Microphlebectomy
Microphlebectomy, also known as ambulatory phlebectomy, is a method of removing varicose veins on the surface of the legs. It is done in the office under local anesthesia. This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are very small and frequently no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique. The patient is able to walk following the procedure. After treatment, a compression bandage and/or compression stocking are worn. Dr. Hopkins will advice you how long to wear any bandages or hose. He also recommends that you walk or bike after treatment. This reduces pressure in the veins, increases the flow in the veins and reduces the risk of forming a blood clot.
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Questions and Answers
WHAT IS MICROPHLEBECTOMY?
Microphlebectomy is an outpatient office-based procedure that removes superficial veins through small, slit-like incisions in the skin. The procedure involves four different steps:
1. Outlining or marking the veins to be treated;
2. Injecting local anesthesia into the skin;
3. Surgical removal of the bulging veins, segment by segment, through small (2 mm) incisions and steer-strips are used to close the incisions.
4. Wearing compression stockings for three days to one week after surgery.
WHAT SHOULD FIRST BE DONE BEFORE CONSIDERING AMBULATORY PHLEBECTOMY?
The patient should have a proper vein evaluation, which may include a relevant history and physical, a Doppler and/or a duplex ultrasound examination. These tests evaluate such factors as:
1. Are the varicose veins the main problem, or are they connected to other veins that may need to be treated first?
2. Are there clots in the superficial or deep veins which may need to be addressed? Are other procedures needed in addition to microphlebectomy?
WHEN IS MICROPHLEBECTOMY APPROPRIATE?
Microphlebectomy may be used to remove both asymptomatic and symptomatic superficial veins from the skin. Typically, treated veins are the larger, bulging (raised) and varicose veins, although smaller veins may also be removed with microphebectomy. This procedure may be combined with other therapies in the treatment of venous disease.
WHO IS NOT A CANDIDATE FOR MICROPHLEBECTOMY?
Patients who are allergic to the local anesthesia, who are not able to walk on their own and who cannot wear the compression stockings (arterial circulation problems) are not candidates for this procedure. Any active infection or rash in the treated areas needs to resolve before the surgery.
IS MICROPHLEBECTOMY PAINFUL?
This procedure is performed under local (tumescent) anesthesia, and there is mild pain associated with this type of anesthesia. Once the local (tumescent) anesthesia is delivered however, there is rarely pain, but an unusual sensation of "tugging and pulling," should be expected. After surgery, discomfort should also be minimal to none, especially if compression stockings are worn as directed.
WHAT ARE THE COMPLICATIONS OR POTENTIAL SIDE EFFECTS OF MICROPHLEBECTOMY?
Temporary bruising and swelling of the treated area is typical and is minimized with compression stockings. The small incisions heal well without sutures and after six to 12 months, they are minimally visible. (Note: In darker-skinned patients, the incision sites may be darker-colored before fading). Although every attempt is made to remove the entire varicose vein, there may be small segments that remain. These fragments may become inflamed and irritated causing the condition phlebitis. The residual vein may feel like a hard cord and may be tender. Over-the-counter medications, compression stockings and time usually resolve this condition. Rarely, a sensory nerve may be injured and skin numbness results. The skin numbness usually affects a small area only. Movement or leg function should not be affected.
WHAT CAN I EXPECT AFTER HAVING HAD MICROPHLEBECTOMY?
Bruising and swelling is normal and temporary. You can walk immediately after surgery and carry on normal daily activities except for exercise and heavy lifting. You must follow the activity restrictions and wear the compression stockings as directed. Your varicose veins are physically removed and therefore should not come back. However, depending on other factors such as family and personal history, new varicose veins may develop over time.
WHAT IS MICROPHLEBECTOMY?
Microphlebectomy is an outpatient office-based procedure that removes superficial veins through small, slit-like incisions in the skin. The procedure involves four different steps:
1. Outlining or marking the veins to be treated;
2. Injecting local anesthesia into the skin;
3. Surgical removal of the bulging veins, segment by segment, through small (2 mm) incisions and steer-strips are used to close the incisions.
4. Wearing compression stockings for three days to one week after surgery.
WHAT SHOULD FIRST BE DONE BEFORE CONSIDERING AMBULATORY PHLEBECTOMY?
The patient should have a proper vein evaluation, which may include a relevant history and physical, a Doppler and/or a duplex ultrasound examination. These tests evaluate such factors as:
1. Are the varicose veins the main problem, or are they connected to other veins that may need to be treated first?
2. Are there clots in the superficial or deep veins which may need to be addressed? Are other procedures needed in addition to microphlebectomy?
WHEN IS MICROPHLEBECTOMY APPROPRIATE?
Microphlebectomy may be used to remove both asymptomatic and symptomatic superficial veins from the skin. Typically, treated veins are the larger, bulging (raised) and varicose veins, although smaller veins may also be removed with microphebectomy. This procedure may be combined with other therapies in the treatment of venous disease.
WHO IS NOT A CANDIDATE FOR MICROPHLEBECTOMY?
Patients who are allergic to the local anesthesia, who are not able to walk on their own and who cannot wear the compression stockings (arterial circulation problems) are not candidates for this procedure. Any active infection or rash in the treated areas needs to resolve before the surgery.
IS MICROPHLEBECTOMY PAINFUL?
This procedure is performed under local (tumescent) anesthesia, and there is mild pain associated with this type of anesthesia. Once the local (tumescent) anesthesia is delivered however, there is rarely pain, but an unusual sensation of "tugging and pulling," should be expected. After surgery, discomfort should also be minimal to none, especially if compression stockings are worn as directed.
WHAT ARE THE COMPLICATIONS OR POTENTIAL SIDE EFFECTS OF MICROPHLEBECTOMY?
Temporary bruising and swelling of the treated area is typical and is minimized with compression stockings. The small incisions heal well without sutures and after six to 12 months, they are minimally visible. (Note: In darker-skinned patients, the incision sites may be darker-colored before fading). Although every attempt is made to remove the entire varicose vein, there may be small segments that remain. These fragments may become inflamed and irritated causing the condition phlebitis. The residual vein may feel like a hard cord and may be tender. Over-the-counter medications, compression stockings and time usually resolve this condition. Rarely, a sensory nerve may be injured and skin numbness results. The skin numbness usually affects a small area only. Movement or leg function should not be affected.
WHAT CAN I EXPECT AFTER HAVING HAD MICROPHLEBECTOMY?
Bruising and swelling is normal and temporary. You can walk immediately after surgery and carry on normal daily activities except for exercise and heavy lifting. You must follow the activity restrictions and wear the compression stockings as directed. Your varicose veins are physically removed and therefore should not come back. However, depending on other factors such as family and personal history, new varicose veins may develop over time.