Phlebectomy vs Endovenous Laser Ablation for Chronic Venous Insufficiency: What’s the Difference?

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Chronic venous insufficiency (CVI) or venous reflux is a condition that can affect your daily functioning. While lifestyle changes can help alleviate some of the symptoms, medical procedures are often the only way to truly restore proper blood circulation and vein functioning. Getting a phlebectomy or undergoing endovenous laser ablation are two of the most common methods used to treat the condition.

So what are the differences between these two treatments? Both are minimally invasive procedures that have varying methods. Phlebectomy involves using a scalpel to remove the blood vessels through a small incision. Endovenous laser ablation uses heat to reduce the appearance of varicose veins. For both conditions, recovery time takes around 2 weeks.

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Phlebectomy

Phlebectomy, sometimes called vein stripping, is a procedure that can be done in the doctor’s office. Although it’s a form of surgery, it’s just minimally invasive. The doctor uses a scalpel to remove the veins below the upper layer of the skin. 

Patients will be given special instruction regarding the necessary preparations. Candidates for Phlebectomy are carefully screened to avoid any contraindications with medications, allergies, and other illnesses. If you have venous ulcers, the doctor may ask you to take a course of medication to avoid any complications during the surgery.

Doctors recommend the procedure for older patients with venous reflux. Older people have larger vein walls, which accumulate more damage over time. 

How It Works for Chronic Venous Insufficiency

Vein stripping provides fast relief for people with venous reflux since it removes the varicose veins responsible for circulation issues. The procedure can be done outpatient, such as in the doctor’s office or ambulance. Patients who have more problematic blood vessels may need to be admitted. If you have other venous ulcers, the doctor may put off the vein stripping procedure until these have subsided. 

The doctor will begin the procedure by numbing the area with anesthesia. The injection may cause a short stinging sensation before the patient stops feeling a sensation in the area. The local anesthetic only affects the treatment site, which means that the patient will be awake during the operation. 

Once the treatment site is numb and clean, the doctor will make small cuts on the skin. These incisions are in the areas beside the veins. After the cuts appear on the skin, the doctor will use a specialized hook to remove the veins through the incisions. Depending on the size of the veins, the operation may last between 30 to 60 minutes.

If multiple varicose veins will be removed, the process may take even longer. Vein stripping is best for venous reflux patients who have more prominent varicose veins on the surface of the skin. Symptoms improve almost immediately since the varicose veins are removed from the body. The appearance of the skin improves within a couple of days.

Compared to other treatments like endovenous laser ablation, the effects of vein stripping are felt almost immediately. 

Side Effects

Much like other forms of treatment, vein stripping may lead to temporary side effects. These typically resolve within a couple of days or weeks. Doctors will provide you with a treatment plan to help ease the side effects. Most of these are localized to the treatment area, such as inflammation, light bruising, and bleeding.  

To help ease the side effects, doctors may advise the following:

  • Use painkillers to ease any pain and discomfort. The use of non-steroidal anti-inflammatory drugs (NSAIDs) can help make recovery faster. Patients may use these drugs sparingly within the first couple of days to make tasks easier and more comfortable.
  • Apply ice packs to swollen areas. Ice packs help relax the surrounding blood vessels in the area, lessening the inflammation. Doctors advise applying the ice packs for 15 minutes.
  • Wear a compression garment to encourage healing. The garment will also help ease the tenderness and soreness. Most doctors will advise you to wear the compression garment for two to three weeks. During this time, you can already return to daily activities. Make sure to watch your steps to avoid tripping or falling. 
  • Clean the incision sites every day. It is important to maintain cleanliness in the surgical sites to minimize the risks of infection. Replace the bandage every day to avoid any microorganisms from growing in the area. If you experience any signs of infection, such as pus or fever, contact your doctor right away. 

Other visible side effects include swelling and discoloration of the area. Swelling will go down with the help of an ice pack. The discoloration usually subsides after the first few days post-surgery. 

Some patients may also experience persistent numbness in the surgical site for a few weeks. Regular sensation will return to the area in a couple of months, as the nerves may take some time to regenerate. 

Recovery Time

During the procedure, patients will feel very little to no pain and discomfort. Most people can return to work almost immediately, although regular physical activity should only be done after at least two weeks. 

Doctors advise against heavy exercise for at least two weeks. Lifting heavy weights will introduce pressure into the area, possibly causing more pain and inflammation. Make sure to stay in contact with your doctor if you experience any side effects even after two weeks. 

Cost

The general cost for a phlebectomy is around $2,000 to $5,000, depending on the severity and size of the varicose veins. Other factors, such as your location and physician, may also impact the total amount of costs. If you experience any harsh side effects, medications are not included in the calculation of your total phlebectomy bill.

Endovenous Laser Ablation

Vein problem laser treatment

Endovenous laser ablation is an alternative method to surgical treatment for CVI. This procedure involves thermal energy from a laser device to remove varicose veins. Veins located in the thighs and calves are the most common candidates for laser removal. The device is very thin and any discomfort is minimal. 

The heat works by closing and shrinking the problem vein. The vessel develops scar tissue that permanently seals the vein, redirecting blood to healthy veins. This laser procedure is ideal for varicose veins that are sore and swollen. 

