What is Phlebectomy?

Medically reviewed by Mohamed T. Hassan, MD, DABVLM, RPVI, on May 24, 2024

Phlebectomy, often referred to as micro phlebectomy or ambulatory phlebectomy, is a minimally invasive treatment option designed to remove varicose veins. This technique is primarily used to address veins near the surface of the skin that have become enlarged and twisted due to a weakening of the tiny valve within the venous system. Unlike traditional vein stripping, ambulatory phlebectomy is performed in an office setting, is less invasive, and allows quicker recovery.

In this blog, board-certified Center for Vein Restoration (CVR) physician Dr. Mohamed T. Hassan delves into the details of the ambulatory phlebectomy procedure. Dr. Hassan discusses who the right candidate is for this procedure, the techniques involved, and the benefits patients can expect. He will also share insights on post-procedure care and long-term outcomes to help you make an informed decision about your vein health.

Dr. Hassan is the lead physician at Center for Vein Restoration vein clinics in Birmingham, Alabama, and Trussville, Alabama.

Understanding Phlebectomy

Dr. Hassan: "Phlebectomy, a classic surgical treatment for superficial varicose veins, involves removing veins using a small hook. Despite advancements in sclerotherapy, phlebectomy remains a preferred choice in phlebology due to its speed, effectiveness, and minimal scarring.

Phlebectomy provides a reliable solution for varicose veins, patients with lasting relief and improved vascular health. Developed in the 1950s by Dr. Robert Muller, a Swiss dermatologist, phlebectomy entails the removal of superficial veins using a small hook.

Alongside sclerotherapy, it is one of the most commonly used techniques for treating varicose veins and spider veins. The procedure typically begins with a Doppler ultrasound assessment to evaluate the venous condition."

How Phlebectomy Works

Phlebectomy can be performed concurrently with saphenous vein ablation, targeting its branches. According to Verywell Health, the great saphenous vein (GSV), the body's longest vein, runs from the foot to the inner thigh and responds by draining deoxygenated blood from the foot and superficial leg. It ends at the femoral vein in the femoral triangle.

The vein's superficial position (close to the skin) makes it prone to varicose veins, where blood pools due to valve dysfunction, and thrombophlebitis, an inflammation caused by blood clots.

Anatomically, the GSV consists of three layers: the tunica intima (innermost layer), tunica media (middle muscle layer), and tunica externa (outer layer). These layers provide structural integrity and aid in blood flow regulation. Numerous valves within the GSV prevent backflow, ensuring efficient blood circulation.

Dr. Hassan: "Phlebectomy can be done independently for isolated varicose veins or recurrent varicose veins, either in a medical office, ambulatory setting, or hospital. It is suitable for treating superficial vein tributaries with more than 4-5 mm diameter. Phlebectomy is usually conducted under local anesthesia in an outpatient setting. Before the procedure, the veins are marked using ultrasound guidance to guide the phlebologist.

Sclerotherapy may be recommended for smaller veins to achieve optimal results."

How does sclerotherapy work to eliminate small veins?

Sclerotherapy involves injecting a sclerosing solution directly into the affected vein. This solution irritates and scars the vein's inner lining, causing it to collapse and stick together. The body then reroutes blood flow to healthier veins and gradually absorbs the collapsed vein over several weeks or months, making it fade from view.

Sclerotherapy is commonly used for smaller varicose veins or spider veins. It is safe and effective when performed by an experienced vein specialist. It can not only make unsightly veins disappear and improve the overall look of your legs, but it can also provide relief from any achiness and sensations of burning and heaviness.

Combining sclerotherapy and ambulatory phlebectomy

Combining these two techniques allows the physician to address veins of different sizes during the same treatment session. The phlebectomy removes the largest, rope-like varicose veins, while sclerotherapy treats the smaller, unsightly veins.

As Dr. Hassan states, performing these procedures together is quite common. It provides a more complete treatment for eliminating both large and small varicose veins/spider veins. It avoids having to do the procedures separately and can produce better overall cosmetic results.

The two procedures complement each other very well because phlebectomy prevents stasis and reflux through the large veins. At the same time, sclerotherapy eliminates the smaller veins, improving the appearance and comfort of the legs.

What happens during phlebectomy?

Dr. Hassan: "On the day of the procedure, after local anesthesia, micro-incisions (1-2mm) are made along the vein pathway, spaced every 3 to 5 cm. Using a specialized hook (Müller hook), the vein is gently extracted through these small incisions. The micro-incisions are closed with Steri-Strips; no sutures are required. Sterile dressings and compression garments (adhesive bandages or compression stockings) are applied.

Post-operative recovery after phlebectomy

Dr. Hassan: "If performed independently, patients can resume walking and normal activities on the same day. Bruising (also known as ecchymosis) may occur but will resolve within three weeks. Similar to pulling sensations, mild discomfort can be managed with over-the-counter pain relievers such as Paracetamol (also known as acetaminophen).

Minor bleeding may occur when changing dressings, but it can be easily managed by applying a new dressing.

Complications such as reddish patches due to dilated small blood vessels, superficial vein thrombosis, or, very rarely, deep vein thrombosis (DVT) may occur. These will be addressed accordingly.

Patients wear compression bandages for 48 hours before self-removal and then switch to wearing elastic stockings during the day. Any small scars will fade over a few months."

Post-operative care and follow-up

Dr. Hassan outlines what patients can expect after phlebectomy:

• Patients can resume walking immediately after the procedure.
• The pigmented marks from the micro-incisions will gradually fade over time.
• There is no need for a break from activities or work, and sports can be resumed after removing the dressing.
• A follow-up appointment will be scheduled between one and four weeks after the procedure.

What are the risks associated with phlebectomy?

Dr. Hassan: "Phlebectomy carries minimal risks and is generally safe and effective. Thrombosis is a very rare complication associated with the procedure."

What results can I expect after phlebectomy?

The results of phlebectomy are permanent, although new varicose veins may develop over time due to the progressive nature of venous insufficiency.

After undergoing an ambulatory phlebectomy procedure, here are the typical results you can expect:

1. Improved appearance: The large, bulging varicose veins that were removed through the tiny incisions will be gone, resulting in smoother-looking legs with no visible rope-like veins protruding.
2. Relief of symptoms: Many patients experience relief from the achiness, heaviness, swelling, and discomfort previously caused by the varicose veins.
3. Bruising and scarring: Some bruising and small scars at the incision sites are normal and to be expected initially after the procedure. The bruising fades over 1-2 weeks, while the tiny scars continue to fade over several months.
4. Gradual improvement: While the larger veins are instantly removed, it can take several weeks or months for all the discoloration and smaller varicose/spider veins to fully clear up.
5. Relatively rapid recovery: While most people can return to normal activities immediately after an ambulatory phlebectomy, strenuous exercise may need to be avoided for 1-2 weeks.

Considering Phlebectomy?

Phlebectomy can significantly improve the appearance and symptoms of varicose veins. Dr. Hassan and the Center for Vein Restoration team provide expert care using these minimally invasive techniques to address veins of all sizes.

If you are considering treatment for unsightly or uncomfortable varicose veins, schedule a consultation to discuss your options for restoring smooth, comfortable, and healthy legs.

Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.