Phlebectomy is a surgical procedure that involves the removal of all or part of a vein. The term most commonly refers to ambulatory phlebectomy, which is performed on the legs. It’s a common and minimally invasive treatment for the removal of varicose veins just beneath the surface of the skin.
Phlebectomy works by removing a vein through tiny incisions in the leg. The vein is taken out in portions by using a set of small hooks. The procedure has several advantages over other treatment methods for varicose veins, which are discussed below.
Phlebectomy is strictly used for the removal of varicose veins near the surface of the skin. Veins that are situated deeper beneath the skin require different procedures for their treatment or removal, such as vein stripping. Removing the varicose veins through phlebectomy effectively does away with any symptoms they’re causing the patient. Complications from varicose veins can include minor symptoms like aches and pains, or more serious problems like bleeding, thrombophlebitis or venous insufficiency.
Ambulatory phlebectomy refers to the removal of varicose veins on the legs. The legs are where varicose veins most commonly appear. Lack of exercise, genetics and other factors contribute to the development of varicose veins, and about 25 percent of the Caucasian population will be affected by them at some point (women also have a higher incident rate of varicose veins). While a phlebectomy could be performed on other parts of the body, the most common location for varicose veins is on the legs.
Phlebectomy procedure: what to expect
Phlebectomy is performed with the use of a local anesthetic, such as an injection in the treatment area or a topical cream (or both). Many patients say they experience no pain whatsoever during the procedure. Incisions as small as 1mm are made in the skin along the length of the vein to be treated. The vein is then taken out with the use of a phlebectomy hook. The hook is inserted through the incisions one at a time, the vein is hooked, and then the doctor pulls that section of vein out.
Because the incisions are so small, no stitches are required to close them. It usually takes one to two hours to perform the treatment. Near the end of the phlebectomy, the patient’s leg is wrapped in a compression garment.
Patients should stay off their feet and keep their legs elevated for the first 24 hours after phlebectomy. They can go back to work after this first day. Small bandages such as steristrips may be applied to the incision sites.
Compression stockings will need to be worn for the first two or three weeks to help with the healing process. As long as the compression stockings are worn, patients can resume most of their normal activities. The doctor will let you know if there are any exceptions.
The symptoms and appearance of the varicose veins will be gone after phlebectomy. The raised and tender areas on the skin associated with the veins will also be gone, because the vein itself is gone. In a typical phlebectomy, the incisions will have mostly faded away within a couple of months and are completely unnoticeable after six months.
Phlebectomy advantages and risks
The biggest advantage of phlebectomy over other similar procedures has to do with the recurrence rate of varicose veins. In a controlled study of patients, researchers found that 2 percent of patients who undergo phlebectomy had a recurrence of varicose veins within two years. Patients who received sclerotherapy, another common varicose vein treatment, had a recurrence rate of more than 37 percent within two years. Phlebectomy is clearly a more effective long-term treatment for the removal of varicose veins.
Phlebectomy is a very safe procedure, but there are some minor complications that can arise from it. Inflammation or infection of the incision sites and surface veins is a possibility. Blisters and bruises can form along the path where the veins were removed, but these generally clear up on their own within a week or so. Nerve damage is much less likely in phlebectomy than in vein stripping, but is still possible; this complication usually only affects very small areas, and the result is typically numbness or a loss of sensation.
Who is and isn't a candidate for phlebectomy?
Many patients have varicose veins that don’t cause any complications or negative symptoms; they just have the unsightly veins because of lifestyle or genetics. These types of patients are very easy to treat and will usually receive very good results from phlebectomy. People with symptomatic (minor symptoms) and complicated (major symptoms) varicose veins are also good candidates for phlebectomy.
Some types of patients are not good candidates for phlebectomy. The treatment is contraindicated in elderly patients and those who are seriously ill. Certain chronic medical conditions can also be problematic, such as diabetes and heart disease.
If a patient has certain temporary medical conditions, such as dermatitis, cellulitis or severe peripheral edema, the problem should be treated and cleared up before a phlebectomy is performed on her. Patients that experience reflux at large vein junctures should receive a different treatment to remove their varicose veins, like endovenous radiofrequency.