Ambulatory Micro-Phlebectomy

What is Ambulatory Micro-Phlebectomy?

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 procedure 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-guided sclerotherapy first and only after failure then to perform micro-phlebectomy.

How is is Performed?

Micro-phlebectomy is performed with local anesthesia (usually lidocaine). Through a needle hole in the skin or a small nick (1-2 mm), the veins can be removed. This is often performed in conjunction 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-phlebectomy 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. 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.

Vein Stripping

Surgical vein stripping is far more invasive than the VenaCure EVLT™ or VeneFit Radiofrequency ablation procedures. Additionally, a study published in the Journal of Vascular Surgery (JVU) in 1999 revealed that vein stripping surgery was only 71% effective in eliminating varicose veins, compared to a success rate of 98% for the ClosureFast or VenaCure EVLT™ procedures.
Endovenous Ablation has additional benefits including: less bruising and numbness and leaves minimal to no scarring of the extremity when compared to surgical ligation and vein stripping. Advancements in the treatment of vein disease have all but eliminated vein stripping in the United States.

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