Ambulatory phlebectomy has been a treatment used for surgical removal of varicose veins since the days of Hippocrates. This technique has evolved from utilizing large scar forming incisions to small 2-3 mm punctures that remove even the largest veins with minimal scarring. This modification of an age old procedure has now become known as microphlebectomy.
Varicose veins have many treatment options. The majority of treatment options manage a specific element of a patient´s venous concerns. Endovenous thermal ablation and surgical stripping manage long straight veins deep to the surface of the skin. Sclerotherapy manages a wide variety of conditions, yet is best utilized in patients with small blue green and purple vessels, and for veins not accessible for thermal ablation and phlebectomy.
Phlebectomy/microphlebectomy is reserved for large and medium sized vessels at the surface of the skin and can be used on vessels of the face, hands, or legs, or any region with dilated or diseased vessels greater than 3 mm on the body.
Traditionally, phlebectomy has been used as a supplemental treatment to surgical stripping or thermal ablation (cautery) of the great saphenous vein. A procedure known as ASVAL has taken ambulatory/microphlebectomy to a new level. Recent studies have demonstrated that some patients may normalize previously abnormal veins when only the ropey veins are physically removed through phlebectomy. This new finding is changing how diseased saphenous veins are managed.
Compared to surgical stripping this procedure is far different, most commonly performed under local anesthesia in an office setting. Recovery involves compression stockings and compression wraps and there is little to no down time. The amount of discomfort is generally limited, though there is variability with each patient. Complications are rare with most modern varicose vein procedures, but include bruising, scarring, bleeding, phlebitis, numbness, and potential nerve injuries.