Phlebectomy Treatment of Varicose Veins
Phlebectomy is also known as ambulatory phlebectomy, microphlebectomy or stab avulsion. It is a non-invasive surgical procedure to physically remove varicose veins. This differs from other methods of treatment for varicose veins such as laser ablation or radiofrequency procedures in that the diseased vein is removed rather than treated in the leg and left to be absorbed by the body.
Phlebectomy should not be confused with vein ligation and stripping, which is a far more invasive surgical procedure that is no longer often performed in modern clinics. Vein stripping removes the entire saphenous vein, often causing patients post-operative pain and taking weeks to heal.
In contrast, phlebectomy removes the affected side vein, leaving the larger saphenous vein in place. This larger vein is, if necessary, treated with radiofrequency, endovenous laser therapy, or foam sclerotherapy.
When compared to traditional surgical methods of vein removal, phlebectomy is far less invasive, just as effective, and causes much less pain and disruption to the patient’s normal routine.
How is Phlebectomy Performed?
Similar to other procedures, phlebectomy of varicose veins is performed on an outpatient basis in the physician’s office or vein clinic. Patients are given a local anesthetic to numb the affected area, then tiny incisions (1 to 3 mm in length) are made next to the vein. Because veins are collapsible and very flexible, even quite large veins can be removed through very small incisions.
A phlebectomy hook is inserted through the incision and gently moved beneath the vein to ease it through the opening. The exposed vein is then clamped and pulled through the incision. Several small incisions along the length of the vein are used to ensure the removal of the entire affected vein in sections. The cuts are between 5 and 10 centimeters apart.
When the procedure is complete, which normally takes only 30 minutes to one hour, the incisions are dressed and the patient fitted with compression stockings. The tiny cuts are so small they do not require stitches.
This is a similar, minimally invasive procedure, but is performed in an operating room with the patient under light general anesthetic. It is performed on an outpatient basis. During the procedure, the surgeon uses a tumescent cannula illuminator (TCI) with an integral fiber optic light that makes veins under the skin more visible.
Local anesthetic fluid is flushed beneath the skin, separating the vein from the surrounding tissues, and the vein is then removed by cutting it into small pieces. Patients usually feel little post operative pain and are able to leave the surgery after around an hour, and return to normal, light activities. Movement and walking is encouraged but strenuous activity should be avoided.
Are There Advantages in Phlebectomy?
When compared to traditional surgical methods of vein removal, phlebectomy is far less invasive, just as effective, and causes much less pain and disruption to the patient’s normal routine. For this reason, the procedure is often called Ambulatory Phlebectomy because patients are able to walk around and return to normal daily activities immediately after treatment.
As a treatment, phlebectomy of varicose veins has also proved effective for arm varicosities and in the treatment of protruding veins around the eyes (periocular or periorbital veins).
There are very few risks, although any procedure that punctures the skin carries a tiny risk of infection. Other risks include some skin discoloration at the site, which is temporary. With the cuts being so small, any resulting scars look a little like freckles.
Who is Suitable for Phlebectomy of Varicose Veins?
Some disorders may make patients unsuitable for phlebectomy treatment, and these include:
- Those with uncontrolled diabetes.
- Those with edema associated with kidney or heart disease. Once these conditions are brought under control, the patient may be considered for phlebectomy.
- Immune system disorders such as HIV.
- Infectious skin diseases, or cellulitis.
- Those with severe lung or heart disorders.
Phlebectomy of varicose veins is often performed as part of a more comprehensive treatment plan, which may include other forms of vein treatment such as endovenous ablation with radiofrequency or laser energy.
Every patient is individual, so your consulting physician or vascular surgeon will discuss your personal needs with you.