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How much scarring does ambulatory phlebectomy cause?

I've heard that the ambulatory phlebectomy procedure can end up leaving scars. How much scarring does it cause? Are the scars highly visible? Is it worth it to remove my varicose veins if I'm going to end up with scars?


Doctors Answers (6)

Phlebectomy is the physical removal of veins, most often done for prominent leg veins. The oldest and now obsolete method was vein stripping which removed the vein with a long incision alongside of the vein, producing a long scar, required suturing of the skin, and a long recovery time. This procedure is now only done to harvest a normal Greater Saphenous Vein used in heart bypass surgery. A number of better techniques evolved including inversion stripping, stab phlebectomy and others which produced a shorter scar and was less traumatic. These were named ambulatory phlebectomies because you were able to walk (ambulate) after the treatment. The current method is the micro-phlebectomy, where the superficial vein is anesthetized (with a tumescent anesthetic) and remove in an office setting though several very small (1mm) incisions placed along side of the vein, which is then removed painlessly. No sutures are required with this minimally invasive procedure and the incision sites are typically not visible at a one-month follow-up. Surgical punctures or incisions that are 1 mm or less usually heal rapidly without leaving any mark that is easy to find.

With an experienced board certified surgeon who specializes in treating veins, there is little or no scarring. These veins are removed through tiny punctures which do not require stitches. These should be done in the office under local anaesthesia - not in a hospital or surgery center. If you have large, bulging veins, ensure a full evaluation to rule out underlying saphenous reflux.

Properly performed phlebectomy now usually leaves a very narrow scar measuring 2 to 3 mm long. Phlebectomy may range from one to scores of tiny incisions. After six months, most of the scars look like fine white lines in the skin. If you need phlebectomy, it is better to go ahead and treat the veins before they get worse rather than worrying about tiny scars. An alternative to most phlebectomies is foam sclerotherapy, also known as endovenous chemical ablation, which is performed with needle sticks into the veins.

The scars are barely visible in most cases, and patients consider the cosmetic result to be very good to excellent.

When we do ambulatory phlebectomies , we use either an 11 blade knife or 18 gauge needle to make the hole in the leg to pull the vein through. Usually these incisions are very tiny and heal without much scarring if any scarring at all. We do the procedure in the office under local anesthetic.

I seldom use this technique. I mostly use sclerotherapy. There will be very tiny scars if done appropriately.

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