What is a phlebectomy?

A phlebectomy is the surgical removal of varicose veins that have become unsightly or uncomfortable. Your doctor may recommend a phlebectomy to treat symptoms of varicose veins, such as leg pain and heaviness. A phlebectomy can also help prevent related problems, such as skin sores, leg swelling, bleeding, and blood clots in the legs. A phlebectomy can also improve your appearance.

Phlebectomy is a surgery with risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a phlebectomy.

Types of phlebectomy

The types of phlebectomy, or vein removal, procedures include:

  • Ambulatory phlebectomy (also called micro-incision phlebectomy, hook phlebectomy, stab avulsion phlebectomy, and microphlebectomy) involves removing portions of varicose veins through small incisions using a hook. It is usually performed in a doctor’s office using a local anesthetic.
  • Transilluminated powered phlebectomy (TIPP) removes portions of varicose veins using tools that are inserted into the skin near the veins. They include a lighted tool that gives the doctor a good view of the vein’s location, and a tool that breaks up the vein and suctions it out of the leg. 

This type of phlebectomy is usually performed using general or regional anesthesia in a hospital or surgical center. It might require fewer incisions and you may have a shorter recovery time than ambulatory phlebectomy.

Why is a phlebectomy performed? 

Your doctor may recommend a phlebectomy to treat varicose veins near the surface of the skin. Your doctor may recommend a phlebectomy if your varicose veins are large, protruding, unsightly, uncomfortable, or put you at risk for more serious problems. This includes skin sores, leg swelling, bleeding, and blood clots in the legs. 

Veins carry the blood from your body back to your heart. Valves in veins help keep blood flowing back to your heart. When valves become damaged or weakened, blood can pool in your veins causing them to swell and weaken. This results in varicose veins. Varicose veins can look blue, twisted and bulging, and feel uncomfortable. Varicose veins most often occur in the thighs and calves, most often in women.

Your doctor may only consider a phlebectomy for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a phlebectomy. 

Who performs a phlebectomy?

The following specialists perform a phlebectomy: 

  • Vascular surgeons specialize in the surgical treatment of diseases and conditions of the lymphatic system and blood vessels outside the heart and brain.
  • Phlebologists specialize in diagnosing and treating vein conditions including varicose veins, spider veins, chronic venous insufficiency, and vein birth defects.
  • Dermatologists specialize in the medical and surgical care of the skin, hair and nails.

How is a phlebectomy performed?

Your phlebectomy will be performed in a doctor’s office, outpatient setting, or hospital. Your doctor will likely use local anesthesia. Local anesthesia involves injecting an anesthetic in the skin and tissues around the surgical area to numb them. Other types of anesthesia that may be used include:

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. 
  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.  

What to expect the day of your phlebectomy

Phlebectomy generally takes 30 minutes to an hour and includes these steps:

  • You will remove your clothing and dress in a patient gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. The surgical team will respect your privacy and give you blankets for modesty and warmth.
  • While you stand up, your doctor will mark the veins to be removed with a pen.
  • You will lie on a table in a position to allow the best access to the varicose vein(s). 
  • Your doctor will insert a needle and inject local anesthetic into the area near the vein to be removed. You will be awake and alert during the procedure. Sometimes an anesthesiologist or nurse anesthetist will give you a spinal nerve block or general anesthesia for the surgery. 
  • For an ambulatory phlebectomy, your doctor will make a small nick in the skin, and use a hook to pull out the vein. Your doctor will repeat this for other veins as needed.
  • For a transilluminated powered phlebectomy (TIPP), your doctor will make a small incision and insert a lighted instrument near your vein to make it easier to see. Your doctor will then insert another instrument under your skin to break up the vein and suction out its fragments. This process is repeated for other veins as needed.
  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing normally, and your vital signs are stable.