The number of non-surgical treatment options for varicose veins has proliferated in recent years, and some of those treatments have shown better patient outcomes than surgery, with fewer complications. So doctors are performing fewer vein-removal surgeries than before. Still, surgical treatments — particularly ambulatory phlebectomy — remain the standard of care to which all other varicose vein treatments are compared. This article explains what the various surgical vein treatments are and how they work.
Ambulatory phlebectomy is an outpatient treatment to remove varicose veins. It's primarily used to treat larger veins, particularly ones that bulge right on the surface.
The area to be treated is numbed with a local anesthetic and so the procedure can be done in the doctor's office. It involves making a number of tiny incisions through which the varicose veins are pulled out, small segments at a time. The incisions are generally so small stitches aren't needed. Veins are very collapsible, so even large veins can be removed through the tiny incisions used in this technique.
You can get up and walk immediately or shortly after surgery and should be able to continue your normal daily routine. You may experience some temporary swelling and bruising. After treatment, your doctor will likely instruct you to wear a compression bandage or compression stocking for at least a week.
The risks are minimal, but they include the possibility of skin numbness due to damage to nearby nerves.
The cost of an ambulatory phlebectomy typically ranges anywhere from $1,000 on up to several thousand dollars.
Transilluminated Powered Phlebectomy (TIPP)
Transillumination is when a light is used to help the doctor more clearly see the vein to be removed, a lot like when a flashlight is shined through your skin. In a transilluminated powered phlebectomy (TIPP), this special light source (called an endoscopic transilluminator or tumescent canula illuminator) is placed under the skin, allowing your doctor to see, more accurately target, and remove varicose veins, and then visually confirm that the extraction was entirely successful. One of its key advantages over traditional ambulatory phlebectomy is that it enables your doctor to remove more varicose veins through fewer incisions. It's also said to be faster.
Your doctor performs the procedure in a darkened operating room under general anesthesia or in the doctor's office using a local anesthetic and sometimes sedation. The endoscopic transilluminator is placed underneath the varicose veins. Its cool xenon fiberoptic light allows the surgeon to see the veins easily. Fluid similar to that used in liposuction is infused under the skin, loosening the vein from the surrounding tissue and delivering local anesthesia.
Your doctor then guides a second instrument, the vein remover, to the veins. 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 transilluminated powered phlebectomy (TIPP) cost from $5000-$10,000.
The small incisions usually don't require stitches. Most patients return to work in 2–3 days and are required to wear compression bandages, followed later by compression stockings.
TIPP can cost more than traditional ambulatory phlebectomy. It's a newer procedure, and to date, there hasn't yet been sufficient research to indicate whether it really holds significant advantages over traditional ambulatory phlebectomy or not.
Vein ligation and stripping
Ligation historically has been used for very severe cases, in an attempt to treat both large, 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 cuts off the blood flow to the varicose vein, which in turn causes it to become less visible. It's usually coupled with vein stripping — removing the vein. In traditional vein stripping, a wire is inserted into the veins, which are then stripped out. A newer technique is PIN stripping, in which a thin device is inserted into the vein and then sewn into the vein. Finally, it is pulled out, caused the vein to be pulled into itself and out of the body.
Vein ligation and stripping is performed under general anesthesia, usually as an outpatient operation. Recovery usually takes from one to four weeks.
Many physicians do not recommend the ligation and stripping technique for most veins because the rate of recurrence of varicose veins is fairly high. Ligation also has the most severe side effects, including the potential for numbness around the treated area. In rare cases, patients can experience blood clots, scarring, infections, and severe pain.
Updated: October 1, 2014