Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions

CPT4 code

Name of the Procedure:

Stab Phlebectomy of Varicose Veins, 1 Extremity
Common Names: Varicose Vein Removal, Microphlebectomy

Summary

A stab phlebectomy is a minimally invasive surgical procedure to remove varicose veins through tiny incisions in the skin. It is performed on one leg, using about 10-20 small cuts to extract segments of the problematic veins.

Purpose

This procedure aims to treat varicose veins, which are enlarged, twisted veins often visible under the skin. It helps alleviate symptoms like pain, swelling, and skin irritation, and improves the leg's cosmetic appearance.

Indications

Visible varicose veins causing discomfort or pain.
Swelling, throbbing, or heaviness in the leg.
Skin changes or ulcers due to varicose veins.
Failure of conservative treatments (e.g., compression stockings).

Preparation

Patients may need to fast for a few hours before the procedure.
Adjustments or temporary discontinuation of certain medications, like blood thinners.
Pre-procedure ultrasound to map the veins and plan the surgery.

Procedure Description

The patient is positioned comfortably, and the leg is sterilized.
Local anesthesia is administered to numb the targeted area.
A series of 10-20 small incisions (about 2-3 mm each) are made along the vein's path.
Special hooks and forceps are used to pull out sections of the vein through the incisions.
Each incision is closed with a small adhesive strip or suture.
A compression bandage is applied to minimize swelling and support healing.

Duration

The procedure typically takes about 30 minutes to 1 hour.

Setting

Performed in an outpatient clinic, surgical center, or hospital operating room.

Personnel

Vascular surgeon or a trained surgeon specializing in vein procedures.
Surgical nurse or assistant.
Anesthesiologist or nurse anesthetist (if sedation beyond local anesthesia is used).

Risks and Complications

Minor bruising and swelling.
Infection at incision sites.
Scarring, though typically minimal.
Rare risks include nerve injury or deep vein thrombosis (DVT).

Benefits

Relief from pain and discomfort caused by varicose veins.
Improved cosmetic appearance of the leg.
Results are often visible immediately, with continued improvement over weeks.

Recovery

Patients can usually go home the same day.
Compression stockings may need to be worn for several days to weeks.
Light walking is encouraged, but strenuous activities should be avoided for a few weeks.
Follow-up appointment to monitor healing and remove any sutures.

Alternatives

Conservative treatment (e.g., compression therapy).
Sclerotherapy (injection of a solution to close the vein).
Endovenous laser therapy (using laser energy to seal the vein).
Radiofrequency ablation (using radio waves to close the vein).

Patient Experience

Minor discomfort during the procedure due to local anesthesia.
Mild to moderate soreness and bruising post-procedure.
Pain is generally well-managed with over-the-counter pain relievers like ibuprofen.
Most patients experience significant improvement within a few weeks.