Surgical treatment of varicose veins (crossectomy and stripping)
The procedure is carried out under local anestesia, so-called tumescent anesthesia. With this technique you will retain your ability to fully move your body on the operating table and therefore can assist in case you need to change position. Also, your risk for venous thrombosis is signifcantly reduced compared to general anesthesia. This method is specially suited for patients with coronary heart disease or asthma, as general anesthesia bears specific risks for those patients. However, any operation for varicose veins can also be carried out under general anesthesia.
Depending on whether the big (V. saphena magna), the small (V. saphena parva) or both feeding veins are defective, a small cut of a few centimeters in length, is made in the inguinal region or the hollow of the knee, after performing the local anesthesia. Subsequently, all branches that flow into the main vein of that region (venous star) are carefully ligated. This is followed by the so-called crossectomy, the ligation of the main feeeding vein where it meets with the deep vein. Then a flexible catheter is inserted into the feeding vein that has just been dissected and pushed forward to the distal point of defect, so no healthy parts of the vein are removed. With the help of the inserted catheter, the vein is removed (stripping). Subsequently, other defective branches of this vein are traced, small 0.5cm incisions performed and the veins are either ligated or stripped. For very small veins, incisions of a few milimeters only are required, allowing for an excellent cosmetic result. the incisions in the inguinal region or the hollow of the knee are closed by intracutaneous sutures, the other incicions are taped with special adhesive bandaids. Sutures and tapes are removed after 10-14 days. During this time contact with water needs to be prevented. A special wound and compression dressing will also be applied and needs to remain in place for 1 day. After the first change of dressing, compression stockings need to be worn during the day for 4-6 weeks.
Mit Hilfe der Sonde wird die Vene gezogen (Stripping). Im Folgenden werden weitere defekte Seitenäste der Stammvene am Bein mit mehreren kleinen ca. 0,5 cm großen Schnitten aufgesucht und entweder kurzstreckig gezogen, oder die Kontinuität der Vene unterbrochen. Bei sehr keinen Venen können die Schnitte auch nur wenige Millimeter groß sein. Dadurch wird ein möglichst gutes kosmetisches Resultat erzielt. Die Schnitte in der Leiste oder Kniekehle werden genäht, die anderen kleinen Schnitte mit Wundklebepflastern verschlossen. Die Faden- bzw. Wundklebepflasterentfernung sollte erst nach ca. 10-14 Tagen erfolgen, in der Zwischenzeit darf kein Wasser an die Wunden gelangen. Es folgt ein Wund- und Kompressionsverband, der einen Tag belassen wird. Nach dem ersten Verbandswechsel am darauffolgenden Tag müssen für 4-6 Wochen tagsüber Kompressionsstrümpfe getragen werden.
Undesired side effects and complications
As every surgical procedure, also this method bears risk that cannot be ruled out even when the greatest care and prudence is being taken. Statistically speaking, these risks are rare. They involve the following:
- bleeding and bruising
- adverse reactions to the anestehtics
- injury of deep veins and arteries
- nerve damage
- injury or damage of lymph vessels
- Burns of the skin, including blister and crust formation, and potential scarring
- delayed wound-healing
- local infections
- deep venous thrombosis, accompanied by the risk of lung embolism
- thrombophlebitis (inflammation of superficial veins)
- perturbed scar formation (e.g. hypertrophic or depressed scars)
- pigment alterations (darks or light patches)
- development of veinectasias/couperosis
Advantages of the conventional surgical therapy
the varicose vein is removed
- the small branches that flow into the main vein of that region (venous star) are ligated in full view
- the conventional surgical therapy (crossectomy and stripping) is fully covered by the state and private insurance companies