What It Is
A phlebectomy is the surgical removal of varicose veins that have become unsightly or uncomfortable. Your doctor may recommend a phlebectomy to treat symptoms of varicose veins, such as leg pain and heaviness. A phlebectomy can also help prevent related problems, such as skin sores, leg swelling, bleeding, and blood clots in the legs. A phlebectomy can also improve your appearance.
Phlebectomy is a surgery with risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a phlebectomy.
Types of phlebectomy
The types of phlebectomy, or vein removal, procedures include:
Ambulatory phlebectomy (also called micro-incision phlebectomy, hook phlebectomy, stab avulsion phlebectomy, and microphlebectomy) involves removing portions of varicose veins through small incisions using a hook. It is usually performed in a doctor’s office using a local anesthetic.
Transilluminated powered phlebectomy (TIPP) removes portions of varicose veins using tools that are inserted into the skin near the veins. They include a lighted tool that gives the doctor a good view of the vein’s location, and a tool that breaks up the vein and suctions it out of the leg.
This type of phlebectomy is usually performed using general or regional anesthesia in a hospital or surgical center. It might require fewer incisions and you may have a shorter recovery time than ambulatory phlebectomy.
Why is a phlebectomy performed?
Your doctor may recommend a phlebectomy to treat varicose veins near the surface of the skin. Your doctor may recommend a phlebectomy if your varicose veins are large, protruding, unsightly, uncomfortable, or put you at risk for more serious problems. This includes skin sores, leg swelling, bleeding, and blood clots in the legs.
Veins carry the blood from your body back to your heart. Valves in veins help keep blood flowing back to your heart. When valves become damaged or weakened, blood can pool in your veins causing them to swell and weaken. This results in varicose veins. Varicose veins can look blue, twisted and bulging, and feel uncomfortable. Varicose veins most often occur in the thighs and calves, most often in women.
Your doctor may only consider a phlebectomy for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a phlebectomy.
Who performs a phlebectomy?
The following specialists perform a phlebectomy:
Vascular surgeons specialize in the surgical treatment of diseases and conditions of the lymphatic system and blood vessels outside the heart and brain.
Phlebologists specialize in diagnosing and treating vein conditions including varicose veins, spider veins, chronic venous insufficiency, and vein birth defects.
Dermatologists specialize in the medical and surgical care of the skin, hair and nails.
How is a phlebectomy performed?
Your phlebectomy will be performed in a doctor’s office, outpatient setting, or hospital. Your doctor will likely use local anesthesia. Local anesthesia involves injecting an anesthetic in the skin and tissues around the surgical area to numb them. Other types of anesthesia that may be used include:
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your phlebectomy
Phlebectomy generally takes 30 minutes to an hour and includes these steps:
You will remove your clothing and dress in a patient gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will respect your privacy and give you blankets for modesty and warmth.
While you stand up, your doctor will mark the veins to be removed with a pen.
You will lie on a table in a position to allow the best access to the varicose vein(s).
Your doctor will insert a needle and inject local anesthetic into the area near the vein to be removed. You will be awake and alert during the procedure. Sometimes an anesthesiologist or nurse anesthetist will give you a spinal nerve block or general anesthesia for the surgery.
For an ambulatory phlebectomy, your doctor will make a small nick in the skin, and use a hook to pull out the vein. Your doctor will repeat this for other veins as needed.
For a transilluminated powered phlebectomy (TIPP), your doctor will make a small incision and insert a lighted instrument near your vein to make it easier to see. Your doctor will then insert another instrument under your skin to break up the vein and suction out its fragments. This process is repeated for other veins as needed.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing normally, and your vital signs are stable.
What are the risks and potential complications of a phlebectomy?
As with all surgeries, a phlebectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of phlebectomy
Complications of a phlebectomy are often temporary and include:
Change of skin color near the vein removal site
Inflammation of remaining fragments of vein
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes avoiding heavy lifting and strenuous activity as recommended by your doctor.
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Stopping smoking. Smoking increases your risk of pulmonary complications and inhibits wound healing
Taking your medications and wearing your compression stockings exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my phlebectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a phlebectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing, especially for general anesthesia, may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners one week prior to surgery.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a phlebectomy? Are there any other options for treating my condition?
What type of phlebectomy procedure will I need?
Where will my phlebectomy take place?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
How long do I need to wear compression stockings?
How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my phlebectomy?
Knowing what to expect can help make your road to recovery after a phlebectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will likely be able to walk normally and go home the same day if you are recovering well. In other cases, a hospital stay of one day is required.
You will need to wear compression stockings for several weeks to stabilize your veins and help them heal. Most people return to normal activities in one to two days, but your doctor will likely recommend that you avoid strenuous activities for a couple of weeks.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a phlebectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness such as passing out, dizziness, unresponsiveness, or confusion
Fever. Follow your doctor's specific instructions about when to call for a fever.
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage or pus coming out of an incision in your leg
How might a phlebectomy affect my everyday life?
A phlebectomy may cure your condition or significantly reduce your symptoms. It will most likely relieve much of the discomfort, bulging and discoloration of varicose veins. It may not prevent varicose veins from coming back, and you may need a phlebectomy or other vein procedure in the future.
You can make changes in everyday life that may help prevent or delay recurrence of varicose veins including:
Wearing compression stockings
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- Ambulatory phlebectomy information. American Society for Dermatologic Surgery. http://www.asds.net/AmbulatoryPhlebectomyInformation.aspx.
- Frequently Asked Questions. The American College of Phlebology. http://www.phlebology.org/patientinfo/faq.html.
- Phlebectomy of Varicose Veins. RadiologyInfo.org http://www.radiologyinfo.org/en/info.cfm?pg=phlebectomy.
- Varicose Vein Treatment [Transcript]. Johns Hopkins Medicine. http://www.hopkinsmedicine.org/heart_vascular_institute/media/video/transcriptions/varicose_vein_tre....
- Varicose veins and spider veins fact sheet. Womenshealth.gov. http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm.
- What Are Varicose Veins? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/vv/.