Stab phlebectomy, also called ambulatory phlebectomy or microphlebectomy, is a minimally invasive procedure designed to permanently remove superficial varicose veins. The term “stab” refers to the tiny, puncture-like openings created in the skin, often no larger than a freckle, through which the diseased vein is extracted. This surgical technique physically removes problematic vein segments, offering an alternative to traditional vein stripping. It allows for the removal of bulging veins with minimal downtime and excellent cosmetic results.
Medical Indications for Treatment
Stab phlebectomy primarily addresses large, bulging surface varicose veins that are often symptomatic. These veins, typically 3 to 5 millimeters or greater in diameter, are manifestations of chronic venous disease, causing discomfort, aching, or swelling. Due to their size, they are generally unsuitable for treatments like sclerotherapy.
The procedure is commonly used as a secondary treatment following definitive procedures like radiofrequency ablation (RFA) or endovenous laser therapy (EVLT). While these heat-based therapies treat underlying reflux, residual varicose branches near the surface may still require removal. Stab phlebectomy eliminates these remaining segments that did not shrink after the initial treatment. It is also performed for cosmetic reasons or to relieve symptoms such as pain, heaviness, or skin irritation.
Executing the Procedure
The stab phlebectomy is typically performed in an office setting, allowing the patient to remain awake and ambulatory. The process begins with mapping the affected veins using a pen while the patient is standing. Local anesthesia is administered along the course of the vein segments to be removed, ensuring the patient feels no pain during extraction.
The surgeon makes multiple, minute incisions, usually 1 to 3 millimeters long, directly over the targeted vein segments. These small openings are strategically placed to allow access to the entire length of the diseased vein. Specialized phlebectomy hooks are inserted through these tiny openings. These fine instruments are maneuvered under the skin to gently engage and grasp the vein segment.
Once hooked, the vein is avulsed, or pulled out, in short sections through the incision. The segment is disconnected from surrounding tissues and removed completely. This method ensures the entire problematic superficial vein cluster is physically extracted. Since the incisions are small, they do not usually require sutures and are covered with small adhesive strips or a sterile dressing.
Post-Procedure Care and Expected Outcomes
Following a stab phlebectomy, the patient is immediately encouraged to walk to promote blood circulation and minimize complications. The procedure has minimal downtime, with most individuals resuming normal daily activities within one to two days.
A crucial component of post-procedure care is the consistent application of compression stockings or bandages. These must be worn continuously for the first 24 to 48 hours, and then during daytime hours for up to two weeks. Compression minimizes common side effects like swelling, bruising, and discomfort, aiding in proper healing.
Bruising along the path where the veins were removed is expected and typically resolves within a few weeks. Patients should avoid strenuous activities, such as heavy lifting or intense exercise, for about a week, though light activity is highly encouraged.
The expected outcomes are both aesthetic and functional, including immediate improvement in the cosmetic appearance of the legs and relief from symptoms like aching and heaviness. The small incision sites heal with minimal to no scarring due to the micro-incisions used. Temporary skin discoloration, or hyperpigmentation, may occur at the treatment sites, but this generally fades quickly. Long-term results are considered excellent.