Phlebectomy

Phlebectomy is a surgical procedure that involves the removal of all or part of a vein. There's more than one type of phlebectomy, and it can be done on various parts of the body, but the term most commonly refers to ambulatory phlebectomy, which is performed on the legs. It’s a common and minimally invasive surgical treatment for the removal of varicose veins just beneath the surface of the skin.

Phlebectomy remains the standard of care to which all other varicose vein treatments are compared. And phlebectomy is one of two procedures recommended for treating varicose tributary (branch) veins by the Society for Vascular Surgery and the American Venous Forum. (The other recommended procedure is sclerotherapy.)

How ambulatory phlebecomy works

During an ambulatory phlebectomy procedure, your doctor will remove a vein or veins through tiny incisions in your leg. First, with you standing, your doctor marks the veins to be removed. You then lay down, and your doctor injects a local anesthetic into the area to be treated. Next, your doctor makes a series of needle punctures or incisions as small as 1–2 millimeters along each vein and removes the vein in sections through each incisions using forceps or small hooks.

Because the incisions are so small, no stitches are required to close them. It usually takes one to two hours to perform the treatment. Doctors often use phlebectomy at the same time as other surgical or non-surgical elimination of larger veins.

Variations of traditonal phlebectomy

A variation on the traditional phlebectomy is powered phlebectomy, otherwise known as transilluminated powered phlebectomy or TIPP. A light is placed under the veins to make it easier to find them, and a powered suction/cutting device removes them. TIPP is best suited for the removal of a large number of varicose veins.

What phlebectomy is for

Phlebectomy is strictly used for the removal of branch (tributary) varicose veins near the surface of the skin, usually medium-size veins. Smaller veins, large veins, and veins deeper under the skin require different procedures for their treatment or removal.

Advantages of phlebectomy

Doctors have long believed that phlebectomy holds an advantage over alternative similar procedures in terms of the recurrence rate of varicose veins, with about a 90-percent success rate reported in studies (success meaning the varicose veins don't come back within three years). Still, in their clinical practice guidelines, the Society for Vascular Surgery and the American Venous Forum say more study is needed.

Studies have shown phlebectomy is effective over the long term, but some researchers say the evidence isn't all that strong. Foam sclerotherapy techniques and success rates are improving, and a number of studies show it's effective at least in the short term, though perhaps not as effective in the long term.

Who should not have a phlebectomy

Patients who have medium-size varicose veins near the surface — whether or not there are complications or other related symptoms — can get very good results from phlebectomy. Patients who are not good candidates for phlebectomy include:

  • Elderly people
  • Anyone who's seriously ill
  • Diabetics
  • Heart patients
  • People currently suffering from dermatitis, cellulitis or severe peripheral edema (swelling of the leg because of fluid buildup)
  • Anyone with veinous reflux (where the vein doesn't close properly, and the flow of blood reverses) at large vein junctures

Recovery after phlebectomy

You won't need bed rest, but you'll usually take it easy the day of the procedure, and you won't be able to drive until the next day. Your doctor will probably suggest you take an analgesic for pain control.

Steri-strips may be applied to the incisions, and they'll stay on for up to two weeks, but you may be asked to come back the next day so the doctor can remove your bandages and put on compression stockings. You'll need to wear them for at least two weeks, during which time you shouldn't do any aerobic exercise involving the legs.

You'll probably go back for several follow-ups so the doctor can see how things are going and decide whether additional treatments are needed.

Results and risks of phlebectomy

Because the veins themselves are gone after phlebectomy, the appearance and symptoms of the varicose veins should likewise disappear. Typically the incisions are barely visible to begin with and will fade away within a couple of months and will typically be completely unnoticeable within about six months.

Phlebectomy is considered to be very safe, but there are risks of some minor potential complications, including:

  • Swelling
  • Infection in the treated area
  • Blisters and bruises, but these generally clear up on their own within a week or so
  • Local numbness over small areas
  • Hyperpigmentation — though you can reduce that risk by avoiding sun exposure during your recovery period
  • Telangiectatic matting (reddish or purplish splotches of tiny spider veins)

Updated: October 1, 2014


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