The words and terms in our profession can sound strange and complicated, so here’s an easy explanation of how these procedures could be the answer to your varicose vein problem.
Microphlebectomy — aka ambulatory phlebectomy — is the medical term for the removal of a large or medium sized varicose vein through a tiny incision in the leg. The incisions are less than 1/4 inch in length–just enough to get the vein out with a cosmetically acceptable result. The incisions are so small that they often don’t require stitches to close them. A small piece of adhesive tape is usually enough. This is known as a butterfly stitch. This procedure is considered minimally invasive and can be performed in the physician’s office using local anesthesia.
EVLT — complete name: EndoVenous Laser Ablation Therapy — is an outpatient procedure that uses a laser and ultrasound imaging guidance. Instead of physically removing the vein from the leg, the problematic vein is heat-sealed shut from the inside using a laser tip. All this happens through an opening in the skin not much larger than a typical IV needle hole. After administering local anesthetic to the area and getting venous access, a doctor inserts a catheter into the vein and uses ultrasound to expertly guide it up the vein to a precise location. The process essentially shuts down the vein, which proceeds to disappear over the next several weeks.
For an EVLT… it begins with numbing the area around the vein, then applying laser energy to the inside of the vein, heating it and sealing it closed. Once the diseased veins are closed, the blood is rerouted to normal, healthy deep veins, and the pain and symptoms start to disappear.
EVLT takes roughly 45 minutes and is performed as an outpatient procedure using local anesthesia. It involves minimal pain, no scarring, quick recovery and immediate return to normal activity.
In a Microphlebectomy, a surgeon makes one or more tiny incisions along the length of a varicose vein to access the diseased vein then remove it using special instruments. Microphlebectomy is used for veins that are too small for EVLT, but really too large to obtain optimal results using sclerotherapy. The entire procedure is done in an hour or two, using a local anesthetic.
Microphlebectomy and EVLT together…
Microphlebectomy and EVLT are frequently used in combination.
Although some people with varicose veins can be treated with a single treatment session, many people will have several veins that vary in size and “thickness,” often requiring more than one treatment. The good news is, varicose vein treatment methods are designed to work well in combination with each other, and one of the most popular options is a combination of Microphlebectomy and EVLT.
Many patients with varicose veins have veins that “fit” into different size “categories,” so a combination of treatments often is, literally, just what the doctor ordered. Studies have shown a combination of EVLT and Microphlebectomy performed in a single treatment session can provide great results, relieving symptoms most common with larger veins while also producing an excellent cosmetic result for those superficial veins.
During a consultation, your mia Aesthetics surgeon can evaluate the size and variety of your varicose veins see which treatment or treatment combination may be most effective for you. Combining treatments isn’t necessary for everyone, and you can also garner excellent results whether treatments are performed in one session or over time. If you have spider veins, you may want to ask the surgeon about possibly adding sclerotherapy to the mix for a one-two-three punch that handles all your vein treatment needs.
You may be a candidate for EVLT and/or Microphlebectomy is your varicose veins are large, protruding or unsightly. Other signs include:
- A varicose vein has become red, swollen, tender, or warm to the touch.
- The skin over your varicose veins has changes in texture or color.
- A varicose vein has started bleeding.
- You are having symptoms like pain, aching, cramping, tired legs, heaviness, and sores.
- Conservative management like losing weight, exercising, and wearing compression stockings hasn’t worked.
First, we recommend you arrange to have someone drive you home because you may have pain and numbness in the legs after the procedure. Pain is usually mild, no more than moderate, and you can use over-the-counter or prescribed pain medications as recommended by your surgeon. Avoid exposure to the sun during the two weeks following the procedure. Afterward, you should wear high-SPF sunscreens with ingredients that block both ultraviolet-A rays and ultraviolet-B rays in the sun light. You will also have to wear compression stockings for at least 24 hours after surgery. Your doctor will give you precise aftercare instructions in the preparation leading up to your procedure.
When can I shower after EVLT and/or Phlebectomy?
At the end of the first 36-48 hours, you may shower. Do not remove steri-strips; they will fall off gradually. Do not scrub over steri-strips when showering. After showering, pat the steri-strips areas dry with a clean towel.
How long does the Phlebectomy procedure take?
One hour. Some patients bring an iPod or reading material or even internet shop to keep themselves occupied during the procedure!
What about taking pain medications before the procedure?
Taking anti-inflammatory medications prior to a procedure has been found to decrease post-procedural pain and discomfort in other surgical procedures. Be sure to discuss this in advance and also tell your doctor any medications you may be taking, including aspirin, over the counter vitamins, and especially blood thinners.
Does everyone need Phlebectomy after EVLT?
No. Only those patients who have bumpy veins that ‘stick out’ on the skin require phlebectomy.
How soon after EVLT will you perform the Phlebectomy?
Usually within a few short days after EVLT, so that everything on your leg is completed within a week, if possible, even if more than one phlebectomy session is required.
Does Phlebectomy procedure hurt?
Before the vein removal starts, the skin and subcutaneous tissue over the vein will get a local anesthetic infusion, so beyond the pin prick for the anesthesia, the removal of the vein itself does not hurt.
Do they come back?
The vein that is removed will not come back, but there is always a chance that other veins might appear on the skin over time. However, there are certain exercises and steps you can take that reduce your chances of getting new varicose and spider veins. Ask your surgeon what you can do to help prevent future varicose veins.