Troyanov-Trendelenburg operation - what is it?

In recent years, varicose veins have acquired a tendency to rejuvenation. Every third woman has a disease at a working age. Among men, one in ten suffers. The development of thrombosis or thrombophlebitis is a dangerous complication of vein pathology. In this case, you will have to use a crossectomy (Troyanov-Trendelenburg operation).

Features of varicose veins

Varicose veins are called a disease, accompanied by persistent changes in the vascular wall, vasodilation and lengthening with the formation of protrusions, nodes and further circulatory disorders.

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 saphenous veins. Large begins in the groin and is located in the upper thigh, flowing into the deep femoral vein.

Varicose veins are accompanied by a change in intravascular pressure, a slowdown in blood flow, and stagnant processes. The vessels are dilated, overflowing with blood. The valve system of veins ceases to cope with its task of regulating unilateral blood flow, and prerequisites for the formation of blood reflux (reverse casting) appear. Often, it is precisely at these moments that 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 Troyanov-Trendelenburg operation. What is it, how is it carried out and what is the result of the intervention, we will consider further.

Crossectomy goal

The specialist is faced with the main task - to get rid of reflux and eliminate stagnant processes in varicose veins. Since it is impossible to stop blood circulation with medication, the only way is to cross the diseased vessels and their tributaries.

Crossectomy (Troyanov-Trendelenburg surgery) is considered a radical intervention. It is performed in case of complications of varicose veins (for example, phlebitis or thrombosis) or as part of a comprehensive treatment.

The difference between 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 highly traumatic and the development of postoperative complications. Soon, the results of a phlebectomy began to show that it was necessary to find a more radical method to reduce the possibility of a relapse of the disease.

A venectomy was accompanied by the intersection of a large saphenous vein in the upper third of the thigh, and not near the anastomosis, which led to the resumption of reflux along the safen tributaries near the anastomosis. Relapse occurred in every third patient.

Crossectomy modernization is based on the fact that the incision and intersection are carried out directly near the place of flowing into the deep femoral vein, as a result of which blood reflux into the deep system does not occur.

Indications for intervention

The Troyanov-Trendelenburg operation 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 vein system to the deep one.

Indications for intervention are the following conditions:

• thrombophlebitis from the level of the knee and above;
• thrombophlebitis complicated by the development of purulent processes;
• recurrent thrombophlebitis or one that does not respond to other methods of therapy;
• thrombosis from the level of the knee and above.

Contraindications

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

With the planned type of intervention, experts identified 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 recover. In this case, it is worth using less radical methods of treatment.
2. Severe atherosclerosis of the lower extremities .
3. The period of pregnancy or lactation.
4. The presence of infectious diseases or purulent rashes at the site of the planned intervention.
5. Conditions in which it is impossible to have a good compression of the legs after surgery (severe obesity).
6. Thrombophlebitis or deep vein thrombosis.

The Troyanov-Trendelenburg operation requires a quick activation of the patient after the intervention, therefore pathologies in which the patient cannot get out of bed on the second day are considered individually.

Preparation for surgery

Since in most cases the patient arrives urgently for an intervention, then the examinations are carried out at the mandatory minimum:

• general blood and urine tests;
• blood biochemistry;
• coagulogram;
• research on syphilis, hepatitis;
• screening for HIV infection.

The therapist consults to rule out the presence of somatic diseases that would be a contraindication. An ultrasound scan of the veins is also performed to determine the localization of the anastomosis, the location of the diseased vessels, and the prevalence of the pathological process.

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

Operation progress

The Troyanov-Trendelenburg operation, the technique of which requires highly qualified surgeon, is performed using local or general anesthesia. The choice of anesthesia is made by the anesthesiologist, agreeing all the nuances directly with the patient.

The Troyanov-Trendelenburg operation described in the article consists of the following steps:

1. The surgical field is treated with antiseptic solutions, sterile underwear is applied, and there is room for access.
2. In the inguinal region, the surgeon probes the pulse of the femoral artery, under which the saphenous vein passes a little inward.
3. The anatomical features of all patients are diverse, which means that the location of the veins is different. The incision is carried out depending on the localization of the anastomosis of the great saphenous vein.
4. After the cut, the surgeon gets to the venous bundle, bandages it and cuts it off.
5. A large saphenous vein stands out to the area where it flows into the deep system, is ligated and cut off. At this point, blood clots may come out with blood flow.
6. Then, at least five vein tributaries along its length are isolated and cut off in the same way (if necessary, several additional incisions are made). This is done to prevent reverse blood collection and relapse.
7. All cuts are sutured, drainages are placed.
8. A compression garment or elastic bandage is put on the lower limb.

The Troyanov-Trendelenburg operation is associated with inflammatory processes and the formation of blood clots, therefore, in emergency cases, specialists do not try to remove as many veins as possible, but stop the area of ​​the pathological process as much as possible.

Postoperative period

The first day the patient spends in bed. This is due to possible side effects after anesthesia. On the second day, the patient's activation is shown in order to protect him as much as possible from repeated thrombosis. The pain is moderate, but if necessary, the doctor prescribes painkillers or non-steroidal anti-inflammatory drugs.

A prerequisite is adequate compression of the lower limb, which is carried out for another month after the intervention.

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

Possible complications after surgery

The Troyanov-Trendelenburg operation, after which complications are extremely rare, refers to radical methods of treatment. A common cause of complications is tissue trauma during the intervention (which is impossible to avoid), as well as a violation of the operation technique. The patient may develop the following pathologies:

• bleeding
• hematomas in the area of ​​intervention;
• infection of the surgical wound;
• disorders of the lymphatic system with the formation of cystic conglomerates;
• paresthesia (violation of the sensitivity of the skin at the intersection of nerve endings);
• lymphorrhea (lymph outflow due to the intersection of the lymphatic vessels).

Some complications go away on their own, others need additional therapy. In severe cases, hematomas are punctured with further antibiotic therapy. Wound infection also requires the use of antibacterial agents (penicillins, macrolides, cephalosporins). Disturbed sensitivity is restored on its own, does not require additional measures.

Conclusion

One of the radical methods for the complex treatment of varicose veins and its complications is the Troyanov-Trendelenburg operation. The course of the operation shows how much the system for eliminating reflux and preventing relapse of the disease has been modernized. Following the advice of the operating specialist will avoid the need for repeated interventions.