WHAT ARE VARICOSE VEINS AND WHY DO THEY OCCUR? WHAT PROMOTES THE PROGRESSION OF THE DISEASE?

The reason for qualifying for surgery is the presence of varicose veins of the lower limbs developing as a result of insufficiency of the large superficial veins of the venous system (saphenous vein, saphenous vein or other large vein). These veins connect to the deep veins of the lower limb and, under normal conditions, drain blood from the limb towards the heart. As a result of damage to the venous valves in the veins, the blood, instead of flowing away towards the heart, returns to the inefficient venous vessels and then varicose veins.

The formation and enlargement of varicose veins is favoured by genetic predisposition and other factors such as prolonged sitting and standing, obesity, constipation, hormonal treatment, pregnancy and a history of venous thrombosis. The incidence of varicose veins increases with the age of the patient.

Small varicose veins may not cause any discomfort. In the later stage of the disease, a feeling of heaviness, fatigue, pain in the lower limbs, swelling, discolouration of the skin and even ulcerations appear, most often in the lower shin area.

Established varicose veins of the lower limbs are an indication for surgical treatment. The procedure can be performed surgically, removing large, inefficient veins, or it can be performed in a less invasive way, e.g. using thermal ablation methods (closing the lumen of the vein through thermal energy). In this case, the idea of the procedure is not to surgically remove the vein causing the varicose veins, but to close its lumen without removing the vein from the tissues of the limb. By closing the vein, the backflow of blood into the varicose vein is inhibited, which, like surgery, treats the cause of the varicose vein. One variation of thermal ablation treatments is ablation using laser light energy. Thermal ablation treatment treats the insufficiency of only the large venous vessels - however, the lack of blood flow to the varicose veins leads in most cases to a reduction in varicose veins or their complete disappearance - the need for follow-up treatment (surgical removal of varicose veins or sclerotherapy).

Surgical treatment of varicose veins of the lower limb with intravenous thermal ablation using laser light energy.

Diagnosed varicose veins of the lower limbs are an indication for surgery. You should read the information outlining the indications and the extent of the planned surgery, its course and possible complications. This information is intended to help you decide whether or not to have surgery.

eligibility for treatment

Eligibility for surgical treatment is decided on the basis of patient-reported symptoms and the results of physical, laboratory and ultrasound examinations of the venous system. Regardless of the proposed treatment modality and anaesthesia, we ask you to answer the questions:

• Are you allergic or overreacting to drugs, anaesthetics, e.g. during previous operations or the administration of anaesthesia for dental procedures?
• Is there an allergy to the patch, rubber, latex or any other allergies?
• Have you had a venous thrombosis or pulmonary embolism?
• Do you have any infections (including skin infections)?
• Do you have a tendency to prolonged or excessive bleeding, e.g. after tooth extraction, after a cut, or a tendency to spontaneous bleeding?
• Do wounds from surgery or cuts heal properly?
• Do you take medication, including those that can be purchased without a prescription?
• Are you pregnant or do you suspect such a likelihood?
• Do you suffer from infectious diseases, e.g. hepatitis?
• Have there been any complications with previous treatments?

If the answer to any of the above questions is positive, the attending physician should be informed. Failure to do so, or withholding such information, may have a negative impact on the final outcome of the procedure and may increase the risk of adverse events.

In the presence of co-morbidities, in order to minimise the risk of „non-surgical" complications, e.g.: exacerbation of coronary artery disease, circulatory failure or respiratory failure, we consult doctors from other specialities.

During the qualification process for the procedure, the doctor may identify contraindications to the procedure. These may be due to the patient's general condition - active infection, poor general condition, advancement of other diseases, inability to perform anaesthesia, allergies related to the drugs used during the procedure, coagulation disorders, and for local reasons - obstruction or thrombosis of the deep veins of the lower limb, skin infections, superficial vein thrombosis, a very tortuous long vein course or very superficial venous vessels.

The use of certain drugs that reduce blood clotting may be a contraindication to surgery. This may require them to be discontinued before surgery or your treatment may need to be changed. Please inform your doctor of any preparations you are taking.

Basic laboratory tests are necessary before surgery. In case of circumstances arising from the patient's state of health, other tests may also be needed - the doctor decides on the need for extended pre-operative diagnostics.

If patients have coexisting risk factors for venous thrombosis, thromboprophylaxis is indicated - usually in the form of subcutaneous injections of low-molecular-weight heparin. The need for pharmacological prophylaxis is decided by the physician.

