Phlebectomy is the actual physical removal of a varicose vein through a small incision site. Patients may require multiple incisions to remove the diseased veins. We have this procedure available for situations where less invasive methods either aren’t working or are not an option. Your doctor will determine if this method is best for your particular situation. Phlebectomy is a proven way to eliminate varicose veins, but it comes with the downside of multiple small incisions and more discomfort. However, it does offer the patient who has risks with the more current and less invasive treatments an option for treating their vein disease.
Our venous system is part of the circulatory system and is responsible for returning deoxygenated blood back to the heart and through the lungs to be recirculated with oxygen rich blood. Our veins have tiny one-way valves that open as the blood flows to the heart and then close to prevent the blood from flowing backwards. When these valves are not functioning properly the blood can pool in the veins. Over time this can lead to venous reflux, or venous insufficiency, which then leads to increasing back pressure that weakens the walls of the veins and causes them to bulge. Eventually, this leads to the development of varicose veins and spider veins on the surface of the legs.
Anyone with vein disease may be a candidate for phlebectomy. The choice to perform phlebectomy as opposed to other treatments is one that will be determined by your doctor. The pros and cons will be discussed with you so you can make the most informed choice.
Very simply put, your doctor will make very small incisions and remove the varicose veins. Your leg will have already been prepared by the nurses and anesthetized by the doctor. Through the incisions, the doctor is able to remove a large length of vein. The incisions will then be closed with Steri-Strips. Sometimes very fine absorbable sutures will be used.
- You can shower the night before or the day of your procedure, but do not apply lotions or oils to the leg being treated.
- Do not wear compression hose 2 days prior to your procedure.
- For your first procedure, we highly recommend you bring a family member into the pre-op room to listen to all of the post-op instructions.
- Do not drink alcoholic beverages 48 hours prior to your procedure. Alcohol can cause dehydration, which may cause the vein to shrink and the procedure to have to be postponed.
The day before your procedure:
- Increase your water intake to avoid dehydration.
- Carefully shave the entire leg that will be treated.
The day of your procedure:
- Bring the medicine and numbing cream we prescribed to your procedure. Do not take any of the medicines at home.
- Drink 24 ounces of water in the morning.
- Do not drink any caffeine or smoke before your procedure.
- Wear loose fitting pants or shorts and slip-on shoes.
- Plan to have a driver take you home after the procedure.
- Eat a light meal prior to coming to the office.
- Take all of your daily medications. Do not stop taking any of your prescription medications unless advised to do so by our physician. Continue to take any blood thinning medicines unless we tell you to stop them.
When you first arrive, the doctor will mark the veins on your leg that are to be removed. The nurses will then prepare you for the procedure by cleaning your leg and applying an anesthetic cream. The doctor will make several small incisions to remove all the marked varicose veins. The incisions will be taped shut with Steri-Strips or sometimes fine absorbable sutures. The leg will then be dressed and wrapped by the nurses.
The day of your phlebectomy you will need to have a driver bring you home. We ask that you go on bed rest, with bathroom privileges, only for the rest of the day. You will need to leave your Ace bandage on for 2 days and avoid showering. You may shower after 2 days, but no bathing for 2 weeks. If your Ace bandage comes loose you will need to rewrap, but make sure it stays snug. After the first 2 days we ask that you wear your compression hose for a minimum of 1 week. This will help minimize pain, bruising and swelling, and will lead to better results. You should wear your compression hose for 23 hours a day (if unable, you may take them off at night).
You will have Steri-Strips over each incision site; do not remove the Steri-Strips for 7 days. The strips may fall off on their own; this is fine, but do not pull on them. For the first week avoid prolonged sitting or standing in the same place and elevate your legs at least 3 times a day for 5 to 10 minutes. You may have significant bruising, redness and tenderness to your leg. This is normal and no reason for concern. You may also have a small amount of blood or clear drainage from the incisions. This is also normal.
Once the veins have been removed by phlebectomy, they will never return. However, you will form more varicose veins in the legs over time. That is the unfortunate nature of vein disease.
Most insurance companies will cover a phlebectomy if you meet their medical criteria for treatment. Treatment criteria can include vessel reflux as determined by ultrasound, patient symptoms and/or compression therapy trial. Individual insurance companies may differ in their criteria for coverage of the treatment. Our nurses will work with you through the insurance submission process to assist you in getting the treatments that are medically necessary. Our financial consultant can help you determine what your insurance coverage is and what your out-of-pocket expenses will be.
If you would like additional information, we offer a complimentary nurse consultation. During your personal consultation our nurses will go over all of your treatment options and what you can expect before, during and after these treatments. They will also help you determine if vein disease is a possible cause of your symptoms. You can also meet with our financial advisor to determine insurance coverage.
If you are ready to begin treatment, you can schedule a physician evaluation. During your evaluation our doctors will perform a medical exam, go over symptoms, and examine areas of concern to determine a treatment plan. Based on this examination, they will order a diagnostic ultrasound. This is performed in an accredited lab supervised by radiologists who specialize in these tests. After your initial consultation and ultrasound, our nurses will submit your information to your insurance company to determine coverage. You may also schedule an appointment with our financial consultant to help you determine what your portion of the cost of treatment will be.
If you are not able to have a phlebectomy, other treatments may be available. Compression therapy can reduce the symptoms of venous disease and assist in healing ulcers. Sclerotherapy may also be effective for the larger refluxing veins. There are also new treatments on the horizon that may be effective for you. It is our mission at Genesis Laser & Vein to offer the best approved treatment options for vein disease to our patients. We will continue to keep up to date on the latest recommendations of care so that you have the best treatments available.