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What is the difference between sclerotherapy and microphlebectomy?

This question was asked in Shallotte, North Carolina and has 10 answer(s) as of 06/05/2013.
I have varicose veins on my legs and I have been looking into possible treatments. What exactly is the difference between sclerotherapy and microphlebectomy? Which is better? Should I be looking into laser treatments instead?


Doctors Answers (10)

Sclerotherapy is the treatment of medium to small veins by injection of an FDA approved chemical sclerosant into the vein (usually a medical grade detergent) which destroys the inner vein lining and helps to close the vein. If the vein remains closed for about a month, it will remain closed and will then be be slowly reabsorbed by the body. If the vein reopens after treatment, usually due to not wearing the compression hose or exposure to heat on the legs (vasodilation as seen with a Jucuzzi or sauna), then the veins will be repaired and relined with endothelial cells so will not disappear without additional treatment. A microphlebectomy is the actual removal of a segment of large bulging vein near the surface of the skin using local anesthetics and through several 1mm incisions that do not need to be closed with suture and are usually not visible at 1 month following the procedure. Sclerotherapy is excellent for medium and small sized veins while the larger veins are best treated with other techniques including microphlebectomy which avoids the large pockets of trapped blood and iron staining of the skin that are often seen when trying to treat larger veins with sclerotherapy. Treatment of leg veins often uses a combination of techniques depending on the size and location of the vein. Endovascular lasers are also excellent in treating large varicose veins using fiber-optics to deliver the energy inside of the vein. The use of external conventional lasers is very limited on the legs to only small superficial veins, it is uncomfortable, incompatible with darker or tanned skin and much less effective than sclerotherapy with increased risks of side effects if not used in expert hands.

Sclerotherapy is an injection of an FDA approved medication into the varicose vein directly, or using ultrasound imaging. Phlebectomy is a surgical procedure that requires sterile surgical technique, local anesthesia, small skin incisions and removal of the varicosities using specially designed surgical instruments.

Microphlebectomy involves small incisions being made in the skin in order to allow for the removal of the varicose vein. This procedure is designed to target larger varicose veins. If it goes well, there is no scarring and recovery is fairly quick. Sometimes some of the vein remains and there is a good bit of soreness, also there can be scarring or pigmentation. Sclerotherapy involves injection of medication into the vein. The vein then hardens and is absorbed into the leg. There is also a possibility of hyperpigmentation and matting. It takes a bit longer for the vein to disappear with sclerotherapy but it is much more versatile in that you can treat veins of all sizes.

The best advice I can give you is to see a Phlebology specialist to evaluate your legs. All of the treatments that you ask about are possible treatments that you may need. Frequently we use all three of these treatments on the same patient. Please call and make an appointment for a complete evaluation. Most all insurances pay for the evaluation and treatment of these symptomatic and painful veins.

If you have had a thorough evaluation and there is no underlying saphenous reflux causing these veins, laser treatments aren't an option for you. Microphlebectomy is a very nice procedure for larger varicose veins where small "punctures" are made and the veins are removed through these tiny incisions. Stitches are rarely required and healing continues without scarring in most cases, maybe a small "freckle" at worst. Even if you do need a endovenous laser ablation for saphenous reflux, this procedure can be performed at the same setting. For small varicose veins and reticular veins (smaller veins below the surface that typically do no bulge), sclerotherapy with foamed Asclera or Sotradecol is a nice option. Typically it can take up to 3 or so treatments on average. We discourage sclerotherapy for larger varicose veins as it can entail more visits to release areas of "trapped blood" and increased chance of pigmentation over the veins while healing and more discomfort for a longer period of time.

Laser treatment for varicose veins has become the mainstay treatment in today's world. Both sclerotherapy and microphlebectomy are adjunctive, post laser procedure interventions for touch- ups and optimal cosmetic results. Microphlebectomy is the removal of small veins with a hook through a small skin incision. Sclerotherapy is the needle administration of a medical solution into a vein to close it. They both work well after a laser procedure is performed.

Sclerotherapy is the injection of a solution into spider veins or reticular veins (which are the thin bluish veins just under the skin). In most cases, large bulging veins don't respond well to sclerotherapy since the flow in them is high and the solution gets washed out. Microphlebectomy is the actual removal of the varicose vein. This is done through small punctures made right next to the vein that is being removed. This is NOT a "vein stripping " since that term is reserved for a much more invasive procedure in which the saphenous vein is removed. If spider veins are associated with leg fatigue, pain, swelling or discoloration of the skin it is very important that a simple ultrasound is done looking at the deep veins in the leg AND for reflux in the superficial venous system of the leg the Greater and Lesser Saphenous Veins. If this is not done, then the sclerotherapy will be a waste of your time and money since the venous pressure will not be treated and you will be very unhappy with the results of the sclerotherapy. Be wary of a vein office that only wants to do sclerotherapy if you have other leg symptoms, because you will need many more treatments and you still will not get the results your looking for. The key to any successful vein treatment is the reduction of venous pressure in the leg. This will not only help your symptoms but you will be very happy with the cosmetics result.

Injection sclerotherapy involves injecting a small amount of liquid into the vein causing the vein to shut down. This technique can be used to treat both large and smaller veins. However, when this technique is used to treat larger veins, the veins become hard and lumpy and stays that way for several months until they finally go away. There is also a risk of skin discoloration associated with injection sclerotherapy. Ambulatory phlbectomies is a technique where a small puncture is made next to the vein and a crochet hook-type device is used to grab the vein and removed a segment of it. Because the vein is entirely removed, lingering lumps and bumps are typically not present. There are some small marks from the sites that are used to remove the veins but typically these fade to white after a six-month period and are very difficult to appreciate. In summary, ambulatory phlbectomies is a good technique to use for larger diameter veins while injection sclerotherapy is a better technique for small veins that are localized to the skin regions.

Sclerotherapy uses injections to close veins whereas phlebectomy surgically removes them under local anesthesia. Both are excellent procedures when performed by experienced practitioners. Seek a qualified expert to learn your options.

Sclerotherapy uses a medication that is injected into the vein, causing it to collapse whereas microphlebectomy is the surgical removal of small veins. Both procedures are useful, depending on the vein itself. Lasers have not been effective in treating these types of veins in our experience.

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