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When is ambulatory phlebectomy a good treatment for varicose veins?

This question was asked in Acequia, Idaho and has 8 answer(s) as of 08/13/2013.
What about injections under the ultrasound? Which is better, ambulatory phlebectomy or injections? Ambulatory phlebectomy looks like it would cause a lot of scarring. Concerned and confused.


Doctors Answers (8)

The choice of ambulatory phlebectomy to physically remove the bulging segment of varicose vein and ultrasound guided injection of liquid or foam sclerosant depends on the diameter of the vein and how close it is to the surface of the skin, which will effect the amount of trapped blood following sclerotherapy which can produce sore bumps that need draining and can stain the skin brown from iron deposits. I prefer a micro-plebectomy using 1mm punctures that do not scar and are typically not visible after 30 days for large prominent varicose veins that are easily visible just below the skin. The older methods of stab-phlebectomy did produce scars that were about 1 inch long and is generally considered to be an obsolete technique along with vein stripping for varicose veins. In areas where the vein is well below the surface and not easily visible without an ultrasound, then sclerotherapy is an option for treating branch varicose veins. The main trunk of this vein problem may still be functioning adequately and not need treatment (as determined by ultrasound exam), but if treatment of the Greater Saphenous Vein (GSV) or Small Saphenous Vein (SSV) is needed, then the best treatment is with endovenous ablation using either RF or laser catheters to deliver energy directly inside of the vein to permanently close the vein with nearly 100% effectiveness and is an office based procedure.

Both are appropriate for treating bulging varicose veins. The nice thing about a phlebectomy is that the veins are gone immediately with some bruising at first. I perform phlebectomies through tiny micro punctures that leaves minimal to no scarring. Injections with or without foam and with or without ultrasound guidance work well but do cause the veins to because hard and bumpy at first, but the veins then gradually fade away. The injections can cause some staining of the skin as well.

Injection with sclero can close veins but it may not be able to remove the "rope like" veins. The only way to remove these veins is by phlebectomy. This procedure should not cause scaring because we use tiny punctures.

An ambulatory phlebectomy or microphlebectomy is a good treatment option for large ropey varicose veins. There are several small incisions made to remove the veins. The number depends on how extensive the vein complex is. If the same vein complex is treated by sclerotherapy / injection, one does not have the small incisions or scars. However, the time for the veins to resolve may take many months and there is a change of brown staining.

A complete venous evaluation will be required for me to answer this. Modern "micro-Phlebectomy " should not leave much of a scar at all. Ultrasound Guided Sclerotherapy can be utilized in many cases, but not in all cases.

Ambulatory phlebectomy is an excellent choice for larger varicosities. The phlebectomy will physically remove the vein and should cause no visible scarring. I make a 1 mm incision for phlebectomies and when they heal it leaving no visible scar. Patients typically have little to no pain after phlebectomies. Sclerotherapy injection work well for smaller vessels. If larger vessels are injected, they will take a long time to resolve, may need multiple treatments, and could leave a brown stain on your skin that may take months to go away. I would use the size of the vessels to be treated as a guide as to what is the best treatment for you.

Ambulatory phlebectomy has excellent functional and cosmetic results when varicose veins are large and very superficial. There's minimal scarring and no hyperpigmentation which frequently occurs with echosclerotherapy.

"ASP" works best for the larger varicose veins, where there is significant reflux and high venous pressure. The incisions in this practice tend to be 3-6 mm in length and are cosmetically very acceptable to all our patients. Injection is best for the smaller veins that have a much lower venous pressure and are more likely to stay closed.

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