NON-INSULATION

Endovascular thermal ablation procedures for the treatment of lower limb varicose veins are nowadays usually performed under tumescent anaesthesia (a variant of local anaesthesia involving the administration of a large volume of very dilute anaesthetic). During the procedure, the surgeon will make a number of punctures of the skin with a thin needle along the vein to be closed and administer the anaesthetic. The advantage of this type of local anaesthesia is that it is very safe and the patient can be started immediately after the procedure. Other, much less commonly used methods are regional anaesthesia (epidural or subarachnoid) and general anaesthesia. However, due to the fact that thermal energy is used for laser treatments, it will also be necessary in these cases to inject an anaesthetic solution into the area of the vein, which, in addition to its analgesic effect, protects the surrounding tissues from the heat. In the case of anaesthesia other than tu-mescal anaesthesia, you will be consulted by the anaesthesiologist, who will provide details of the anaesthetic.

PREPARATION FOR TREATMENT

Once the anaesthetic procedure and the time for which the procedure is scheduled have been arranged, you will be informed about dietary recommendations - your doctor will provide you with detailed information about this (the time you have to fast before the procedure). Immediately before the procedure, you should not eat or drink anything. The only exception to this is if you need to take medication that you are taking permanently, which should be agreed with your doctor. If surgical removal of the varicose veins is performed at the same time as the thermoablation procedure, it will be necessary to shave the operated area. Omitting proper preparation for the procedure can have a significant impact on the final outcome of the procedure. Therefore, please follow the recommendations contained in this information as well as those provided by the medical and nursing staff.

DESCRIPTION OF THE PROCEDURE

The laser ablation procedure is carried out in the supine position (in the case of saphenous vein sealing in the supine position, in the case of saphenous vein sealing in the abdominal position). After lining the surgical field with sterile drapes, the doctor performing the procedure will anaesthetise the area (pricking with a thin needle and administering an anaesthetic), through which first the needle will be inserted into the vein and then the vascular sheath (a type of thin plastic tube through which an optical fibre will be inserted to deliver laser light energy into the vein). There are different fibre systems used for the procedure, in each case the insertion of the fibre into the lumen of the vessel will require prior puncture of the skin and vein. The laser ablation procedure is performed under ultrasound guidance. Once the fibre optic has been introduced into the vein lumen and the fiber optic tip has been appropriately placed in the initial segment of the vein (in the groin in the case of the saphenous vein or in the popliteal fossa in the case of the popliteal vein), the area of the treated vein will be anaesthetised - along its course, the doctor will make punctures (usually every few centimetres) and administer an anaesthetic. In the next stage, the actual thermal ablation procedure will begin, involving the slow withdrawal of a probe (optical fibre) connected to a laser light source from the lumen of the vein. Although the energy delivered by the laser light waves must be high enough to cause shrinkage and subsequent scarring and overgrowth of the vessel lumen, the procedure is not painful. If there is any pain, as well as numbness, burning or other discomfort in the limb during this phase of the procedure - this should be reported to the doctor during the procedure. Such symptoms may be an indication for the administration of more local anaesthetic or a reduction in the energy used in the vein closure procedure. After removal of the fibre optic and vascular sheath, a dressing is applied to the puncture site and a compression stocking is placed on the lower limb. If other veins are also treated using the same method during one procedure, it will be necessary to puncture and anaesthetise each vein (the doctor will inform you if this is necessary).

The laser ablation procedure is carried out using sterile equipment. Other equipment necessary for the procedure (surgical field drapes, gowns, gauze pads, gloves, surgical sutures) is also sterile and the room in which the procedure is carried out ensures appropriate sanitary and epidemiological conditions.

If during the qualification for surgical treatment a decision is made to surgically remove the varicose veins at the same time, the varicose veins will be removed using a surgical technique during the same procedure. A detailed description of the procedure for surgical treatment is also in this form, please refer to it.

Although the extent of the planned surgery is pre-determined in the pre-operative period, it is not always possible to predict all the changes that the surgeon may encounter during the procedure. A precise assessment of the extent of the surgery is only possible during the course of the procedure, which may make it necessary to extend the scope of the surgery. The final type of surgery/procedure is therefore determined by the operating team at the time of surgery. Hence, for each operation, we ask you to agree to a wider range of procedures and possibly to extend the procedure if necessary (both to ensure patient safety and to perform the optimal scope of the procedure).

OTHER AVAILABLE TREATMENTS

Lower limb varicose veins can be treated by other means. The optimal treatment should be sought, taking into account both the nature of the lesions found and the current knowledge and possibilities of medicine, the risk of potential complications, and the patient's preferences. Other treatment options are outlined below - however, it should be noted that not every varicose vein is suitable for their use.