Endovenous laser ablation works well for younger patients due to the structure of their veins. It is more difficult for young people to undergo a phlebectomy since their blood circulation is more active. The use of thermal energy is more compatible with redirecting blood flow to healthy veins in younger people. 

How It Works for Chronic Venous Insufficiency

Endovenous laser ablation doesn’t take long. The procedure can be done in the doctor’s office and confinement is not necessary. Most operations only last for 30 to 60 minutes. Before the scheduled treatment, patients will be asked a series of questions about their medical history. These will help the doctors decide if the patient is a suitable candidate for endovenous laser ablation. 

During the procedure, the patient will wear a hospital gown to make it easier for the doctor to reach the area. While lying down on the examination table, the patient will wear specialized goggles to prevent any adverse reactions from the lasers.

After you wear the necessary protective gear, the doctor will numb the area with a local anesthetic. A small cut will be made to allow the insertion of a small tube or catheter. The healthcare provider will use an ultrasound device to assess the veins before proceeding to the incision. The sound waves will project an image mapping out the varicose veins on a screen. 

The provider will then make the small incisions to insert the tubes directly into the varicose vein. A laser fiber will enter the catheter once it is fully inside the vein. The catheter will slowly be removed once the laser starts to release heat into the vein. This process will take a few minutes to an hour, depending on the length of the blood vessel. No stitches are necessary to facilitate healing, although a small bandage will be used to protect the area. 

The vein will eventually shut off and shrink. The body will absorb the vein after some time has passed, which can take a few months. 

Side Effects

Since endovenous laser ablation is not a surgical operation, complications are less likely. However, the varicose veins may take some time to appear less visible, since the procedure only shuts them off. Additionally, some side effects may arise in the days after the procedure. These include slight swelling and bruising in the treated area.

Doctors will typically advise the following steps to resolve the issues:

  • Place an ice pack over the affected area. The ice pack will help ease the inflammation over the treatment site. It helps to apply this to the area for around 15 minutes a couple of times a day.
  • Clean the infection site. As with any operation, the small cuts may become infected if you do not clean them every day. A light pink discharge is normal, but a yellow or green fluid indicates infection. Make sure to keep the area dry for the first 2 days to avoid bacterial growth. If you feel a fever coming on, contact your doctor right away. Do not self-medicate with antibiotics as you may take the wrong medication. 
  • Wear compression garments. Compression garments help encourage healing in the area by promoting blood flow. The garments provide gentle pressure to the area to prevent blood from pooling near the treatment site. Compression stockings will also help you feel more comfortable since they prevent direct contact with the harsh fabrics of your clothing. 
  • Keep moving. To encourage normal blood flow, doctors will advise you to keep walking or moving around. Avoid sitting or standing for long periods of time to prevent blood from pooling in the area.
  • Take painkillers as necessary. As with surgery, NSAIDs can lessen the blow of the side effects. Make sure to follow the prescribed dosage period to avoid any complications. Consult with your doctor before taking any medicine, as some NSAIDs may cause adverse reactions in some people. 

Other side effects, such as numbness, resolve within a couple of days In rare cases, some people may develop serious complications. Although the chances of these happening are slim, it helps to watch out for the warning signs. Contact your doctor if you experience any of the following:

  • A fever from an infection. Infections may occur if you don’t properly clean the area. You will need a dose of antibiotics to prevent larger complications, such as sepsis. Make sure to contact your doctor immediately. Self-medication may lead to antibiotic resistance, which is more harmful in the long run. 
  • Deep vein thrombosis (DVT). In very rare instances, some people may develop a blood clot in another vein. DVT is very painful and it’s important to notify your doctor if you experience persistent cramping in the legs after the procedure. To avoid DVT, try to lightly exercise during your recovery period. Doctors advise at least 30 minutes of walking per day. 

Recovery Time

The overall recovery time after endovenous laser ablation lasts for 2 weeks. You may feel a little difficulty when walking, which is why it helps to have someone accompany you when going home from the doctor’s office. After a few hours, you can start to walk around to encourage blood circulation in the legs. 

Most people can return to work and other daily activities at least an hour after the thermal energy procedure. People who undergo endovenous laser ablation may experience more soreness after the procedure than phlebectomy patients. However, the soreness resolves faster since there are fewer incisions on the skin. 

Cost

The cost of the procedure depends on a wide range of factors, including the size, location, and severity of the disease. Most operations cost anywhere from $600 to $3,000. Some doctors may prescribe additional medication after the procedure, although these expenses aren’t included in the initial summary of costs. 

Vein Doctor Center: Helping You Find a Solution to Your Vein Problems

Vein Center Doctor is a leading healthcare provider with branches in New York and New Jersey. Our clinic offers 4 different treatment plans to improve the outlook of venous diseases in patients. We believe that surgical treatment isn’t the only way to resolve conditions like superficial thrombophlebitis, CVI, deep vein thrombosis, and varicose veins. 

Through consultations, we can help you decide on the right path to take for treating and managing your venous disorder. To discuss your next steps in treating your varicose veins, get in touch with us today.  

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