Stab phlebectomy is a minimally invasive surgical procedure designed to remove varicose veins located near the surface of the skin. This technique is often referred to as ambulatory phlebectomy or microphlebectomy.
It is performed as an outpatient procedure, meaning the patient can return home the same day the treatment is completed.
The goal is to physically extract the problematic veins through tiny openings, eliminating the source of visible bulging and associated symptoms. The procedure is typically performed in a doctor’s office or specialized clinic setting.
Conditions Addressed by the Procedure
Stab phlebectomy is specifically employed to address varicose veins that are superficial, bulging, and have a tortuous, or winding, shape. These veins are often too large or complex to be effectively treated by non-surgical methods like sclerotherapy. Sclerotherapy, which involves injecting a chemical solution to close the vein, is generally better suited for smaller, less prominent veins or spider veins, typically those less than 3 millimeters in diameter.
The physical removal of the vein is necessary when the vessel is significantly dilated, sometimes measuring 5 millimeters or greater, and is close to the skin’s surface. These larger, bulging veins are often responsible for symptoms like aching, heaviness, and skin changes. Unlike other treatments that collapse the vein internally, stab phlebectomy immediately removes the diseased segment.
This surgical method is frequently used in combination with or following other primary treatments, such as endovenous laser ablation (EVLA) or radiofrequency ablation (RFA). After these procedures address the underlying source of venous reflux in larger trunk veins, residual or persistent varicose branches may still be present. Stab phlebectomy provides a solution for these remaining visible segments. The immediate physical extraction of these prominent veins offers a high success rate and is effective for improving appearance and discomfort.
How Stab Phlebectomy is Performed
The procedure begins with the medical provider marking the specific veins to be removed, usually while the patient is standing, so the course of the vein is clearly visible when it is filled with blood. Once the patient is positioned on the table, the area surrounding the veins is cleaned and a local anesthetic is administered. This local anesthetic is often delivered using a tumescent technique, which involves injecting a large volume of very dilute solution to numb the tissue and compress the surrounding area, minimizing bleeding.
The surgeon then creates a series of micro-incisions, or “stabs,” directly over or adjacent to the targeted vein segments. These openings are intentionally small, typically measuring only 1 to 3 millimeters in length, and are designed to heal without the need for sutures.
Through these tiny openings, a specialized tool known as a phlebectomy hook is inserted beneath the skin. This instrument is used to gently find, grasp, and tease the vein segment out of the surrounding tissue. Because veins are highly flexible and collapsible, even large, dilated vessels can be removed through these minute entry points.
The surgeon systematically extracts the vein in sections along the entire length of the marked varicosity. Once the problematic vein has been fully removed, the small incisions are generally closed using adhesive strips or surgical glue. The procedure is usually completed within 45 to 60 minutes, depending on the extent of the veins being treated.
What to Expect During Recovery
Recovery following a stab phlebectomy is typically rapid due to the procedure’s minimally invasive design. Patients are encouraged to begin walking immediately after the procedure is finished. This movement helps promote healthy blood circulation and reduces the risk of blood clot formation.
The most important aspect of immediate post-procedure care is the use of compression stockings or bandages, which are applied immediately after the treatment. Wearing these graduated compression garments is mandatory for a period, often continuously for the first 24 to 48 hours, and then during waking hours for a subsequent period that can range from one week up to a month. Compression helps to minimize swelling, decrease bruising, and support the healing process.
Patients should expect some minor side effects, including bruising and slight swelling in the treated area. Any discomfort is usually manageable, often described as a dull ache or pressure, and over-the-counter pain relievers are typically sufficient. Most patients can return to light activities, including work, within 24 hours of the procedure. However, strenuous exercise, heavy lifting, or activities that involve prolonged standing should be avoided for about one to two weeks to allow the micro-incisions to heal. Patients are also advised to avoid hot tubs and soaking baths for about a week after the procedure.