Phlebectomy of Varicose Veins

What is Phlebectomy of Varicose Veins?

Phlebectomy is a minimally invasive procedure used to remove varicose veins that lie just beneath the surface of the leg. This is usually done in a physician's office using local anesthesia.

How should I prepare?

You will receive specific instructions on how to prepare, including any changes you need to make to your regular medication schedule.

Wear comfortable, loose-fitting clothing to your exam. You may need to change into a gown for the procedure.

What does the equipment look like?

The doctor uses a small scalpel or needle to make very small incisions close to the vein. They use a phlebectomy hook to remove the veins. The hook is like a tiny crochet hook with a blunt tip and a straight shaft.

How does the procedure work?

Phlebectomy involves making tiny punctures or incisions in the skin near the varicose vein. Veins are very collapsible and the doctor can remove even large veins through the tiny incisions this technique uses.

How is the procedure performed?

This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Ask your doctor if you will need to be admitted.

Your doctor will numb the area with a local anesthetic. This may briefly burn or sting before the area becomes numb.

Because the doctor will numb the area with a local anesthetic, you will typically be awake during the procedure.

After cleansing and anesthetizing the skin, the doctor will make a series of small incisions. These incisions are no larger than a pencil eraser. They are made in the skin next to the enlarged vein. The doctor inserts the phlebectomy hook under the surface of the skin and removes the varicose vein through the tiny incision. This procedure usually takes between 30 minutes and one hour.

What will I experience during and after the procedure?

Patients rarely report any pain during this procedure because the area involved is under a local anesthetic.

The procedure uses such small incisions that no stitches are necessary. The doctor or nurse will simply apply a small dressing to cover the incisions.

When the procedure is complete, the doctor or nurse will wrap your leg in a comfortable but snug compression wrap.

You will need to wear graduated compression stockings for about two to three weeks. As long as you wear them, you can do almost all of your usual activities starting the day after the surgery.

You should be able to resume daily activities within 24 hours. Strenuous activities will be limited for approximately two weeks.

Who interprets the results and how do I get them?

After the procedure is complete, the interventional radiologist will tell you whether the procedure was a success.

Your interventional radiologist may recommend a follow-up visit.

This visit may include a physical check-up, imaging exam(s), and blood tests. During your follow-up visit, tell your doctor if you have noticed any side effects or changes.

What are the benefits vs. risks?

Benefits

• No surgical incision is necessary—only a small nick in the skin that does not need stitches.

Risks

• Any procedure that penetrates the skin carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• Skin pigmentation at the site of the treated varicose vein may occur but is usually temporary.

What are the limitations of Phlebectomy of Varicose Veins?

Doctors have observed long-term success in more than 90 percent of patients. The long-term results of phlebectomy are excellent when the procedure is performed in patients who are good candidates.

Often, doctors use phlebectomy with a more comprehensive treatment plan. This plan may include additional procedures such as endovenous catheter ablation that use radiofrequency or laser energy.

Patients should discuss their individualized treatment plan with their interventional radiologist.