EVLT and stab phlebectomy on left leg?

It’s important to distinguish between varicose veins and spider veins when choosing between laser therapy, sclerotherapy, and vein surgery. With two board certified vein specialists, our center uses a combination of visual examination, functional flow measurements, ultrasound, transillumination, and infrared light to map out vein networks prior to therapy. Lasers can be used to treat deep varicose vein insufficiency, vein perforators, and varicose veins. Sclerotherapy is ideal for spider veins and reticular veins. Whereas surgery is reserved for severely incompetent varicose vein segments.


Best,
Dr. Karamanoukian
Realself100 Surgeon

Ambulatory phlebectomy or microphlebectomy is a minimally invasive procedure to treat superficial varicose veins under the skin. It is used to complement saphenous vein reflux treatments with thermal energy such as EVLT (endovenous laser treatment) or RF (radiofrequency). Ambulatory phlebectomy is effective and also save on the remaining varicose veins after treating reflux. It causes minimal or no scarring. Incisions that are necessary to perform the procedure are very small and only local anesthetic is needed for the comfort of the patient. On the other hand, guided sclerotherapy treats feeder veins that are harder to see, and therefore ultrasound guidance is needed to deliver the medication to the correct area. The medication that is used is Asclera (polidocanol). This medication makes the vein smaller and eventually disappear. Spider veins can be also treated with sclerotherapy without the need of ultrasound guidance. For all of these procedures patients are advise to wear compression stockings after for optimal results. Your physician can help you make informed health care decision on the best treatment or combination of treatments that is best for you according to your specific goals. 

It sounds like you are under the care of someone who knows what they are doing. Microphlebectomy is also called stab phlebectomy or ambulatory phlebectomy; all these terms mean essentially the same thing. The doctor uses a local anesthetic which numbs the area and controls bleeding and then makes a series of small (usually 1-2 mm) incisions in the skin in order to physically remove the vein. In selected parts of the leg, and with certain vein types, this means quick results and rapid healing. Sclerotherapy can also be used for most of these, but typically requires longer healing and may result in discoloration of the skin.

What your doctor told you was correct.  Below the knee the saphenous nerve is close to the vein and can be injured from the heat of the laser.  However this can be avoided by generous use of tumescent anesthesia or by using a different form of closure procedure such as Clarivein or Varithena.  Varicose veins can be treated by either sclerotherapy (injection of a solution to dissolve the vein) or removal through very tiny incisions.  I prefer the phlebectomies.

There are EVLT lasers that are safe to ablate the saphenous veins below knee. With adequate administration of tumescent anesthesia, saphenous nerve injury can be avoided. We perform such procedures daily in our practice. Contact me on the link below for more information. H Karamanoukian MD FACS RVT RPVI RPhScertified vein specialist with ABVLM credentials