As you age, or in response to disease or injury, the veins in your legs sometimes develop faulty valves that allow the blood traveling to your heart to leak backward into the surrounding tissue. This causes varicose veins, skin ulcerations and swelling, especially in your ankles. These veins can be unsightly and painful when you’re standing.

Today’s modern medicine has evolved to make this a successful surgical procedure for removing varicose veins. While many nonsurgical procedures exist and should be considered first, phlebectomy has been proven effective, especially when performed by an experienced vein doctor. It’s primarily performed on larger, superficial veins, so it is not useful in every case.

Risk Factors for Venous Insufficiency and Varicose Veins

Anyone can develop issues with venous insufficiency, but some individuals have a greater chance of the troubling symptoms and complications that require treatment. These include:

• Older individuals who have lost the elasticity in their veins
• A family history of venous insufficiency
• History of blood clots in your legs
• Obesity
• Being female, due to changing progesterone levels
• Pregnancy
• Being tall
• Sitting or standing for long periods of time
• Smoking
• Cancer
• Muscle weakness, trauma or injury

Who Should Consider Phlebectomy

Also called micro-phlebectomy or stab phlebectomy, this procedure helps those who have varicose veins, whether they are symptomatic or not. The unsightliness and possible discomfort make most people good candidates. There are a few instances where the procedure is not a good fit. Possible reasons to consider other treatments include:

• You have infectious dermatitis or cellulitis in the surrounding areas. Any surgical procedure increases the chance that an infection will spread.
• You have severe peripheral edema — or swelling of ankles and feet.
• You are already seriously ill, since this invasive procedure may compound your illness.
• You take any kind of anti-coagulant, such as warfarin, Coumadin, Plavix, Pradaxa or others.
• You have a bleeding disorder of some kind.
• You cannot walk or wear compression hose for some reason.

Phlebectomy Procedure

After performing a physical exam and taking an extensive medical history, your doctor proceeds with the phlebectomy procedure in the Midtown Manhattan or Upper East Side office:

1. While you stand, your doctor marks the troublesome varicose veins with a felt-tip marker.
2. You lie down, and the treatment area over the veins is sterilized.
3. Your doctor injects local anesthetic to numb the area around the veins.
4. The anesthetic also loosens the varicose veins from the adjacent tissue and compresses surrounding capillaries to reduce any post-op bleeding.
5. Tiny incisions or needle pokes are made over the veins. These incisions are so small, stitches are not needed afterward.
6. Your doctor pulls each vein out in sections using special tools.
7. After the targeted veins are removed, your vein specialist places absorbent bandages over the incisions and wraps your leg in a compression bandage.

You have to wear the compression bandage for 24 to 48 hours. Then your doctor removes it and checks the incisions. Most people return to work and normal activities within a day or two, but avoid prolonged periods of standing, heavy lifting and aerobic exercise involving your legs for the first few weeks.

Your vein specialist recommends wearing compression hose for one to three weeks to keep new varicose veins from forming. By walking during recovery, you work the surrounding muscles. Contracting those muscles clears any excess fluid and prevents blood clots.

Risks of a Phlebectomy Procedure

This is a minimally invasive procedure; if you are otherwise healthy, risks are low. As with any type of medical procedure, though, there is always the possibility of some risks, such as:

• Swelling and inflammation at the site of the incisions
• Swelling of your ankles and feet, if excess fluid is not absorbed
• Bleeding at the incision site
• Infection
• Bruising
• Reddish or purplish splotches that resemble a bruise
• Hyperpigmentation that usually resolves itself over time
• Blistering at the incision site due to a reaction to the anesthetic
• Skin numbness if adjoining nerves are affected by the anesthesia or procedure
• Allergic reaction to the anesthetic, the bandages or the compression hose
• Rarely, a chance that your varicose veins return

Stab phlebectomy procedures provide a minimally-invasive and relatively safe method for reducing the troublesome symptoms of varicose veins and venous insufficiency. Following the treatment protocols your doctor recommends eases your discomfort and allows you to return to a more active lifestyle after your recovery