Treatments

Microphlebectomy

Bulging surface veins removed through punctures a few millimetres wide — in the office, under local anaesthesia, walking out the same day.

Medically reviewed by Satish Tadepalli, MD, MPH, DABVLM · Last reviewed 18 August 2026

A Clinical Overview

Microphlebectomy — also called ambulatory or stab phlebectomy — removes rope-like varicose veins that sit close to the skin surface. Through a series of punctures of roughly two to three millimetres, a fine hook is used to lift the vein and withdraw it in segments. The punctures are small enough to close with adhesive strips rather than sutures.

It addresses a different problem from ablation. Ablation closes the failing trunk vein that generates the pressure; microphlebectomy deals with the enlarged tributaries that pressure has already produced. The two are complementary, and in many patients both are needed — the source first, the visible branches afterwards.

Who May Benefit

Microphlebectomy is generally considered when:

You have prominent, bulging varicose veins that stand proud of the skin.
Those veins ache, throb, itch or catch on clothing.
The veins are too large for injection alone to give a satisfactory result.
An underlying refluxing vein has already been treated, or is being treated at the same time.

It is not the right tool for spider veins or fine reticular veins — those are treated by injection. It is also not a substitute for correcting reflux: removing branches while the source continues to leak makes recurrence more likely.

What Happens During Treatment

Before

A duplex ultrasound establishes where the reflux originates. Insurance benefits are verified and pre-authorisation obtained. On the day, the veins are marked while you stand — they collapse when you lie down, so marking has to happen upright.

During

Local tumescent anaesthesia is infiltrated along the marked course, numbing the area and separating the vein from surrounding tissue. Dr. Tadepalli then makes the small punctures and removes the vein in segments with a phlebectomy hook. A typical session takes around 45 to 90 minutes depending on how much vein is being addressed. You are awake throughout.

After

Punctures are closed with adhesive strips, a compression stocking is applied, and you walk out. Walking soon after is part of the protocol.

Recovery

Most people return to desk work within a day or two and resume full activity, including strenuous exercise, after about one to two weeks. Compression is worn as directed.

Bruising along the treated course is expected and is often more dramatic in appearance than it is in discomfort; it typically settles over two to four weeks. Some firmness or tenderness under the skin is common while healing completes. Numb patches near a puncture site can occur and usually recover, though occasionally a small area of altered sensation persists.

Risks and Limitations

Microphlebectomy is well established, but it is a procedure and carries risk. Expected effects include bruising, swelling, tenderness and small puncture marks. Less common are skin pigmentation along the treated vein, temporary or occasionally lasting numbness from small sensory nerve irritation, superficial phlebitis, infection, and — uncommonly — deep vein thrombosis. Some patients need more than one session, and new varicose veins can develop over time, particularly if the underlying reflux is not fully corrected.

Scarring is a realistic consideration rather than a certainty in either direction: the marks are small, most fade substantially, and how visible they remain depends on skin type and individual healing.

Alternatives

Depending on vein size and location, alternatives include ultrasound-guided sclerotherapy and Varithena® for veins better suited to injection, and compression therapy where a conservative approach is preferred or a procedure is not appropriate. For the underlying trunk vein, RFA, EVLA and VenaSeal™ are the usual options.

"Phlebectomy is a craftsman's procedure. The result depends on marking accurately while the patient is standing and then working patiently — it is not a step to rush."— Dr. Satish Tadepalli, MD, MPH, DABVLM

Frequently Asked Questions

01Will microphlebectomy leave scars?

The punctures are approximately 2–3 mm and are closed with adhesive strips rather than stitches. Most heal to small marks that fade considerably over months, though how a given person scars varies with skin type and individual healing. Some marks may remain faintly visible.

02Is microphlebectomy done under general anaesthesia?

No. It is an office procedure performed under local tumescent anaesthesia. You remain awake and walk out afterwards. No hospital admission and no sedation are involved for a standard case.

03How is it different from sclerotherapy?

Sclerotherapy closes a vein with an injected medication and the body absorbs it over time. Microphlebectomy physically removes the vein segment during the visit. For large, rope-like surface veins, removal often gives a more reliable cosmetic and symptomatic result; for smaller vessels, injection is usually more appropriate.

04Is the underlying vein treated at the same time?

Bulging tributaries are usually fed by a refluxing saphenous vein deeper in the leg. That source is normally addressed first — often by ablation — because removing surface branches without correcting the source makes recurrence more likely. Sometimes the two are staged, sometimes combined; the duplex findings decide.

05How soon can I return to normal activity?

Walking begins the same day and is encouraged. Most people resume desk work within a day or two. Heavy lifting and strenuous exercise are usually deferred for one to two weeks. Bruising along the treated course is expected and settles over several weeks.

06Is it covered by insurance?

Microphlebectomy is often covered when it is performed for symptomatic varicose veins and documented as medically necessary, typically after a trial of conservative therapy. Criteria differ between plans. Benefits are verified and pre-authorisation obtained before treatment is scheduled.