Treatment Options → Endovascular Laser Ablation → Sclerotherapy → Microphlebectomy

What is microphlebectomy?
Microphlebectomy (pronounced mike-row-fle-beck-tomy) is a procedure to remove varicose veins on your legs.  Varicose veins are thick, bulging, ropey veins that often throb or ache, especially when standing for prolonged periods.  While varicose veins can be isolated in their occurrence, more often they are associated with venous insufficiency. This is a condition where the larger veins in the legs allow some blood to leak (or reflux) towards your toes rather than flow upwards towards your heart.  When the blood refluxes, it often fills and causes enlargement of smaller, superficial vessels causing varicose veins.  Even after the refluxing problem in the larger veins has been fixed, (with a vein stripping or an ablation treatment) the varicose veins can remain.  Microphlebectomy is a safe and effective way to remove these residual veins.

Microphlebectomy is an outpatient procedure. After thoroughly numbing the areas around the veins, small nicks are made in the skin and the veins, or segments of the veins, are removed.  Compression dressings and stockings will then be applied and you will be able to go home.
 
What are my pre-procedure instructions?
Unless told otherwise, you may eat and drink before your procedure.  If possible, we advise that you avoid aspirin, ibuprofen (i.e. Advil and Motrin), and vitamin E for 5 days prior to treatment, as they can be associated with increased bruising.  If you have been advised by another physician to take these medications daily, please discuss this with him/her prior to stopping them.  Please take any regular medications as you normally would on the day of your procedure.  If you have not yet done so, you will need to get the prescribed compression stockings, as you will need to bring them with you on the day of your procedure.  The stockings will be quite tight but they are essential in the outcome of the procedure.  It is very important that you have compression stockings that you fit properly.  For this reason, it is a good idea to try them on prior to the day of your procedure.
 
What can I expect on the day of my procedure?
After you have had the opportunity to ask all of your questions and completed the consent form, the physician performing your microphlebectomy will use a marker to make marks on the skin over the areas of your varicose veins. The physician will have you stand while he/she does this because veins are better seen when you are standing.  You will then lie down and your leg will be cleaned for the procedure. The physician will completely anesthetize the areas around the veins and then proceed with making very small nicks (usually 1-2mm) in your skin to remove the veins or segments of the veins.  While you may feel some pressure during this part of the procedure, you should not be in pain.  If you are feeling uncomfortable during your procedure, be sure to let your nurse or physician know.  When finished, your skin will again be cleaned, dressings will be applied, and we will assist you with getting your compression stocking(s) on.  Procedure time varies, but the average microphlebectomy takes about one hour.
 
What are my post-procedure instructions?
While it is important to remain relatively active during your recovery, most people find they are more comfortable being able to rest and elevate their legs off and on while sitting during the first 24 hours following a microphlebectomy. Complete bed rest is not necessary.  Below are some specific guidelines for you to follow during your recovery:

Leg Care:

Leave the compression stockings and dressings in place for approximately 48 hours following your procedure. After 48 hours, remove the compression stockings and all the dressings except the steri-strips. (If you have them, the steri-strips will look like small pieces of tape applied directly on the skin over the small skin nicks). Allow the steri-strips to fall off on their own (in 7-10 days). After you have bathed, dry your legs completely and re-apply the compression stocking(s). No new dressings are needed.

Bathing:

You may shower but avoid baths or soaking (including swimming pools and spas) for at least one week after your procedure and longer if the incisions have not yet completely healed.

Compression Stockings:

You will then wear the compression stocking(s) continuously for 48 hours. You may remove them after the 48 hours and take a shower. You will then need to wear the compression hose while you are up and around for the next three to four weeks. You do not have to sleep in the compression hose. After the fourth week, you should wear the stocking(s) if you will be on your feet for an extended period of time.

Exercise:

We advise that you limit your exercise activity for 24 hours and avoid lifting anything heavier than 15 pounds for two weeks following your procedure. Following your procedure, you should wait at least one week before resuming heavy exercise (i.e. weightlifting, uphill biking). Regular activity can be resumed the next day. Judge this according to how you feel. You may want to consult with the physician regarding return to regular exercise activity.

Follow-Up:

Schedule a follow-up visit to the Vein and Laser Center in one week following your microphlebectomy. If you have any questions or concerns before then, we are happy to see you sooner.

What can I expect as I recover from microphlebectomy?
During the recovery period following microphlebectomy, the treated leg(s) may look quite bruised and mildly swollen. It is important to remember that the maximal outcome from this procedure will be realized at about 4-6 weeks following the procedure.  You may or may not experience the following during your recovery:

Bruising:

Tenderness and bruising is expected following microphlebectomy. The use of compression stockings as prescribed may decrease some bruising and pain and this will likely all resolve with time. Occasionally, patients will get some hyper pigmentation (darkening) over the areas of bruising or at the skin nicks. Wearing the compression stockings as prescribed and avoiding sun exposure to these areas will decrease (but not completely reduce) the likelihood of developing hyper pigmentation.

Bleeding:

Occasionally patients will experience some bleeding from one of the small nicks that were made in the skin. Should this happen, lie down and apply gentle pressure (or have someone else apply gentle pressure) to the area for 15 to 20 minutes. When the bleeding stops, reapply a clean dressing and continue to lie quietly for another 30 minutes. Excessive bleeding is very rare, but if you are unable to get the bleeding to stop using these measures, go to your nearest emergency department.

Swelling:

Mild swelling at or near the area of the microphlebectomy site is normal and will decrease with time. Widespread leg swelling and pain with walking can be a sign of a significant blood clot or infection. Should you have these symptoms, call the Vein and Laser Center or go to your nearest emergency department.

Scarring/Skin Changes:

All skin heals with some scarring.  You will have small (1-2mm) scars that usually fade over time, but may not completely go away.  The scars may appear lighter or darker than the surrounding skin, even when completely healed.

Please contact the Vein and Laser Center if you experience any of the following as it may be a sign of infection:

• Red streaks around the skin nicks
• Pus or any drainage that is not pink/red or clear
• Swelling with extreme tenderness
• Fever, chill, nausea, and vomiting