Vascular surgery – Surgeries

We are among the first in Hungary to use varicose vein surgery with glue, developed by Sapheon, to occlude dilated varicose veins. The essence of varicose vein glue surgery is to deliver a glue into the vessel through a special catheter, and as a result, the whole length of the vessel sticks together, thus the circulation stops in it. The catheter is guided from the groin to a height of 5 cm, and glue is injected into the vein as it the catheter is retracted. After gentle pressure, the glue sets and obstructs the vessel along its entire length. Most of the dilated side branches recede spontaneously as a result of surgery. Any remaining side branches can be injected later.

A major advantage of the procedure is that it does not use thermal energy and does not even require local anesthesia, except for anesthesia at the puncture site where the catheter is inserted.

This treatment is performed on an outpatient basis: the patient can get up immediately after surgery and after a surgical check-up, they can go home.

For details on the symptoms of the disease or possible conservative treatments, please click here.

What are the steps of aftercare?

There is essentially no substantial aftercare. The undoubted advantage of the procedure is that the patient can continue his/her daily activities after the surgery, and does not even have to wear compression stockings. There is no recovery time and aftercare, no need to go on sick leave, and no need to wear compression stockings.

But why is this good for the patient?

With the surgery, the patient can get rid of the constant pains that have limited him/her in daily life and work. In lieu of the surgery, however, an increase in complaints, chronic venous insufficiency, and possibly the development of leg ulcers can be expected, and the surgery of these complicated cases involves a significantly higher risk of surgery.

The basic condition of varicose vein surgery with radiofrequency ablation is intact deep vein circulation, and duplex ultrasound examination is required to confirm it. As a preliminary examination, an ECG, laboratory parameters and a chest X-ray are performed. The preliminary outpatient protocol also contains a preoperative risk assessment by an anesthetist.

The essence of varicose vein surgery with radiofrequency ablation is that the vein is punctured at the height of the poplitea, under local anesthesia, with ultrasound guidance, and a radio frequency (RF) catheter is advanced through the needle to the groin area. The entire length of the vein is surrounded by a so-called Tumescens solution, and then the catheter is gradually retracted to obstruct the dilated vein using RF waves. The process of treatment can be well controlled on the ultrasound image. After taking care of the main venous trunk, the additional side branches are treated from separate punctures under anesthesia. There is no need to suture the resulting wounds of a few millimeters as they heal without a trace. At the end of the surgery, a tight pressure bandage is placed on the limb with an elastic bandage up to the thigh.

The operation is performed under superficial sedation to reduce surgical stress.

This treatment is performed on an outpatient basis: the patient can get up 2 to 3 hours after surgery and after a surgical check-up, they can go home with someone escorting them.

For details on the symptoms of the disease or possible conservative treatments, please click here.

The following video shows the details of the intervention:

What are the steps of aftercare?

Anticoagulant injection therapy for 7-10 days is recommended to prevent thrombosis. It is possible to move freely in your home, a short-stretch elastic bandage should be used, and then, when postoperative wound pain has subsided, it is recommended to wear a grade II compression stocking for another 2 weeks. The patient can take a shower after 48 hours, but bathing is only recommended after two weeks.

After radiofrequency varicose vein surgery, a thicker bundle can be palpated along the path of the occluded main venous trunks and lateral branches, which gradually disappears within a few months as the veins are absorbed. This can be a little sensitive in some cases, and local cooling of the painful skin area helps alleviating the complaints. After the operation, tension and swelling will occur in the legs, which can be alleviated by leg elevation. During a long walk, the legs can easily get tired and elevation is also recommended in such cases.

Two days after radiofrequency varicose vein surgery, it is allowed to return to work but for lasting results, no heavy physical work should be done until the first (one-week) follow-up visit. If no reaction is seen on the surgical area and the patient has no complaints, sports are also allowed after 2-3 weeks.

But why is this good for the patient?

With the surgery, the patient can get rid of the constant pains that have limited him/her in daily life and work. In lieu of the surgery, however, an increase in complaints, chronic venous insufficiency, and possibly the development of leg ulcers can be expected, and the surgery of these complicated cases involves a significantly higher risk of surgery. There is no absolute indication for laser varicose vein surgery, we only perform the surgery after considering the risk-benefit ratio. The cosmetic result is already clearly visible a few weeks after the procedure.

