Multiple Venous Phlebectomy for Varicose Veins

Multiple venous phlebectomy is a minimally invasive technique used to remove bulging or prominent varicose veins through a series of tiny incisions. At The Vein Clinic in Swindon, all phlebectomy procedures are performed by a consultant vascular surgeon in a regulated, hospital‑based environment, with treatment decisions guided by duplex ultrasound and clinical assessment.

Phlebectomy is often used to remove surface varicosities that remain after endovenous laser treatment (EVLT) or radiofrequency ablation (RFA), or when tributary veins are unsuitable for thermal ablation. It is performed under local anaesthetic and allows immediate walking afterwards.

What Is Multiple Venous Phlebectomy?

Multiple venous phlebectomy (also called ambulatory phlebectomy, microphlebectomy or stab avulsion phlebectomy) involves removing varicose veins through a series of 2–3 mm incisions. These incisions are so small that they usually do not require stitches. The procedure targets veins that are visible, bulging or causing discomfort, particularly tributary veins that remain after treating the underlying reflux.

The aim is to remove the problematic surface veins while preserving normal circulation. Because the incisions are tiny, recovery is typically quick, with most patients returning to normal activities soon afterwards.

Who Is Phlebectomy Suitable For?

Phlebectomy may be recommended for patients with:

• Bulging or lumpy varicose veins close to the skin surface


• Residual varicosities after EVLT or RFA


• Tributary veins unsuitable for thermal ablation


• Localised discomfort, aching or cosmetic concern from surface veins

A full duplex ultrasound scan is performed at consultation to confirm whether phlebectomy alone is appropriate or whether it should be combined with EVLT, radiofrequency ablation (RFA) or foam sclerotherapy.

How the Procedure Is Performed

Phlebectomy is carried out under local anaesthetic. Once the area is numbed, tiny incisions are made along the course of the vein. A fine instrument is used to gently remove the vein in small sections. The incisions are so small that they typically heal without stitches.

The procedure is usually combined with compression therapy and immediate walking afterwards to support circulation and reduce bruising.

Recovery and Aftercare

Most patients return to normal activities quickly. Bruising is common and may take several weeks to settle. Compression stockings are usually recommended for a short period after the procedure. Walking is encouraged immediately, while strenuous exercise is avoided for a brief time.

Any specific downtime depends on the number of veins treated and will be discussed during consultation.

Phlebectomy vs Other Treatments

Phlebectomy is often compared with foam sclerotherapy, EVLT and radiofrequency ablation. These treatments address different parts of the venous system:

• EVLT/RFA: Treat the underlying reflux in the main trunk vein.


• Phlebectomy: Removes the visible surface varicosities.


• Foam sclerotherapy: Used selectively for smaller or residual veins.

We can advise which combination is most appropriate based on ultrasound findings.

Frequently Asked Questions

Is phlebectomy painful?

Local anaesthetic is used to numb the area. Patients typically feel pressure rather than pain.

Will the veins come back?

The removed veins do not return. However, new veins may develop over time depending on underlying venous health.

Do I need time off work?

Most patients return to normal activities quickly. Any specific downtime depends on the extent of treatment.

Is phlebectomy performed alone or with other treatments?

Phlebectomy (vein removal) may be performed as a stand‑alone procedure when bulging surface varicose veins are present without significant underlying venous reflux. In our patients, phlebectomy is performed as part of a comprehensive treatment plan, in combination with endovenous laser treatment, radiofrequency ablation, or occasionally foam sclerotherapy, depending on detailed duplex ultrasound findings.

Our experience in Swindon, backed up by clinical studies, includes seeing many patients who attend for further or repeat treatment after having procedures performed elsewhere. These patients are often advised initially to wait, return for review, or undergo additional treatment at a later stage when visible bulging veins are not addressed at the time of the first intervention. In practice, this can result in persistent surface veins, skin staining, and the need for additional procedures. Evidence suggests that nearly one in three patients require further intervention when phlebectomy is delayed or omitted, compared with only a small minority when vein removal is performed at the same time as truncal endovenous treatment.

For this reason, a comprehensive, consultant‑led approach that addresses both the underlying reflux and the visible bulging veins at the outset is often associated with better early quality‑of‑life outcomes, fewer repeat visits or procedures, and a more complete cosmetic and symptomatic result. Our treatment decisions are individualised, based on ultrasound findings, vein anatomy, and your priorities, rather than a limited or staged approach.