Phlebectomy is not a first-line treatment for all varicose veins.
The procedure is usually performed on large, ropey veins that likely won’t respond to sclerotherapy, a noninvasive treatment that works by injecting an irritating chemical into a vein, causing it to collapse, explains Dr. Ramandeep Sidhu, a vascular surgeon in Seattle and medical director of Vein, Vascular & Aesthetic Associates (VIVAA). “In my practice, if the veins are too big and we know sclerotherapy either wouldn’t work or would require too many sessions, then stab phlebectomy would be ideal.”
The term varicose means abnormally swollen or dilated, and superficial veins become this way when the blood pressure inside increases.
Veins have one-way valves inside of them that open and close to keep blood flowing toward the heart. If the valves become weakened or damaged, some of the blood flows in the wrong direction (towards the feet) and pools in the veins there. The backflow of blood is known as venous reflux or venous insufficiency. Left untreated, this pooling puts excess pressure on the veins and leads to their expansion and the appearance of bulging veins, along with symptoms associated with them.
Your provider will determine if venous reflux is the root cause of your varicose veins via duplex ultrasound. This technology shows a detailed picture of the venous network of your legs, helping your provider detect the source of the problem and determine the type of treatment that best suits your condition.
For instance, malfunctioning valves in the great saphenous vein (GSV), the long vein that runs from the ankle bone along the inside of the leg, are a common culprit. The high pressure and blood flow reversal in this vein can damage the normally small tributary veins near the skin's surface and cause them to bulge. Without first shutting down this source of reflux, treatments like this one are likely to fail and result in new varicose veins.
Moderately bulging veins can sometimes occur without any underlying venous reflux. In these cases, your vein doctor can treat these veins alone with procedures like a microphlebectomy.
Sometimes, phlebectomy is performed after a laser or radiofrequency treatment (like radiofrequency ablation) is used to shut down the GSV. While treating the GSV can provide a dramatic improvement, sclerotherapy or phlebectomy is often needed to fully treat other damaged veins.