A very efficient treatment method of dilated capillaries and varicose veins is sclerotherapy (vascular occlusion). It can be used both for small veins that cause only cosmetic problems, for so-called spider veins, and for the treatment of larger varicose veins. During treatment, a substance is injected into the vessel with a fine needle which damages the vessel’s wall and minimal inflammation develops in the internal layer of the vessel, and as a result the vessel’s wall sticks together when compression is applied after treatment (elastic bandages, compression stockings). The blood vessel that was thus excluded from circulation is absorbed over time and the blood continues to flow in other directions through healthy blood vessels. Sclerotherapy is an outpatient treatment method which is not associated with any particular pain and therefore does not require general or local anesthesia and leaves no scar. Sometimes one treatment is enough, other times it is necessary to repeat the treatment 2-3 times depending on the extent of the disease. The treatment can be safely repeated when new veins appear or in the case of dilated veins left on the peripheries. The result of the treatment is visible immediately after the intervention, the full result is visible after the absorption of the coagulated veins.

In what kind of dilated vessels is sclerotherapy effective?

• Tiny dilated vessels that are thinner than 1 mm, red in color and fading under pressure
• so-called spider veins 1-2 mm in diameter, dark red to blue in color, not completely fading under pressure
• bluish, dark purple vasodilations 2-4 mm in diameter, which may even protrude

For details on the symptoms of the disease or possible conservative treatments, please click here.

In this short video, we present the procedure and you can see yourself the immediate results of the therapy.

What are the steps of aftercare?

The first one or two days after the procedure can cause more discomfort as the injected material destroys the vein wall, causing small hemorrhages and swellings at the puncture site. However, this is only a temporary problem that will quickly disappear. Given that sclerotherapy is an outpatient and minimally invasive procedure that involves little stress, we cannot talk about a real recovery period, we just need to follow a few rules:

• After the sclerotherapy of larger veins, a 10 to 15-minute walk is recommended immediately after treatment to increase deep vein circulation!
• For two days after the procedure, rest and elastic bandage or grade II. elastic stocking use is recommended.
• The treated area should not be massaged!
• After the procedure, refrain from all strenuous sports and physical activities for 1 week and avoid sunbathing and solarium for 3 weeks!

But why is this good for the patient?

With this minimal intervention, there is a good chance that the aesthetically adverse lesion will disappear from the patient’s leg and the likelihood of developing a subsequent more serious illness will be significantly reduced.

Radiofrequency (RF) treatment of spider veins, telenagiectasias, and rosacea is based on the principle of thermocoagulation. The heat effect caused by the high-frequency vibration applied through a thin needle destroys the wall of the capillary vessels and their contents: the treated vessel wall closes, the blood in it suddenly coagulates and its cells disintegrate. Thermocoagulation uses precisely controlled and directed energy that affects only the target tissue but protects the surrounding tissues. Thus, no burns, skin necrosis or pigmentation is experienced after the procedure.

The procedure is almost painless, requires no anesthesia and can be performed on any part of the body, including the face, knees and ankles.

Radiofrequency (RF) treatment is extremely effective in treating vascular lesions on the face (most commonly rosacea on the cheeks). It can be used for any skin type; the shape and color of the blood vessels are also irrelevant. The device can also be used to treat vessels with a diameter of less than 0.3 mm. There are no complications or side effects during the treatment, a vascular section of up to 40-50 cm can be treated during one session.

Radiofrequency varicose vein surgery is contraindicated in the presence of nickel allergy, pregnancy, pacemaker use, and infectious skin diseases. There are practically no side effects!

For details on the symptoms of the disease or possible conservative treatments, please click here.

What are the steps of aftercare?

Although there is no significant need for aftercare, in some cases skin redness and red spots may develop for a few days after the procedure. In sensitive skin, small blisters may appear for a few hours, which disappear without a trace without treatment. Micro-scars may form in the treated area (in the form of small abrasion-like dots), which gradually fade and then disappear without a trace within 3-4 weeks. There is no scar or pigmentation formation.

It is important to prevent the formation of new spider veins, so please pay attention to reducing overweight, avoid sunbathing, solarium, and extreme heat (e.g., sauna), as well as wearing tight clothing regularly. Physical trauma (e.g., rough massage, vacuum, bumps) and standing or sitting for several hours should also be avoided.

But why is this good for the patient?

The result is clearly visible after 24-48 hours. A clinical study was conducted during the development of the device and has demonstrated efficacy over 90%, which is outstandingly high in the treatment of small diameter vessels.

In the case of leg ulcers and thrombosis, varicose vein surgery usually becomes feasible after the medical treatment of inflammation and thrombosis. Its purpose is to prevent the recurrence and cause of the above diseases. The surgical procedure is the same as the varicose vein surgery with radiofrequency or with glue detailed above, and thus the details are described there.