Is phlebectomy necessary after VNUS procedure?

I went to a vein clinic (Dr 1) for my varicose and spider veins and was referred to a vascular surgeon (Dr 2). VNUS was done on my greater saphenous by Dr 2. I'm 3 weeks post-procedure and Dr 1 called today to start scheduling for my spider vein injections, but they also want to do phlebectomy on my now closed vein. Is this normal? Dr 2 said the vein would become scar tissue and reabsorbed by my body? Is it necessary to still have phlebectomy after VNUS? What's typical post-procedure?

Answers from doctors (3)


More About Doctor David Green, MD

Published on Dec 27, 2021

Almost any non-Saphenous varicose vein can be permanently removed by Sclerotherapy. And almost any non-Saphenous varicose vein can be more completely removed by Sclerotherapy than Phlebectomy, without having the scars that invariably appear from the latter.

Phlebectomy is the procedure in which incisions are made in the skin and segments of Varicose Veins are found and - literally - pulled out. Invariably segments of the Varicose Veins remain behind, which often continue to bulge. As noted above, it always produces scar (even though often small). Sclerotherapy is the procedure in which a solution is injected into the vein causing its denaturation and eventual absorption and disappearance. It is possible to inject the solution through the entire length of the varicose veins - and its tributaries - ensuring that the entire vein is removed. Phlebectomy almost never results in the removal of the entire length of the Varicose Vein or its branches.

Answered by David Green, MD (View Profile)

Almost any non-Saphenous varicose vein can be permanently removed by Sclerotherapy. And almost any non-Saphenous varicose vein can be more completely removed by Sclerotherapy than Phlebectomy, without having the scars that invariably appear from the latter.

Phlebectomy is the procedure in which incisions are made in the skin and segments of Varicose Veins are found and - literally - pulled out. Invariably segments of the Varicose Veins remain behind, which often continue to bulge. As noted above, it always produces scar (even though often small). Sclerotherapy is the procedure in which a solution is injected into the vein causing its denaturation and eventual absorption and disappearance. It is possible to inject the solution through the entire length of the varicose veins - and its tributaries - ensuring that the entire vein is removed. Phlebectomy almost never results in the removal of the entire length of the Varicose Vein or its branches.

Published on Jul 11, 2012


Vein Specialties of St. Louis

Published on Oct 12, 2018

All doctors approach treatment differently. I do not stage treatments. In theory, 50% of varicose veins will shrink after sealing the affected saphenous vein. That means 50% may not. I will typically do the ablation and then remove many of the bulging veins. Happier patient, less cost as it is done in one procedure.

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Answered by Vein Specialties of St. Louis

All doctors approach treatment differently. I do not stage treatments. In theory, 50% of varicose veins will shrink after sealing the affected saphenous vein. That means 50% may not. I will typically do the ablation and then remove many of the bulging veins. Happier patient, less cost as it is done in one procedure.

Published on Jul 11, 2012


Vanish Vein and Laser Center

Published on Oct 12, 2018

A closure procedure does not treat varicose veins primarily. Some varicose veins may shrink or reduce in size post-closure, but it is more common that a secondary procedure will need to be done to eradicate the varicose veins such as ultrasonic-guided sclerotherapy or microphlebectomies.

//imgs-origin.edoctors.com/imageresizer/image/user_uploads/58x58_85-1/doctors/1053_1499982262.jpg
Answered by Vanish Vein and Laser Center

A closure procedure does not treat varicose veins primarily. Some varicose veins may shrink or reduce in size post-closure, but it is more common that a secondary procedure will need to be done to eradicate the varicose veins such as ultrasonic-guided sclerotherapy or microphlebectomies.

Published on Jul 11, 2012


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