Microphlebectomy, also known as ambulatory phlebectomy, is a safe and effective treatment for the removal of small to medium varicose veins which are swollen, twisted veins visible at the surface of the skin. While microphlebectomy can be used to remove smaller varicose veins, spider veins are rarely removed by this method. Microphlebectomy uses a series of tiny incisions (stab incisions) between 1 - 3 mm in length to remove portions of the problem vein in succession.
Microphlebectomy can be used in conjunction with other common vein removal procedures such as EVLT (endovenous laser therapy) and sclerotherapy and to address different sized vein problems and yield the best cosmetic results.
Microphlebectomy procedure: what to expect
Your specialist will examine your legs while you stand to identify the veins to be worked on. Using a surgical marker your doctor will mark the areas where incisions will be made. Localized tumescent anesthesia (saline infused anesthesia) will be administered at various points along the vein to be removed. Tumescent anesthesia numbs and firms up the area, and makes removal of the vein easier by separating the vein from surrounding tissue and pushing it closer to the surface of the skin. After the anesthesia has taken effect, your doctor will make a few tiny incisions along the length of the vein to be removed, inserting a tiny phlebectomy hook to “tease out“, grasp, and remove sections of the vein. Removal by section minimizes the occurrence of blood clots, and encourages faster healing.
Once the procedure is completed, the leg or legs are washed down with a sterile solution, and wound dressings are applied. Over the initial non-elastic wound dressings, a secondary elastic compression dressing is applied from the foot up the leg to cover the incisions. Alternatively, compression stockings (usually 30-40 mm Hg) can be worn. Dressings are removed after 1-2 days, but compression garments remain for 1-3 weeks following the procedure.
Skilled physicians can usually perform microphlebectomy on one leg in one hour or less, and on two legs in two hours or less, depending on the extent of the veins to be removed.
Recovery after microphlebectomy
Most individuals are able to return to their normal routines immediately following the procedure. Bed rest is prohibited after venous surgery; Daily walking and movement is greatly encouraged following microphlebectomy. Avoid sun exposure while your legs are healing, as the sun may cause hyperpigmentation at the incision sites during the healing process.
There may be some temporary and mild discomfort or bruising for a day or two at the treatment site. Other side effects include bleeding and swelling. On rare occasion, infection, blood clots or scarring can occur. If minor nerve injury surrounding the vein removal area occurs, the injured nerves usually heal with time. Sometimes spider veins (telangiectasias) may fade and disappear following microphlebectomy procedure, but occasionally patients experience telangiectatic matting, which is the development of a new network of spider veins along the treatment area.
You can expect a follow-up appointment with your doctor following ambulatory phlebectomy procedure within 4-6 weeks of the procedure. . At your follow-up visit, your doctor can assess how well you’ve recovered, and whether other complementary venous procedures are needed.
Results of microphlebectomy
When performed by a skilled physician under appropriate conditions, ambulatory phlebectomy yields a long-term success rate of 90%. Once initial bruising resolves there will be a noticeable reduction in varicose veins. Because only tiny incisions are made, there should be virtually no scarring, and most patients are pleased with the results of ambulatory phlebectomy.
What is the difference between microphlebectomy and sclerotherapy?
Sclerotherapy is a vein removal technique in which a doctor injects an irritant (sclerant) directly into the vein to irritate and scar the problem vein. The vein eventually gets reabsorbed into the body. Several sessions of sclerotherapy my need to be administered to achieve desired cosmetic result. While sclerotherapy is currently the most commonly used vein removal procedure for small to medium sized veins (less than 4mm in diameter), ambulatory phlebectomy continues to be a solid, effective treatment for varicose veins. One 2003 study comparing the effectiveness of both microphlebectomy and sclerotherapy suggests that microphlebectomy may yield a slightly better outcome for the removal of varicose veins. Talk to your doctor about the advantages of both procedures to determine which procedure would yield the best results for you.
What is the difference between microphlebectomy and EVLT?
Endovenous Laser Treatment (EVLT) uses lasers to treat larger varicose veins and problem veins which are deep in the skin. Laser energy is applied directly into the vein through a thin fiber inserted directly into the vein. EVLT is often performed first to remove larger varicose veins which are often the source of vein problems. Following treatment with EVLT, doctors frequently perform ambulatory phlebectomy or sclerotherapy to remove smaller or more surface veins that remain. A combination of EVLT, microphlebectomy and/or sclerotherapy can often be used to remove problem veins for better cosmetic result. Talk to your doctor about whether a combination of these therapies may be right for you.
Advantages of microphlebectomy
Microphlebectomy offers several benefits over other procedures. Generally speaking, microphlebectomy:
- Is minimally invasive
- Requires only local anesthesia
- May be used in combination with EVLT and sclerotherapy
- Quick recovery, with almost immediate return to normal daily activity
Does insurance cover microphlebectomy?
Private insurances generally cover procedure which are a “medical necessity”. Your doctor can determine the extent of your varicose veins or vein issues. Talk to your insurance provider regarding your coverage options.
Reviewed February 3, 2017