What is Microphlebectomy & When is it a Good Treatment Option for Varicose Veins?

Complex Varicose Vein Anatomy

In many cases, the anatomy of the diseased vein can deviate from this consistent profile. A patient may present with a long, bulging, tortuous vein that, from the outside, looks like a long sequence of ripples on the surface of the leg. Given this more complex profile, the endovascular vein specialist is faced with a couple of considerations – the first of which is that a segmental catheter-based approach is not ideal for the reasons described above. Fortunately, there are other tools and techniques at our disposal that may fit this need – namely, foam sclerotherapy and microphlebectomy. The second consideration is the specific anatomical profile of the culprit vein, as this determines which of these approaches makes the most sense.

Sclerotherapy describes the injection of a sclerosant agent into the veins, which damages the internal lining of the vein and causes blood to clot within the vein. When injected in liquid form, much of the sclerosant becomes diluted by the blood in large veins, which is why foam sclerotherapy is used. In the instance of foam sclerotherapy, the sclerotherapy solution is mixed with gas to create a foam that completely fills the vein when injected.²

Because of its injection delivery mechanism, foam sclerotherapy is a particularly good option if the target vein is short (requiring less than 10cc of the foam) and lies at a significant depth beneath the skin. In the opposite case of a long vein and/or a vein that bulges out from the skin, sclerotherapy may unnecessarily increase the patient’s risk of phlebitis. In most cases, phlebitis is easily managed with over-the-counter non-steroidal anti-inflammatory medication, but we’d rather eliminate the risk of any unnecessary complications altogether.

Excellent Results in the Right Patients

At the beginning of this article, we show firsthand that microphlebectomy can yield excellent results in the right patients. To corroborate our anecdotal experience, we dug into the evidence to see how microphlebectomy performs at scale. The most recent randomized controlled trial looking at microphlebectomy as a stand-alone therapy was published in 2004. Aremu and colleagues performed conventional microphlebectomy procedures in 100 legs with varicosities below and above the knee and observed healing at 6 weeks, 26 weeks, and 52 weeks following the procedure. Based on satisfaction scores, about 90% of individuals were ‘very satisfied’ with treatment at all time points, and over 85% of individuals responded “yes” when asked, “Would you recommend this operation to a friend?” ⁷ These are compelling findings and continue to support the use of microphlebectomy in the treatment of varicose veins.

In most cases, we’re able to address large varicose veins with minimally invasive catheter-based techniques. But for more complex varicosities and small branching veins, microphlebectomy is an important technique in our repertoire to attain symptomatic relief and cosmetic resolution.

About the Author

Dr. Dev Batra, M.D. is a vein specialist and founding partner of Texas Vascular Institute. Holding board certifications in radiology and vascular & interventional radiology, he is well-versed in vein issues and has been voted one of D-Magazine’s best doctors in Dallas for three years running.

This blog post was written with research and editorial assistance from OnChart™.

References

[1] Joh, J. H., Kim, W.-S., Jung, I. M., Park, K.-H., Lee, T., Kang, J. M., & Consensus Working Group. (2014). Consensus for the Treatment of Varicose Vein with Radiofrequency Ablation. Vascular Specialist International, 30(4), 105–12.

[2] Perrin, M. (2012). History of venous surgery (3). Phlebolymphology, 19(2), 59–67.

[3] Muller R. Traitement des varices par phlébectomie ambulatoire. Phlébologie 1966;19:277-9

[4] Hager, E. S., Ozvath, K. J., & Dillavou, E. D. (2017). Evidence summary of combined saphenous ablation and treatment of varicosities versus staged phlebectomy. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 5(1), 134–137.

[5] El-Sheikha, J., Nandhra, S., Carradice, D., Wallace, T., Samuel, N., Smith, G. E., & Chetter, I. C. (2014). Clinical outcomes and quality of life 5 years after a randomized trial of concomitant or sequential phlebectomy following endovenous laser ablation for varicose veins. British Journal of Surgery, 101(9), 1093–1097.

[6] Lane, T. R. A., Kelleher, D., Shepherd, A. C., Franklin, I. J., & Davies, A. H. (2015). Ambulatory Varicosity avUlsion Later or Synchronized (AVULS). Annals of Surgery, 261(4), 654–661.

[7] Aremu M, Mahendran B, Butcher W, et al. Prospective randomized controlled trial: conventional versus powered phlebectomy. J Vasc Surg. 2004;39:88-94.

Medical Disclaimer

The Materials available in the Texas Vascular Institute blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.