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What precautions are taken during macrophlebectomy to avoid nerve damage?

I have varicose veins on my legs and I am considering treatment options. I am particularly interested in marcophlebectomy, which appears to have good results. The one concern I have, however, is that I read that there is a risk of damage to the nerves around the vein that is being treated. How common are such injuries and what precautionary measures are taken to avoid these potential risks?

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Doctors Answers (6)

Any surgical procedure can cause numbness in small areas where there is an injury to a small nerve which provides sensation to the skin. Numbness in small areas is not uncommon with mirophlebectomy, but most of the numbness usually resolves within a few months. There are several locations where a nerve to muscle can be injured during a microphlebectomy. This is a very rare event because the areas where these nerves are expected to be located are avoided. Foam sclerothrapy is a good choice for treating veins near the nerves to the muscle (motor nerves).

Small sections of varicose veins may not require complex resection under anesthesia, but can instead be removed under local anesthesia without drugs with excellent results. "Microphlebectomy" is a technique that utilizes a very small (2-4mm) incision that is used to expose the vein, which is then removed with micro surgical tools, removing relatively long segments of vein through very small incisions. Although there is sometimes a minor loss of sensation, there has not been a significant injury seem at our clinic. The procedure is performed under sterile conditions, using intense lighting and optical magnification, which minimizes the chance for technical error.

No one intentionally injures the nerves. It is just a potential hazard of the procedure.

I assume you are considering a microphlebectomy to physically remove varicose veins that are visibly bulging and close to the surface of the skin. The risk of damaging cutaneous sensory nerves and causing either a temporary or permanent area of numbness on the skin is small and related to the location where the vein being treated. There is a greater risk when treating by phlebectomy at the ankle, at the posterior and medial knee, and over the shin bone (anterior tibial) areas. Discuss this with the vein doctor doing the procedure and whether any proposed varicose veins are in any higher potential risk areas.

I am assuming you mean "micro" phlebectomy which is tiny incisions through which sections of veins are removed. Micros means small. Macrophlebectomy would be more like the old style which a large incision is made required stitches etc. An experienced surgeon is aware of where nerves are and also able to recognize veins visually. In addition experience means that the nerve won't be injured at the time or removal of the vein. However, in certain areas, such as the ankle, there are many nerves. On occasion these are "stuck" to the vein due to inflammation. When removing the vein they may stretch and cause a sharp temporary pain and possibly a little localized numbness or tingling. This is usually temporary and relieve by massage. The key is to have these procedures performed by an experienced board certified surgeon who specializes in treating varicose veins.

The more experience a doctor has, the better his technique and the less chance of nerve damage during phlebectomy. However, it is impossible to avoid all cutaneous nerves even with the best technique, which is why most people opt for sclerotherapy. Although phlebectomy gives quicker results, injections provide the same benefit at a lower cost with fewer risks, no scars, and no nerve damage.

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