The heart pumps oxygen-rich blood through the arteries to the organs and tissues of the body. As soon as the blood has delivered the oxygen via the capillaries, it returns to the heart via the veins. It is then replenished with vital oxygen in the lungs. The cycle then starts all over again.
Strictly speaking, there are two venous systems: The deep and the superficial venous system. The two venous systems are connected by blood vessels. Superficial veins drain blood from the superficial skin and subcutaneous tissue into the deep venous system. Both systems can be affected by diseases.
Varicose veins(varicose veins) are very well-known and often clearly visible on the outside. Varicose veins are dilated superficial veins or their side branches. These bulges in the superficial veins cause the blood vessels to form convolutions (knot-shaped bulges and tortuosities).
These sometimes shimmer through the skin as a bluish discoloration and are visible to the naked eye.
If left untreated, varicose veins can progress and, over time, cause eczema in the form of
- itchy patches,
- blood clots,
- open sores and bleeding and
- inflammations
as well as inflammation.
A mini phlebectomy can be used to treat varicose veins © Solarisys | AdobeStock
During a phlebectomy (phleb = vein, ectomy = removal), a vein specialist removes superficial varicose veins with the help of hooks. Instead of open surgery with possible risks due to anesthesia and skin incisions, the so-called hook method is a minimally invasive procedure. It is therefore also known as a mini-surgical phlebectomy or mini-phlebectomy.
The surgeon penetrates the affected veins through small incisions no more than two millimetres long. Using hook-shaped instruments, he then pulls the vein out of the body. In this way, he permanently removes the pathologically altered blood vessels from the tissue.
Miniphlebectomy is used in particular for side branch varicose veins (pathological enlargements on the side branches of truncal veins) from the superficial venous system.
The surgical procedure was developed by the Swiss vein specialist Muller and is therefore also known as phlebectomy according to Muller.
Mini-phlebectomy is an established procedure for treating varicose veins. In addition to medical requirements, it also meets the aesthetic demands of patients.
Miniphlebectomy can be performed on an outpatient basis and does not require general anesthesia. The procedure therefore places little strain on the patient's body.
Miniphlebectomy is used for varicose veins and their subtypes, for example spider veins.
The minimally invasive operation is only suitable for treating varicose veins in the superficial venous system. Especially patients with
- short trunk varicosis of the saphenous vein magna or parva,
- Lateral branch varicosis (dilation of lateral branches of the main vein = great saphenous vein)
- Perforating varicosis (damage to connections between the superficial and deep venous system)
- Phlebectasias (isolated dilation of veins in the subcutaneous fatty tissue) and
- spider vein varicosis (reticular, reddish-bluish veins as the first sign of venous disease)
are used.
The indication for surgery for patients with primary varicosis is based on the anatomical and pathophysiological individual circumstances.
Miniphlebectomy is not possible in the case of severe general illnesses or blood clots in the deep veins(deep vein thrombosis). In addition, before the operation
- connection disorders between the superficial and deep venous system or
- other blood flow disorders
must be clearly demonstrated.
Varicose veins resulting from thrombosis of the deep vein system are only an indication for surgery in individual cases. Varicose complications such as
- increasing phlebitis and
- and the risk of functional vein insufficiency
can significantly increase the urgency of performing a miniphlebectomy.
Before a minisurgical phlebectomy can be performed, a thorough medical history is taken. During this consultation, the patient receives important information about the surgical procedure. In return, the patient tells the doctor all relevant illnesses and personal details. Information about the risks of the operation is also an important part of the preliminary consultation.
In order to make the decision to perform a phlebectomy, the vein specialist identifies blood flow disorders in the superficial venous system. He also rules out all contraindications to the miniphlebectomy method.
From around two weeks before the operation, the patient refrains from taking
- Medication containing acetylsalicylic acid,
- sleeping pills and
- alcohol,
so as not to disrupt blood clotting and prevent bleeding. Smokers also severely restrict their nicotine consumption around four weeks before the procedure to avoid wound healing problems.
Hair is removed from the surgical area before the procedure.
Based on the findings and individual imaging, the vein specialist marks the varicose veins to be removed on the standing patient. Shortly before the operation, an anesthetist injects the patient with a local anesthetic. This is followed by thorough disinfection and sterile draping of the planned surgical area.
The surgeon uses a scalpel to make tiny incisions in the previously marked areas. The incisions measure a maximum of two millimetres and act as an entrance for the surgeon's microsurgical instruments.
The doctor uses a hook-shaped instrument or a surgical vascular clamp (mosquito clamp) to locate the vein to be removed. As soon as he has found the varices, he removes them from the venous system and tissue.
The resulting wounds are treated with skin adhesive or a plaster bandage. The operation takes around an hour in total.
The patient wears a pressure bandage or compression stocking ("thrombosis stocking") for around two weeks after the phlebectomy. This measure helps to prevent blood clots and allows the patient to move freely as usual.
Moderate exercise is crucial after every operation to prevent thrombosis.
The dressing is changed every two to four days. After two weeks, the patient visits their vein specialist for a follow-up check.
Minimally invasive operations such as the Muller phlebectomy offer patients numerous advantages. These include
- The avoidance of general anesthesia in favor of a lower-risk local anesthetic,
- the fact that it can be performed on an outpatient basis
- the short 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 operation include short-lasting conditions such as
- bruising,
- swelling,
- wound healing disorders,
- a feeling of tension or pressure,
- Skin nerve injuries with numbness or pain symptoms,
- skin rash, sneezing, itching, watery eyes, vomiting or dizziness as an overreaction to the anesthetic.
Rare serious complications
In individual cases and extremely rarely, serious complications can occur. These include
- Infections up to and including blood poisoning,
- thrombosis (clot formation in the vein) and embolism (spread of the blood clot),
- Leg swelling and lymph congestion,
- Nerve damage,
- cardiovascular arrest due to allergic reactions to the anesthetic.
The doctor weighs up all possible risks and side effects of the operation in advance against the benefits and expected success of the operation. Only if the benefits for the patient clearly outweigh the risks will the decision be made in favor of phlebectomy according to Muller.