Outpatient surgery

Varicose vein microsurgery

Varicose vein microsurgery (ambulatory microphlebectomy) removes varicose veins through 1–2 millimetre incisions, under local anaesthesia, without stitches and without a hospital stay.

Which cases is it for?

For visible branch or tributary varicose veins, on their own or together with treatment of the saphenous vein by radiofrequency, VenaSeal or CHIVA. The 2022 European guideline recommends phlebectomy or foam for these varicose veins.

How it is done

1. The varicose veins are marked with the patient standing, guided by examination and duplex ultrasound.
2. Local anaesthesia in the areas to be treated.
3. Micro-incisions with a needle or fine scalpel, and removal of the vein with a small hook.
4. The incisions are closed with adhesive strips, with no need for stitches.
5. A bandage or compression stocking for the first few days.

Recovery

• You can walk straight away.
• Normal activity is usually resumed within a few days.
• Bruising is common and fades in 2–3 weeks.
• Over time the micro-incisions leave barely any mark.

CHIVA: vein-sparing surgery

In some patients, microsurgery is planned as part of a CHIVA strategy, which preserves the saphenous vein. A 2021 Cochrane review compared CHIVA with stripping, radiofrequency and endovenous laser: it found no clear differences in varicose vein recurrence, and suggested fewer nerve injuries and haematomas than with stripping, although slightly more bruising than with radiofrequency. The certainty of this evidence is low, because the studies are few and small.

Risks

Bruising, small areas of altered sensation, local inflammation or temporary pigmentation. Serious complications are rare.

Videos on this topic (in Spanish)

References

Patient information reviewed by Dr Óscar Merino, vascular surgeon. It does not replace an individual medical assessment.