Varicose vein treatments: What is ambulatory phlebectomy, or microphlebectomy?

At East Tennessee Vein Clinic, you have more than one option when it comes to varicose vein treatment. We offer a number of different treatments, including ambulatory phlebectomy

Dr. Douglass and his staff are among the most experienced in the Knoxville and East Tennessee area to perform ambulatory phlebectomy, also known as microphlebectomy, treatments. We often recommend this procedure when there are very large, visibly bulging varicose veins that persist after endovenous thermal ablation which is often the first step in treatment of varicose veins. Endovenous thermal ablation uses heat to seal hidden ridden sources of visible varicose veins, but afterwards many patients will still have very large visible varicosities on their legs which remain to be addressed. That is because these large twisted veins are inaccessible to a catheter passed through veins to seal from within.

Not every patient will need this procedure, but when it is used, the improvement of the appearance of the veins as well as improvement of symptoms is often quite dramatic. 

If your varicose veins are too twisted for an endovenous catheter to pass through and are quite large, microphlebectomy is our next option. 

What can I expect during microphlebectomy?

Microphlebectomy is not a painful procedure. The feeling can be better described as pressure, and no scalpel or stitches are required. It requires only local anesthesia and the entire procedure is typically completed in under an hour. 

The process is fairly straightforward:

  • The vein is anesthetized locally
  • You will be given nitrous oxide to make you feel more comfortable
  • A small needle puncture is made over the vein
  • A “knitting hook” type of instrument grasps the vein through the needle puncture
  • The bulging portion of the vein is pulled through the puncture
  • You drive yourself to the appointment and  home again.
  • When the bandage comes off 1-2 days later the large bulging veins in the leg should be largely (though not necessarily completely) smoothed out.

Who is microphlebectomy not good for?

Microphlebectomy is not needed for patients who only have smaller varicose veins. Before scheduling any form of treatment, our doctors will evaluate which procedure is best for you. We will perform a diagnostic ultrasound, which will let us know whether there are any clots or deep veins that need to be treated first. We will also determine what other treatment you may need to completely resolve your varicose veins. 

What can I expect after microphlebectomy?

After microphlebectomy, steri strips are placed and you will wear a bandage over your leg for two days. (You will need to sponge bathe until the bandage is removed in two days to avoid getting the bandage wet.) Continue to wear compression stockings during the day for five more days. Most, if not all, of the bulging veins will be gone then. 

Our procedures are all outpatient. You can expect to walk and return to your normal activities immediately after your procedure! You’re welcome to drive yourself to and from your appointment. We do recommend that you avoid strenuous activities for 1 week with no heavy lifting over 40 lbs for a week, and make sure to wear compression stockings for a week afterward. 

We also recommend daily walks for about 20 minutes. To prevent any scarring, we recommend using Mederma cream to the puncture sites where the vein was removed. For most people, there will be no sign of a scar between 6-12 months.

In the past, surgery for varicose veins was more invasive. Luckily, the treatments we offer at East Tennessee Vein Clinic allow you to see immediate results with minimally invasive procedures. 

We recommend the following precautions after microphlebectomy:

  • Avoid strenuous activity for seven days (such as lifting over 40 lbs.)
  • Avoid anything that puts prolonged stress on core abdominal muscles, such as sit ups. This is because abdominal pressure is displaced down the refluxing veins, and you will want to avoid that for a week after this procedure
  • Replace strenuous exercise routines with aerobic exercises such as walking, running or jogging for 7 days
  • Avoid flying for 48 hours
  • If you do fly or travel long distances within 30 days of your procedure, wear compression stockings

Most patients do not require microphlebectomy.  These will be treated with endovenous thermal ablation and/or sclerotherapy. 

If you would like to learn more about varicose vein treatment options, schedule a free consultation today! Varicose veins are genetic and progressive, but our minimally invasive procedures can relieve your symptoms fast.

“I have been to several doctor offices over the years from my FMD to other medical specialist. The ETVC clinic has the kindest staff of all the offices I have ever been to. I never felt like I was just another person in their door, and they were always friendly and kind.

I have a fear of needles and a low tolerance to pain so I was nervous to start my procedures in the beginning. The staff took this into consideration during every procedure and made my visit as comfortable as possible; Trecia and Shannon were wonderful! Dr. Douglass and his staff even sang with me during my surgery to take my mind off the procedures. My legs are looking good and feeling great and I would recommend ETVC to anyone! I actually shared your offices’ information with a co-worker as I typed this. Thank you, Dr. Douglass & Staff!”

- A. S., Knoxville, TN