Are there any alternatives to ambulatory phlebectomies?
Most vein experts and patients alike would prefer there to be a more elegant alternative to phlebectomies – but in the majority of cases there is no good alternative.
Endovenous laser ablation (EVLA), radiofrequency ablation (RFA) and the other thermoablation techniques that use heat inside the veins to destroy them are not particularly useful in these superficial varicose veins as these techniques would burn the skin at the same time as destroying the target vein.
Sclerotherapy or foam sclerotherapy have been used and, if the veins are very small, this is a viable alternative. However there is considerable research showing that although veins with a diameter of 3 mm or less respond well to foam sclerotherapy, as the veins get bigger, the results get worse. Therefore in people with large lumpy varicose veins, sclerotherapy or foam sclerotherapy is not usually an option and may well lead to a poor cosmetic result with red inflamed areas or brown stains. (It should be noted at this point is that there are exceptions and in some patients with very inflamed skin, occasionally phlebectomy can be impossible. In these cases foam sclerotherapy is a viable alternative.
Mechanical removal such as the Trivex system; There have been numerous inventions to try to replace the phlebectomy procedure. The most elaborate and one of the most successful has been the Trivex (or powered phlebectomy) system. In essence, this is a two instrument system using two small incisions to remove a large number of severe varicosities. One instrument injects local anaesthetic solution and also provides a strong light from deep below the veins. The second instrument has a rotating “blade” and suction, allowing the surgeon to remove veins that can be seen through the skin, silhouetted by the strong light.
Although some experts get good results from powered phlebectomy, it does need considerable experience to get optimal results and does make a simple and inexpensive procedure into a more complex and more expensive treatment. Therefore as a conclusion, it is probably correct to say that powered phlebectomy is certainly a viable alternative to phlebectomy, but many experts seem to feel that the advantages are not convincing enough compared to the costs and the training required to get optimal results.