Also known as ambulatory phlebectomy, this is a procedure that can be performed in the office and is commonly performed at the time of endovenous ablation. The preocedure is intended to remove larger bulging varicose veins near the skin surface. This procedure is far less invasive than vein-stripping, is minimally painful and produces minor scarring, while the procedure can be very effective in the short term there is some evidence that neovascularization a common problem post stripping and high ligation is also a problem post phlebectomy. For this reason it is prudent to try ultrasound guded sclerotherapy first and only after failure then performe micro-phlebectomy.
Micro-phlebectomy is performed with local anesthesia (usually lidocain). Through a needle hole in the skin or a small nick (1-2 mm), the veins can be removed. This is often performed in conjuction with additional procedures such as vein ablation, ultrasound guided sclerotherapy or sclerotherapy. Since the veins are compressed with the local anesthetic, and their blood supply is disrupted, there is little to no bleeding. The veins are also small when removed, as there is no distension from the blood. A good analogy is removing a deflated balloon.
After micro-phlebecomy procedures a compression stocking is worn for 2 days and nights and then during the day for 1-2 weeks following. Mild bruising and swelling can be expected post-procedure. In addition, retained fragments of veins can cause lumps or bumps under the skin which can be tender and inflamed. These bumps should resolve over time and ultrasound guided sclerotherapy may be needed for any residual tributaries that are left patent. The removed veins will not reoccur; however, new veins can form over time, especially if the area is not reevaluated and all of the veins irradicated.