”.

Varicose veins – disease or aesthetic imperfection?

Most patients treat varicose veins as a purely aesthetic problem. A defect that needs to be hidden under trousers, but not necessarily treated. That’s wrong.
Venous insufficiency is, despite appearances, a major health issue that can lead to various complications if untreated. Varicose veins of the lower extremities may provoke inflammation of superficial veins, which can be accompanied by oedema, soreness, and redness of the skin.

Venous insufficiency increases the risk of thrombosis in the deep vein system, which in turn can cause a life-threatening pulmonary embolism. Varicose veins occur when the durability and elasticity of the wall of the veins that transport blood to the heart is reduced. They are accompanied by insufficiency of the superficial vein valves, which prevent blood from receding in the veins. If ineffective, the blood flows down to the lower extremities, causing hypertension in the veins and making them widen, thus causing varicose veins. The changes are irreversible and require specialist treatment or a surgical intervention.
Even a single varicose vein should not be ignored, as it increases blood stagnation and makes the disease worse.

When should you visit a doctor?

  • When the look of your legs bothers you
  • When your leg suddenly swells
  • When varicose veins are painful
  • When skin changes appear (reddened or brown skin)
  • Open wounds appear on your leg (ulcerations)

The treatment process starts with a consultation with a vascular surgeon. You can schedule such a visit at the Medicover Hospital’s Consultation Centre by calling 500 900 900. On the basis of a clinical evaluation and a Doppler ultrasound examination, the doctor assesses venous flow, anatomy, and possible valvular failure, as well as potential abnormalities. Based on this information, the doctor and the patient decide on the best treatment.

Treatment methods

Obliterative methods are used to stop the progress of the disease, and involve injections with a special solution, or varicose veins are closed surgically.
Modern procedures, apart from their high effectiveness, guarantee a good aesthetic effect. This is especially true about minimally-invasive methods. Non-operative methods, namely pharmacological obliteration, are recommended only in the case of single small varicose veins where valve capacity is preserved.

Pharmacological obliteration (closing telangiectasia on the legs) – injecting a solution into an inflamed vein causes it to close. Depending on the number of varicose veins, the procedure takes up to 20 minutes to perform. The procedure is performed in outpatient conditions, doesn’t require anaesthesia, and doesn’t leave any traces. It is used in the case of so-called spider veins and minor venous enlargements. In the case of veins that have a higher diameter, foam sclerotherapy under ultrasound guidance is used to ensure greater injection accuracy, high effectiveness, and lower drug dosage.
This type of treatment is always administered under ultrasound probe guidance, hence its common name: echo-sclerotherapy. There are different variants of this method.
The most common are injection echo-guided sclerotherapy and catheter-directed sclerotherapy with tumescent local anaesthesia. A very effective form of catheter-directed sclerotherapy has recently become popular, which involves mechanical closure of the vein wall. An improved catheter-directed sclerotherapy (mechanical and chemical) is called Flebogrif. We use it at the Medicover Hospital to close varicose veins in the main trunks in outpatient conditions. An advantage of this method is that anaesthesia is not necessary and the procedure takes a short time to complete. It is also relatively cheap compared to thermal methods involving a laser or steam. When closing varicose veins in the Flebogrif system, just as in the case of classic injection sclerotherapy, the patient needs compression wear during the post-operative period.
In the case of atypical varicose veins in the lower extremities (usually caused by pregnancy) or varicose veins in the genitalia, the Medicover Hospital offers diagnostics of so-called pelvic venous insufficiency. If diagnosed, a minimally-invasive intravascular treatment is offered that restores normal blood outflow from the pelvis.

Microphlebectomy, which involves ligation and excision of varicose veins in the lower extremity (tibia), is used in the case of small varicose veins. It is offered to patients if their vascular changes don’t qualify them for sclerotherapy and if major surgical interventions are not necessary. Micro-phlebectomy is a state-of-the-art procedure consisting in the removal of dilated veins by making 2–3 mm micro-cuts in the skin. It is performed as a one-day surgery. The procedure takes around 40 minutes, and the patient can leave the hospital as soon as a few hours after surgery. The most important advantage of this method is its great aesthetic effect.

The most popular and the most effective minimally-invasive procedure is endo-venous laser treatment (EVLT), consisting in ligation and excision of varicose veins in the lower extremity), by sealing varicose veins using laser techniques. After puncturing the great saphenous vein, a fibre-optic cable is introduced and, under ultrasound guidance, the vein is coagulated by irradiating its walls with a laser from the inside. Co-existing varicose veins are removed using the mini-phlebectomy method. A compression stocking is worn on the operated leg, and after a short period of observation the patient leaves the clinic. This method avoids standard surgery involving the removal of the entire great saphenous vein and disfiguring scars in the groin. The use of this method significantly reduces post-operative pain and helps the patient to recover faster and return to full fitness.

Minimally-invasive methods, as the name suggests, are patient-friendly and don’t leave visible aesthetic imperfections. Let’s care for our legs so that such procedures are unnecessary. Wear comfortable shoes, remove tight clothes from your closet, be more physically active, quit smoking, avoid high temperatures (e.g. saunas and tanning salons), massage your legs regularly, and, most importantly, if you notice any symptoms, see a doctor as soon as possible. The quicker you react, the better it will be.

If you have any doubts about whether your ailments are the result of a disease or are only a cosmetic problem, visit a vascular surgeon at the Medicover Hospital.

  • Maciej Kielar (MD, PhD, Hab. Dr)
  • Cezary Szary (MD, PhD)
  • Marek Witkowski (MD, PhD)
  • Jacek Waligóra (MD, PhD)