Microphlebectomy is an office based procedure that involves the removal of the varicose vein through tiny needle punctures.  This procedure is reserved for the treatment of large bulging varicose veins that remain visible under the skin.  Because of their size and location,  these veins cannot be treated with sclerotherapy or ablation.  Since they are very superficial, staining and permanent thickening is a risk with ablation and sclerotherapy.

Advantages of Microphlebectomy include no incisions,  minimal scattering and long-lasting results with complete removal of varicose veins.  Microphlebectomy results in quick healing, relatively pain-free and superior cosmetic and symptom relief.

What Is The Recovery Time Following Microphlebectomy?

Most patients recover rapidly and resume daily activities within a day or two of the surgery. Minor bruising and tiny scabs will be present initially, but in less than two weeks, legs look and feel better without any trace of scarring. Most patients report not needing pain medication, while some take an over the counter pain reliever as a precaution.

What Types Of Complications Can Arise, If Residual Varicose Veins Are Left Treated?

Untreated, varicose can continue to cause pain, heaviness, and fatigue in legs. Large varicose veins can get complicated with blood clot formation (thrombophlebitis), which can sometimes have serious consequences. Large varicose vein branches can negate the benefit of previous treatments. We, therefore, recommend that the veins should be removed.

What To Expect During The Procedure?

The physician will examine your legs in a standing position to identify the veins to be removed.  Using a surgical marker physician will locate and mark the areas where incisions will be made. The affected leg will be sterilized and draped in sterile drapes.  Local tumescent anesthesia (saline infused anesthesia) will be administered at various points along the vein to be removed, through tiny needle punctures.  Tumescent anesthesia helps to perform the procedure painlessly by numbing the skin and making it easier to separate veins from the subcutaneous tissue, numbs and firms up the area and makes removal of the vein easier by separating the vein from surrounding tissue and pushing it closer to the surface of the skin.  Your doctor will remove varicose veins by hooking the veins on small phlebectomy hooks and removing the vein through tiny incisions made on the skin surface.

Once the procedure is completed, wound dressings are applied. Over the initial non-elastic wound dressings,  a secondary elastic compression dressing is applied from the foot up the leg to cover the incisions.  Alternatively, compression stockings (usually  30-40  mm  Hg)  can be worn.  Bandages are removed after 1-2  days, but compression stockings remain for 1-3 weeks following the procedure.

What To Expect After The Procedure?

You will be able to return to routine immediately following the procedure. Bed rest is prohibited after Microphlebectomy; Daily walking and movement are much encouraged following Microphlebectomy.  Avoid excessive sun exposure, because sunlight can cause skin pigmentation along incision lines. There may be some temporary and mild discomfort or bruising for a day or two at the treatment site. Other side effects include bleeding and swelling. On rare occasion, infection, blood clots or scarring can occur. If minor nerve injury surrounding the vein removal area occurs, the injured nerves can cause numbness or pain, which usually heal with time. Sometimes spider veins (telangiectasias) may fade and disappear following micro phlebectomy procedure.

A follow-up appointment with your physician will be made following ambulatory phlebectomy procedure within 1-2 weeks of the procedure. At your follow-up visit, your physician can assess how well you have recovered, and whether other complementary venous procedures are needed. This visit also helps to exclude and treat infection if it is developing.

Results Of Microphlebectomy?

In our hands, Microphlebectomy yields a higher than 95% success rate. Once initial bruising resolves, there will be a noticeable reduction in varicose veins. Because only tiny incisions are made, there is virtually no scarring. The incisions heal over time, and skin discoloration improves, and most patients are satisfied with the results of Microphlebectomy.

What Is The Recovery Time Following Microphlebectomy?

Most patients recover rapidly and resume daily activities within a day or two of the surgery. Minor bruising and tiny scabs will be present initially, but in less than two weeks, legs look and feel better without any trace of scarring. Most patients report not needing pain medication, while some take an over the counter pain reliever as a precaution.

What Types Of Complications Can Arise, If Residual Varicose Veins Are Left Treated?

Untreated, varicose can continue to cause pain, heaviness, and fatigue in legs. Large varicose veins can get complicated with blood clot formation (thrombophlebitis), which can sometimes have serious consequences. Large varicose vein branches can negate the benefit of previous treatments. We, therefore, recommend that the veins should be removed.

ADVANTAGES OF USING Microphlebectomy TO REMOVE VARICOSE VEINS

Following are some of the benefits of microphlebectomy.

• 1. It is Minimally Invasive.
• 2. It’s performed under local anesthesia.
• 3. The procedure is performed in comfortable surroundings in the office and not in a hospital.
• 4. Stab incisions performed to remove veins are small and disappear after few weeks.
• 5. Immediately after the procedure patients can resume activities of daily living.
• 6. It is covered by most insurance companies when associated with varicose veins and is symptomatic.

Pre-Procedure Watch List?

