Varicose Vein Questions

Stab Phlebectomy
What is a stab phlebectomy?
But don’t I NEED those veins?
What if I need bypass surgery later?
Does it HURT?
What about scarring?
What is the “down” time for a stab phlebectomy?

Endovenous Laser Treatment

What is ELT?
ELT stands for Endovenous Laser Treatment. This is an exciting new technique that is replacing traditional vein stripping in practices across the nation. It is predominantly used to treat varicose veins. ELT involves threading a laser fiber into the diseased vein and firing it along the length of the vein. This effectively “closes” the vein, preventing blood flow and the increased pressure associated with varicosities. Local anesthetic (numbing medication) is used, and all ELT procedures are done here at our facility.
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Is the procedure painful?
As mentioned, the procedure is carried out under local anesthetic. A dilute solution called “tumescent” is used. You will feel the prick of the needle used to inject the anesthetic, but you will be completely numb for the remaining part of the procedure. Many people describe a feeling of pressure as the anesthetic is injected into the tissue, but this only lasts for a few seconds until the medication takes effect. Since the entire area around the vein is numb, you will feel nothing as the laser is fired. After the procedure, the anesthetic lasts a few hours. We then recommend that you take the prescription-strength ibuprofen we provide at regular intervals for at least 3-4 days. This decreases inflammation and pain. After this, you may take extra-strength Tylenol or Motrin. Most people find the pain-relief we recommend to be more than sufficient. Very rarely will patients require a stronger pain-reliever, but if they do, we are happy to prescribe something.
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How effective is the ELT treatment?
The ELT procedure is about 98% effective in closing the vein. Obviously, when a vein is stripped, it is impossible for it to return as it is completely removed. However, with traditional stripping, there is a greater chance of new veins growing. So even though the original vein is gone, new ones may recur which require treatment in the future. With ELT, new veins are unlikely to grow thus greatly decreasing the likelihood that you will require additional treatment in the future. In short, ELT is considered more effective at treating varicosities than traditional stripping.
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Can all varicose veins be treated with ELT?
No, unfortunately. If the vein is greater than 2cm in diameter, then the laser will not be effective. Also, if the vein is very tortuous or “winding”, then it may be impossible to insert the laser fiber far enough into the vein to be helpful. If the vein is located very close to the surface, ELT is not appropriate. In these cases, an alternative treatment will be recommended by the surgeon.
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Stab Phlebectomy

What is a stab phlebectomy?
A “stab” phlebectomy, also called micro-phlebectomy, is used to treat certain types of varicose veins. The word “phlebectomy” literally means removing the vein. The day of the procedure, the doctor or nurse will mark your leg where the veins bulge out. Then, a special local anesthetic (numbing medication) called “tumescent” is injected into the area surrounding your vein. The doctor will make tiny incisions or “stabs” of about 2-3mm – the size of a ball-point pen tip – and use a crochet-type hook to “grab” the vein and remove it. This interrupts the vein, causes any remaining portions of the vein to “clot off”, and gets rid of those unsightly bulgy areas!
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But don’t I NEED those veins?! What if I need bypass surgery later?
If the veins were functioning normally, then yes! But since the veins are dilated and not working properly, they are doing more harm than good. Heart doctors do not use varicose veins for bypass surgery for this very reason!
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Does it HURT?
Most patients say that the procedure does not hurt at all. You will feel the pin prick of the needle as we inject the anesthetic, but then the area is instantly numb. You will not feel any of the “stabs”. You will not feel pain from the veins being removed. We will give you some prescription-strength ibuprofen to help you for the first day or two, but the vast majority of patients require only extra-strength Tylenol or Motrin to keep them comfortable. Rarely will patients require a stronger pain-killer post-operatively.
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What about scarring?
The incisions are so tiny, that any scarring is not seen. Most patients can barely see their incisions four to six weeks following surgery. Compared to the “railroad tracks” associated with traditional vein stripping, the scars are practically non-existent.
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What is the “down” time for a stab phlebectomy?
The “down” time for this procedure is negligible. You will need to take it easy for the first 48 hours, but walking is encouraged to promote healing - you will walk out of the office! After the first two days, normal activities are resumed. Only strenuous exercise is discouraged for the first week to ten days, as are swimming and hot tubs. After that, it is business as usual!
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The information on this web site is for informational purposes only.
It does not replace the advice of your physician.