Phlebectomy is a surgical procedure most commonly performed to treat superficial varicose veins. Often called microphlebectomy or ambulatory phlebectomy, it is a minimally invasive treatment targeting visible, enlarged vessels. The procedure uses tiny incisions to physically extract the problematic veins without requiring general anesthesia or an overnight hospital stay.
Conditions Addressed by the Treatment
Phlebectomy is indicated for removing bulging, superficial varicose veins visible on the legs. These veins often cause medical symptoms such as chronic pain, a heavy or aching sensation in the legs, or persistent itching and skin irritation.
The treatment is typically considered when conservative therapies, such as wearing compression stockings, have not provided adequate symptomatic relief. Phlebectomy also addresses cosmetic concerns by removing prominent veins. It is often performed alongside other procedures, like endovenous thermal ablation, which treats the underlying cause of varicose veins in deeper truncal veins.
The procedure is well-suited for veins that are too large or tortuous (twisted) to be effectively treated by less invasive methods like sclerotherapy. Since phlebectomy targets veins close to the surface, it is not used for removing veins deep within the muscle tissue. The vessels must be near the skin and easily accessible through micro-incisions for a successful outcome.
Understanding the Ambulatory Technique
The ambulatory phlebectomy technique uses local anesthesia. The process begins with careful mapping of the target veins, typically done while the patient is standing, as veins collapse and become difficult to locate when lying down. The surgeon uses a surgical marker to outline the path of the enlarged vessels.
Once the area is sterilized and numbed, the surgeon makes a series of minute incisions, often measuring only two to three millimeters in length. These small cuts are precisely placed over or adjacent to the marked varicose veins. Because of their tiny size, these openings usually do not require stitches to close them after the procedure.
Through these micro-incisions, a specialized surgical instrument called a phlebectomy hook is inserted beneath the skin. This hook is used to gently find, grasp, and carefully extract the targeted vein segment by pulling it out through the tiny incision.
Due to the extreme collapsibility of veins, even large sections of the damaged vessel can be removed piece by piece. The body naturally reroutes blood flow to surrounding healthy veins once the diseased segment is removed, which does not compromise overall circulation. The procedure usually takes 30 to 60 minutes, depending on the extent of the veins being treated.
Immediate Post-Procedure Care and Recovery
The small incision sites are covered with a dressing, and the treated leg is immediately wrapped in a snug compression bandage or stocking. Compression minimizes bruising, reduces swelling, and promotes proper healing. Patients are typically instructed to wear the compression garment continuously for several days, followed by daytime wear for up to two weeks.
Patients are encouraged to begin walking almost immediately after the procedure, often for 10 to 15 minutes before leaving the office. This early ambulation stimulates blood circulation and reduces the risk of blood clot formation. While light daily activities can be resumed right away, patients should avoid strenuous exercise, heavy lifting, or high-impact activities for one to two weeks.
Mild to moderate discomfort, bruising, and localized swelling along the treated vein paths are common. These symptoms are temporary and generally resolve within a few weeks. Over-the-counter pain relievers, such as acetaminophen, are usually sufficient to manage any soreness. Patients should also temporarily avoid soaking the treated leg in a bathtub, hot tub, or pool for about one week to prevent infection.
The tiny incisions heal quickly and typically leave minimal scarring that fades significantly over time. Follow-up appointments monitor the healing process and ensure desired results are achieved. Adherence to post-procedure instructions, especially regarding compression and activity, is important for a successful recovery.