There is little preparation required on your part before the procedure. Drinking fluids liberally and keeping yourself hydrated improves the chances of vein removal. It is advisable to bring a friend or a family member with you. You DO need to bring your compression stocking that was prescribed at the time of your consultation. Bring a pair of shorts with you. After the procedure, your leg will be wrapped with ace bandages and your stocking; therefore, shorts will feel more comfortable.

Typically, after the procedure, you are required to walk for 20-30 minutes. Kits therefore advisable to wear comfortable shoes. After the shower in the morning does not use any lotion or oil on your legs. Oils and creams make it difficult to mark the veins on your skin.  We play music for you, and we also have a tablet if you wish to browse the internet during the procedure, most patients feel more comfortable chatting during the procedure If you take a blood thinner, please notify us as soon as possible. We usually stop blood thinners before the procedure. Aspirin therapy is not interrupted.

What To Expect During The Procedure

You will be asked to stand first to make sure that the veins fill with blood and a stencil marker is then used to trace the course of the veins to be removed. You then lie down on the table. The leg to be treated is then cleaned and draped using sterile technique. A local anesthetic will be administered over the area to be treated. A small incision, about 2-3 mm long, will be created in the skin over a varicose vein. A small hook, resembling a tiny crochet needle, is used to pull the vein through the skin.

This process is repeated using additional stabs about one inch apart until the varicose veins are removed. The procedure typically lasts between 30 minutes to an hour depending on how many veins are going to be removed. The procedure is usually painless. Discomfort observed during injection of anesthesia is no more significant than the pain felt during the blood draw. You will feel occasional pulling when the vein is removed. The additional liberal anesthetic can be administered during the procedure for residual pain.

What To Do After The Procedure?

Upon completion of the procedure, sterile gauze pads are applied and kept in place with an ace wrap. The dressing is applied to help absorb the small amount of oozing of blood that occurs typically after removal of varicose veins and to add compression to the skin nick sites. Stocking should be worn uninterrupted for two days. After this period, the stocking should be removed and the ace wrap and gauze pads disposed of.

After a shower, the stocking should let us change in her be put back on and worn for one more night. You should then wear the stocking except to sleep or bath for a total of two weeks. The skin nicks sometimes require stitches. Occasionally steri-strips or butterfly type band-aids are applied to some of the skin incisions. Sutures, if used, are removed after ten days. If the dressing or bandages underneath the stocking become very uncomfortable in the first 48 hours after the procedure, you can remove it and rewrap it, to alleviate any discomfort and avoid creating blisters.

Activity Restrictions And Recommendations?

After the procedure, you may immediately resume all your usual activities except vigorous gym workouts, heavy weight lifting or long, hot baths. Prolonged sitting or standing should be avoided.  Walking around the office and doing toe raises is recommended at work.

Frequent walking is strongly recommended for a total of at least 2 hours a day for the first two weeks following the procedure. You can resume daily routine including exercise 1 week after the procedure, but the stocking should be worn during the first week after the procedure. We recommend that you do not fly in an airplane for one month after the procedure.

When do I return for a follow-up visit?
You will come back for a follow-up visit in 10 days. If you have received sutures during the procedure, they will be removed. Complications that require medical attention are rare after this procedure and will be reviewed with you before the procedure. In case of complications or concern, the physician can be reached through the office or answering service by calling 410-761-8007.

Discharge Instructions Following The Microphlebectomy Procedure?

1. 1. You can eat and drink when you like. It is rare to have nausea after the procedure. If you have some nausea following the procedure, start with liquids and bland foods, and then progress to regular food until nausea resolves.
2. 2. If you are not allergic or intolerant, take MOTRIN/IBUPROFEN/ALEVE 600 mg immediately after the procedure and 400mg three times a day for one day after the procedure to avoid discomfort. For mild pain, you can take Tylenol.
3. 3. Its recommended not to remove ACE wrap for 24 hours.  It should be snug, but not too tight. If the ACE wrap feels too tight, you can remove it and rewrap it around the leg. Leave the steri-strips on. You may shower over them.
4. 4. You may shower the first day after your procedure but avoid tub baths or swimming pools until the wounds are healed.
5. 5. Following discharge, you can resume usual activities. You can go up and down the stairs. It’s not recommended to sit or stand in one position for a long time.
6. 6. Restart aspirin on the following day after your procedure.  If you take Coumadin, let us know. Restarting coumadin is individualized based on patients medical history.
7. 7. Bleeding following the procedure is rare. If notice is bleeding, apply firm pressure over the bleeding site for 20 minutes with a clean towel. If bleeding does not stop call our office at 410-761-8007
8. 8. Call us if you experience any following problems; such as, fever, severe pain, sudden swelling of the leg that has been treated, or bleeding or drainage from the incisions.
9. 9. Minor bruising of your thigh/calf is expected, and it will improve with time.
10. 10. Remember to apply sunscreen on scars for two (2) years following your surgery.