Microphlebectomy Vein Removal Los Angeles
The phlebectomy hook, similar in shape to a crochet hook, is the most important instrument for microphlebectomy; also called ambulatory microphlebectomy, or simply phlebectomy. During microphlebectomy, the targeted vein is gripped with a hook and then hooked and pulled out through a tiny incision right above the vein. Galen of Pergamon (129-199 AD), a Greek surgeon and philosopher, is believed to be the first to use a hook to remove varicose veins through several incisions. But it was only in the mid-1950’s that a Swiss dermatologist named Robert Muller experimented with this technique and presented it during the annual meeting of the French Phlebology Society in 1966. Microphlebectomy was first introduced in the United States during the 1980’s. Since then many vein doctors have acquired the technique and are practicing it whenever convenient because over the years, microphlebectomy has proven to be a simple, elegant, and safe vein treatment modality.
During the past couple of decades, microphlebectomy has been successfully used to treat varicose veins of all sizes at almost all parts of the body with the exception of saphenofemoral or saphenopopliteal junctions. Accordingly, microphlebectomy is usually performed for removing the very superficial veins that remain after treating saphenous vein reflux with surgery, or endovenous thermal ablation techniques, such as EVLT or Venefit. Microphlebectomy is also the treatment of choice for the veins that appear on the dorsal aspect of the foot and around the ankles because venous surgery and Sclerotherapy are only suitable for special cases in that region.
Despite the fact that microphlebectomy is a very time consuming procedure, it is widely used in many countries because capital investment is the least with this technique, results are lasting, and the cosmetic outcome is excellent, especially for the very superficial varicose veins. As with other vein treatment techniques, ambulatory microphlebectomy is most effective when the sources of reflux are identified and eliminated before removing any superficial vein.
The Microphlebectomy Procedure
Microphlebectomy is performed under local anesthesia in an out-patient office setting. Prior to starting the procedure, the patient is inspected in standing position and the targeted varicose vein is traced on the skin with an indelible pen. After the patient lies down, local anesthesia is injected into the skin all along the varicose vein, the area is disinfected, and the hook is inserted into the very tiny puncture made just above the vein with a 1 mm dermal punch or even a needle depending on the size of the vein to be removed. During vein extraction, the varicose veins is hooked, and gently pulled out with the aid of a clamp until the vein breaks. The incision is then covered with a mildly absorbing dressing and a new incision is made 2 to 4 inches away from the previous one. Stitches are not needed. Finally, the treated leg is bandaged and compression stocking is placed over the bandage. When the procedure is over, the patient is asked to walk around in the office before leaving, wear compression stockings for at least five days and avoid direct sun exposure of the legs for a couple of weeks to minimize scarring. The Patient will be able to resume regular activities immediately after the procedure. The cosmetic outcome of the procedure is excellent.
Complications of Microphlebectomy
The incidence of complications following microphlebectomy is low. Scars at the incision sites would hardly be noticeable after a few months, except when the vein removed has required relatively large incision and the patient has exposed the area to the sun in the first couple of weeks following the procedure. Wound necrosis, unsightly scars, and infection do not occur, but occurrence of hematomas is common. Rare complications of microphlebectomy include the appearance of spider veins near the sites of incisions, pigmentation, blister formation, and temporary or permanent nerve damage.