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Services and Treatments Endovenous Laser Therapy (EVLT) | Injection Sclerotherapy | Microphlebectomies | Upper Endoscopy Colonoscopy | Vasectomies | Spider and Varicose Veins | Breast Care | Support Stockings | Other Office Surgeries Microphlebectomies Microphlebectomy is a minor surgical procedure which allows for the removal of large surface varicosities through very small incisions, which do not require sutures. The procedure is normally done in the office using a local anesthetic and normally takes less than one hour. There is very little discomfort with the procedure, and very little “down time” during your recovery. Most people who work can go back to work the day following the procedure, although many patients take the day off just to be sure they are fully recovered before returning to work. After cleansing and anesthetizing the skin, minute skin incisions are made with an instrument that limits the size of the micro-incision to 1.5-2.0mm. Another instrument is inserted under the surface of the skin to extract a length of the varicose vein through this micro-incision. With this procedure, a support stocking is worn over a compression bandage for the first 48 hours. After this, a support stocking is worn for another two weeks. The compression bandage and support stocking minimizes swelling and discomfort and allows for proper healing.
The basic steps in the Microphlebectomy procedure are as follows:
The Benefits- A very simple procedure - Performed under local anesthetic in the doctor’s office - Cost effective. It does not incur any charges from the hospital or an anesthesiologist. - Minimally invasive, so minimal risk of scarring or postoperative infection - Less than one hour treatment time - Rapid recovery with reduced postoperative pain - Normal activities can be resumed immediately - Excellent clinical and cosmetic results The Risks As with any invasive procedure, there are potential complications, but the risks of serious complications from microphlebectomies are extremely low. Over 95% of our patients who have undergone this procedure have had none of the following problems. Even though the procedure is extremely safe, the following potential risks do exist: -Unexpected tenderness and soreness. If you have more than the average amount of bruising, swelling or inflammation, you can experience temporary tenderness and soreness that may last longer than the average 1-3 days. All of these problems are temporary and resolve completely given enough time. -Nerve irritation. Occasionally, nerves that are adjacent to the extracted vein can be irritated by the surgery. This can lead to a small area of numbness or an area that just doesn’t “feel right” where the sensation in your skin is mildly altered. Although some mild irritation of surrounding nerves happens in about 5% of patients, it is usually mild and resolves completely given enough time. -Failure to completely remove all of the desired varicose veins at the time of the procedure. Occasionally, a small branch of the varicose vein may be missed. If this happens, it is usually best treated by additional microphlebectomies or sclerotherapy. -Hemosiderin staining. In about 1% of patients, they will get a mild brownish discoloration of the skin in the area to be treated. This is due to the break-down of the hemoglobin molecule in the surrounding tissues. If this occurs, it usually fades away, but it can sometimes take 18 to 24 months. This complication can occur following any type of vein treatment, but it is most common following sclerotherapy of larger veins, especially when saline is used as the sclerosant. -Infection at a micro-incision site. Rarely, a mild superficial infection can develop at a micro-insertion site. This is usually just a minor set-back which slows down the healing of the micro-incision and does not lead to any more serious consequences. -Bruising. This happens to some degree in 100% of the cases. It is usually mild and small. It is always self limited. Typically, the bruising that does occur is painless. -Deep Venous Thrombosis. I mention this here for the purposes of completeness only. Although this complication has been reported in the medical literature following microphlebectomies, it is an extremely rare complication, having only been reported once following a procedure that is done hundreds of thousands of times per year. Dr. Cox has personally never seen this complication following a microphlebectomy procedure. The reader should be aware that this complication can occur with any type of vein treatment, including sclerotherapy, laser treatment, surgery, or even bed rest. The best way to prevent this rare complication is to wear your compression bandage or support hose and to walk immediately after the procedure. Aftercare After the vein is removed, the leg is wrapped with a compression bandage followed by support stockings. You can get up and walk comfortably and normally. After two days, you can remove all dressings and bathe or shower. The compression stocking should be worn during the day for the first two weeks. Most patients are not at all uncomfortable and need no pain medication, although Dr. Cox can give you a prescription for some mild pain medication in case you need it. You may stand and walk and return to work on the day following surgery, unless your work involves prolonged stationary standing or sitting. Strenuous activity is limited for two weeks. The results of the procedure have been excellent both from a cosmetic and patient satisfaction point of view. FAQs How does the procedure actually work? Skin incisions or needle punctures as small as 1 mm are used to extract veins with a phlebectomy instrument. An instrument is inserted into a micro-incision in the leg. A section of the vein is gently grasped and then removed through the incision. With this procedure, a compression stocking is worn for two weeks. This minimizes swelling and discomfort and allows for proper healing. What is the recovery and post-operative care like after microphlebectomy? Patients can go back to work and normal activity after 24 hours. A support stocking is worn for two weeks. What are the side effects of microphlebectomy? Compared to traditional vein stripping, this technique has virtually no scarring or side effects. Also, because it is an in-office, minimally invasive procedure performed under local anesthesia, patients have very little “down time” and virtually no problems after the procedure. Skin pigmentation at the site of the varicose vein can occur and is usually temporary. What are the side effects of microphlebectomy? How successful are microphlebectomies? Long-term eradication of varicose vein signs and symptoms after microphlebectomies are excellent when the procedure is performed for the appropriate indications by a qualified practitioner. Are microphlebectomies covered by my insurance? All insurance companies determine coverage for any treatment based on medical necessity. We have found that if your varicose veins meet your insurance company’s criteria for medical necessity, then your insurance company will provide insurance benefits for microphlebectomies. It is always a good idea however, to get written authorization from your insurance company before proceeding with any elective procedure, and Steven D. Cox MD Inc. will do this for you. If your varicose veins are best treated by microphlebectomies, then we will send a letter to your insurance company along with supporting documentation, asking for pre-authorization to perform the procedure. Once medical necessity is determined by your insurance company, it is your responsibility to know if your plan covers varicose veins. We can discuss your insurance coverage further at the time of consultation. 
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