Miniphlebectomy: Specialists & Treatment Information

The heart pumps oxygen-rich blood through the arteries to the body’s organs and tissues. Once the blood has released its oxygen through the capillaries, it returns to the heart via the veins. It is then re-oxygenated with vital oxygen in the lungs. After that, the cycle begins again.

Strictly speaking, there are two venous systems: the deep and the superficial venous systems. The two venous systems are connected to each other via blood vessels. Superficial veins carry blood from the superficial skin and subcutaneous tissue into the deep venous system. Both systems can be affected by disease.

Varicose veins (varices) are very well known and often clearly visible on the surface. Varicose veins are dilated superficial veins or their side branches. These bulges in the superficial veins cause the blood vessels to form convolutions (knotty bulges and twists).

These sometimes appear as a bluish discoloration visible through the skin and can be seen with the naked eye.

If left untreated, varicose veins can progress and, over time, lead to eczema in the form of

• prurigo,
• blood clots,
• open sores and bleeding, as well as
• inflammation

.

A miniphlebectomy can be used to treat varicose veins © Solarisys | AdobeStock

In a phlebectomy (phleb = vein, ectomy = removal), a vein specialist removes superficial varicose veins using small hooks. Instead of open surgery, which carries potential risks from anesthesia and skin incisions, the so-called hook method is a minimally invasive procedure. It is therefore also called a mini-surgical phlebectomy or miniphlebectomy.

Through small incisions no more than two millimeters long, the surgeon accesses the affected veins. Using hook-shaped instruments, he then pulls the vein out of the body. In this way, he permanently removes the diseased blood vessels from the tissue.

Miniphlebectomy is used specifically for lateral branch varicose veins (abnormal dilations in the lateral branches of trunk veins) originating from the superficial venous system.

The surgical procedure was developed by the Swiss vein specialist Muller and is therefore also known as Muller’s phlebectomy.

Miniphlebectomy is an established procedure for treating varicose veins. In addition to meeting medical requirements, it also addresses patients’ aesthetic concerns.

Miniphlebectomy can be performed on an outpatient basis and does not require general anesthesia. As a result, the procedure places minimal strain on the patient’s body.

Miniphlebectomy is used to treat varicose veins and their subtypes, such as spider veins.

This minimally invasive procedure is suitable exclusively for the treatment of varicose veins in the superficial venous system. It is particularly suitable for patients with

• short-segment trunk varicosities of the great or small saphenous vein,
• side-branch varicosities (dilatation of side branches of the main vein = great saphenous vein)
• perforator varicosities (damage to connections between the superficial and deep venous systems)
• phlebectasias (isolated dilation of veins in the subcutaneous fatty tissue), and
• spider veins (net-like, reddish-bluish veins as the first sign of venous disease)

are used.

For patients with primary varicose veins, the indication for surgery is based on the patient’s individual anatomical and pathophysiological circumstances. 

In cases of severe systemic diseases or blood clots in the deep veins (deep vein thrombosis), a miniphlebectomy is not possible. Additionally, prior to surgery,

• communication defects between the superficial and deep venous systems or
• other blood flow abnormalities

be clearly demonstrated.

Varicose veins resulting from deep vein thrombosis are an indication for surgery only in individual cases. Complications of varicose veins, such as

• progressive phlebitis and
• the risk of functional insufficiency of the trunk veins

can, however, significantly increase the urgency for performing a miniphlebectomy.

Before a minimally invasive phlebectomy can be performed, a thorough medical history is taken. During this consultation, the patient receives important information about the surgical procedure. In turn, the patient provides the doctor with details of all relevant medical conditions and personal information. Explaining the risks of the surgery is also an important part of the preliminary consultation.

To determine whether a phlebectomy is appropriate, the vein specialist identifies blood flow disorders in the superficial venous system. At the same time, the specialist rules out any contraindications to the miniphlebectomy procedure.

Starting about two weeks before the surgical procedure, the patient must stop taking

• medications containing acetylsalicylic acid,
• sleeping pills, and
• alcohol,

to avoid interfering with blood clotting and to prevent bleeding. Smokers should also significantly reduce their nicotine intake about four weeks before the procedure to prevent impaired wound healing.

Before the procedure, hair is shaved from the surgical area.

Based on the findings and individual imaging results, the vein specialist marks the varicose veins to be removed while the patient is standing. Shortly before the operation, an anesthesiologist administers a local anesthetic to the patient. The planned surgical area is then thoroughly disinfected and covered with sterile drapes.

At the previously marked sites, the surgeon makes tiny incisions—essentially puncture incisions—with a scalpel. The incisions are no more than two millimeters in size and serve as entry points for the surgeon’s microsurgical instruments.

Using a hook-shaped instrument or a surgical vessel clamp (mosquito clamp), the doctor locates the vein to be removed. Once the varicose veins have been identified, he removes them from the venous system and surrounding tissue.

The resulting wounds are closed with skin glue or a bandage. The entire procedure takes about one hour.

After the phlebectomy, the patient wears a pressure bandage or a compression stocking (“thrombosis stocking”) for about two weeks. This measure helps prevent blood clots and allows the patient to move around freely as usual.

Moderate exercise is crucial after any surgery to prevent thrombosis. 

The dressing is changed every two to four days. After two weeks, the patient returns to their vein specialist for a follow-up visit.

Minimally invasive surgeries such as Muller’s phlebectomy offer patients numerous benefits. These include 

• the use of local anesthesia instead of general anesthesia, which carries fewer risks,
• the ability to be performed on an outpatient basis,
• minimal downtime, and
• faster healing.

Miniphlebectomy is a standard procedure and is generally considered a low-risk treatment. Nevertheless, complications can occur. 

Common Side Effects

The most common side effects of the surgery include short-term conditions such as

• bruising,
• swelling,
• wound healing problems,
• a feeling of tightness or pressure,
• skin nerve damage with numbness or pain,
• skin rash, sneezing, itching, watery eyes, vomiting, or dizziness as adverse reactions to the anesthetic.

Rare serious complications

In isolated cases and extremely rarely, serious complications may occur. These include:

• Infections, including sepsis,
• thrombosis (blood clot formation in a vein) and embolism (displacement of the blood clot),
• leg swelling and lymphatic congestion,
• nerve damage,
• cardiac arrest due to allergic reactions to the anesthetic.

Before the procedure, the doctor weighs all possible risks and side effects of the surgery against the benefits and expected outcomes. The decision to perform a Muller phlebectomy is made only if the benefits clearly outweigh the risks for the patient.