Phlebectomy vs. Foam Sclerotherapy: Weighing Options for Varicose Vein Treatment

Two common approaches address varicose veins: microphlebectomy and foam sclerotherapy. Each presents distinct advantages and drawbacks for patients seeking relief from these enlarged, often unsightly veins.

Microphlebectomy involves the surgical removal of varicose veins through a series of small incisions, allowing for the physical extraction of the affected vessels. Following removal, the veins are often examined under a microscope in the pathology department for potential nerve damage.

During the procedure, veins may fragment, necessitating the use of a hook to grasp subsequent segments. Reflecting on my general surgery residency and interventional radiology fellowship, which included approximately 50 cases, I noted a surprising discrepancy between the small size of the extracted veins and their appearance on ultrasound imaging.

A significant downside of phlebectomy includes notable downtime, the potential for scarring, and compromised healing in areas subject to high tension, such as the anterior shin.

Furthermore, phlebectomy carries a risk of recurrence; many patients develop new varicose veins in different locations and near the phlebectomy site due to residual varicose veins over time.

However, a key advantage of phlebectomy is the relatively rapid visibility of results, typically within one to two months after bruising subsides and incisions heal.

In contrast, foam sclerotherapy, particularly with agents like Varithena, demonstrates high effectiveness in treating complex varicose veins. However, achieving optimal results often requires multiple sessions, potentially increasing the overall cost. The procedure itself is swift, typically lasting only two to five minutes, and allows for the treatment of multiple areas in a single visit.

For larger, superficial varicose veins, patients may experience a firm lump sensation for four to six weeks before the veins begin to shrink.

Foam sclerotherapy leaves no scars or incisions. However, accessing very complex varicose veins under ultrasound guidance can be technically challenging, often requiring at least a one-centimeter straight segment for stable access establishment. Consequently, experienced vein specialists are typically needed to navigate the vein and inject the foam sclerosant.

Recovery from foam sclerotherapy is generally quick, with no downtime. Patients can typically drive and resume normal activities immediately. However, individuals without insurance may face a financial burden due to the potential need for two to five treatment sessions for extensive varicose veins.

I prefer Varithena foam sclerotherapy over phlebectomy because, when thoroughly treated, it delivers long-lasting effects without scarring or significant downtime. From a provider's perspective, this method also eliminates the need for a surgical instrument sterilization facility, requiring only a catheter and syringe. Additionally, it negates the risk of nerve injury.