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It is important to recognize that bulging surface varicose veins are often due to underlying problem veins. In order to get better results, these underlying veins should be treated, in addition to treatment of the surface veins. In the case of bulging surface veins, most physicians use duplex ultrasound to evaluate the underlying veins of the leg prior to developing a treatment plan.
Ambulatory phlebectomy is a method of removing varicose veins on the surface of the legs. It is done in the office under local anesthesia. This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are so small no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique. The patient is able to walk following the procedure.
After treatment, a compression bandage and/or compression stocking are worn. Your physician will advice you how long to wear any bandages or hose. Many physicians recommend that you walk or bike after treatment. This reduces pressure in the veins, increases the flow in the veins and reduces the risk of forming a blood clot.
Transilluminated Powered Phlebectomy (TIPP)
Transilluminated Powered Phlebectomy (TIPP) is a minimally invasive procedure for removing varicose veins that is performed using the TriVex® System.
Transillumination is a unique feature - much like a flashlight placed under the skin - that allows a surgeon to see, accurately target and remove varicose veins, then visually confirm the extraction. Traditional varicose vein surgery is considered a "blind procedure," meaning that surgeon cannot see the vein or confirm removal.
The procedure in performed in an operating room under a light anesthetic. The surgeon works through two small incisions in a darkened room.
The tumescent canula illuminator is placed under the varicose vein. The cool xenon fiberoptic light allows the surgeon to see the varicose veins easily through the skin. Tumescent fluid, similar to that used in liposuction, is infused under the skin, loosening the vein from the surrounding tissue and providing local anesthesia.
A second instrument, the vein remover, is then guided to the veins using the TCI light. The vein is suctioned into a small hole at the tip of the vein remover and a protected blade cuts the vein into small pieces that can be suctioned out of the body.
The procedure can be performed in about 30 minutes. The small incisions do not require stitches. With the large volume of local anesthetic used, most patients wake up without any pain and go home in about one hour. Normal activity is encouraged immediately and most patients return to work in 2–3 days.
Ligation historically has been used in an attempt to treat both bulging varicose veins and underlying veins. During this type of vein surgery, incisions are made over the problem vein and the vein is tied off. This is done in order to cut off the flow of blood to the varicose vein, which in turn causes it to become less visible.
Many physicians do not recommend this technique for most veins because the recurrence rate of varicose veins is very high. It is important to remember that bulging surface varicose veins are often due to underlying problem veins. These underlying veins should be treated, in addition to treatment of the surface veins, in order to get the best results.
Vein stripping involves tying off of the upper end of a problem vein and then removing the vein. Vein stripping is performed in an operating room. The patient is usually under general anesthesia. Approximately 150,000 such surgeries are performed each year in the U.S.
Modern alternatives to vein stripping include endovenous laser treatment, radiofrequency occlusion and ultrasound-guided sclerotherapy. These techniques are done in-office under local anesthesia.