Operation Troyanov-Trendelenburg - what is it?

In recent years, varicose veins have acquired a tendency to rejuvenate. Every third woman has the disease even at the working age. Among men, every tenth suffers. The development of thrombosis or thrombophlebitis is a dangerous complication of the pathology of the veins. In this case, it is necessary to use a crossectomy (the Troyanov-Trendelenburg operation).

Features of varicose veins

Varicose veins are called diseases, accompanied by persistent changes in the vascular wall, expansion and lengthening of the vessels with the formation of protrusions, nodes and further violation of blood circulation.

The venous network of the lower extremities is represented by superficial and deep vessels communicating with each other. The superficial system consists of large and small subcutaneous veins. The large one begins in the groin area and is located in the upper part of the thigh, falling into a deep femoral vein.

Varicosity is accompanied by a change in intravascular pressure, slowing of blood flow, stagnant processes. Vessels are dilated, full of blood. The valve system of veins ceases to cope with its task of regulating unilateral blood flow, prerequisites for the formation of blood reflux (reverse casting) appear. Often in these moments the clinical picture of the disease is in full swing, which makes the patient turn to a vascular surgeon.

A frequent choice of specialists is the operation of Troyanov-Trendelenburg. What this is, how it is conducted, and what the result of the intervention is, let us consider further.

The purpose of a crossectomy

The specialist has the main task - to get rid of reflux and eliminate stagnant processes in varicose veins. Since it is impossible to stop blood circulation with the help of medications, the only way is to cross the sick vessels and their inflows.

Cross -ectomy (operation according to Troyanov-Trendelenburg) is considered a radical intervention. It is performed in case of complications of varicose veins (for example, phlebitis or thrombosis) or as a part of complex treatment.

The difference between a crossectomy and phlebectomy

More recently, phlebectomy (venectomy) was considered an excellent option for the treatment of varicose veins. It was performed under spinal anesthesia under stationary conditions. The operation was characterized by high traumatism and the development of postoperative complications. Soon the results of phlebectomy began to show that it is necessary to find a more radical method to reduce the possibility of relapse of the disease.

The venectomy was accompanied by the intersection of a large saphenous vein in the upper third of the thigh, and not near the anastomium, which led to a renewal of reflux along the tributaries of the saphene near the anastomosis. Relapse of the disease occurred in every third patient.

The modernization of the crossectomy is based on the fact that the incision and the intersection are carried out directly near the place of confluence into the deep femoral vein, as a result of which there is no reflux of blood into the deep system.

Indications for intervention

The operation of Troyanov-Trendelenburg is carried out urgently in the first days after the formation of thrombosis in order to stop the transition of the pathological process from the superficial veins system to the deep one.

Indications for intervention are the following conditions:

• Thrombophlebitis from knee level and above;
• Thrombophlebitis, complicated by the development of purulent processes;
• Recurrent thrombophlebitis or one that does not respond to other therapies;
• Thrombosis from the knee level and above.

Contraindications

It is important to understand that the operation of Troyanov-Trendelenburg, the testimony of which is urgent, does not consider the presence of contraindications. In this case we are talking about the life of the patient.

When planning the intervention, specialists determined a number of factors when the operation is undesirable:

1. Somatic diseases - the patient's body is greatly weakened, and any operation requires a lot of effort to restore. In this case, it is worth using less radical methods of treatment.
2. Atherosclerosis of the lower extremities of a severe form.
3. Period of pregnancy or lactation.
4. Presence of infectious diseases or purulent rash in the place of planned intervention.
5. Conditions in which it is impossible to carry out a good compression of the legs after surgery (severe form of obesity).
6. Thrombophlebitis or deep vein thrombosis.

Operation Troyanova-Trendelenburg requires rapid activation of the patient after the intervention, so that pathologies in which the patient can not get out of bed on the second day, are considered individually.

Preparing for an operation

Since in the majority of cases the patient comes urgently to intervene, the examinations are held at a mandatory minimum:

• General blood and urine tests;
• Biochemistry of blood;
• Coagulogram;
• Research on syphilis, hepatitis;
• Examination for HIV infection.

The therapist conducts a consultation to exclude the presence of somatic diseases, which would become a contraindication. Also, ultrasound scans of the veins are performed to determine the localization of the anastomosis, the location of the sick vessels, the prevalence of the pathological process.

Having made the necessary measurements, the vascular surgeon explains which compression knitwear or elastic bandage should be purchased in order to compress the limbs immediately after the operation.

Progress of the operation

The Troyanov-Trendelenburg operation, the technique of performing which requires high qualification of the surgeon, is performed using local or general anesthesia. The choice of anesthesia is made by an anesthesiologist, coordinating all the nuances directly with the patient.

The Troyanov-Trendelenburg operation, the description of which is given in the article, consists of the following stages:

1. The operating field is treated with antiseptic solutions, sterile underwear is applied, and a space for access is left.
2. In the groin, the surgeon probes the pulse of the femoral artery, under which the subcutaneous vein passes a little inside.
3. The anatomical features of all patients are diverse, and hence the location of the veins is different. The incision is performed depending on the location of the anus of the large saphenous vein.
4. After the cut, the surgeon gets to the venous bundle, binds it and cuts it off.
5. A large subcutaneous vein is allocated to the area where it enters the deep system, is bandaged and cut off. At this point, blood clots can leave blood clots.
6. In the same way, no less than five inflows of the vein along its length are isolated and cut off (if necessary, several additional incisions are made). This is done to prevent reverse collection of blood and relapse of the disease.
7. All incisions are closed and drains are put.
8. Compression linen or elastic bandage is put on the lower extremity.

The Troyanov-Trendelenburg operation is associated with inflammatory processes and the formation of thrombi, therefore, in urgent cases, specialists do not try to remove as many veins as possible, but as much as possible cut down the zone of the pathological process.

Postoperative period

The patient spends his first day in bed. This is due to possible side effects after anesthesia. On the second day, activation of the patient was shown to protect it from repeated thrombosis as much as possible. Soreness is moderate, but if necessary, the doctor prescribes anesthetics or non-steroidal anti-inflammatory drugs.

An obligatory condition is adequate compression of the lower limb, which is carried out for a month after the intervention.

Attention should be paid to measures aimed at preventing stagnant processes in the veins system (walking, exercise therapy).

Possible complications after surgery

Operation Troyanov-Trendelenburg, complications after which are extremely rare, refers to radical methods of treatment. A frequent cause of complications is traumatization of the tissues during the intervention (which can not be avoided), as well as a violation of the technique of the operation. The patient can develop the following pathologies:

• Bleeding;
• Hematoma in the field of intervention;
• Infection of the operating wound;
• Disorders of the lymphatic system with the formation of cystic conglomerates;
• Paresthesia (a violation of the sensitivity of the skin at the intersection of nerve endings);
• Lymphatic drainage (lymphatic drainage due to lymphatic vessels crossing).

Some complications go away on their own, others need additional therapy. Hematomas in severe cases are subject to puncture with further antibiotic therapy. Infection of the wound also requires the use of antibacterial agents (penicillins, macrolides, cephalosporins). Disrupted sensitivity is restored independently, does not require additional measures.

Conclusion

One of the radical methods of complex treatment of varicose veins and its complications is the Troyanov-Trendelenburg operation. The course of the operation shows how modernized the system of elimination of reflux and prevention of recurrence of the disease. Observance of the advice of the operating specialist will avoid the need for repeated interventions.