Why are tributaries removed separately?
The laser closes the straight venous trunk, but the tortuous tributaries extending from it cannot be processed with a light guide - their shape does not allow the instrument to be passed through. If left in place, they will remain visible under the skin and continue to expand. Therefore, tributary miniphlebectomy is almost always performed in the same procedure as EVLT. The first degree means a limited number of tributaries in a small area - the procedure adds about 20–30 minutes to the main intervention.
What is miniphlebectomy
This is the removal of varicose veins through micropunctures of the skin using special Varady hooks. No incisions or stitches are required, punctures heal without leaving any traces.
The method almost always complements EVLT: the laser closes the main trunk, and miniphlebectomy removes tortuous tributaries that cannot be treated with a laser due to their shape. Together they give a complete cosmetic and functional result.
Non-saphen veins and tributaries of the main veins
The two main saphenous veins are called saphenous - the great and the small. Their tributaries are the branches flowing into these trunks. Non-saphen veins are not connected to the main trunks and expand independently, often on the back and outer surface of the leg and thigh.
The difference is practical: tributaries of the main veins are treated after the main trunk is closed and are usually located predictably, while non-saphenous ones require more careful ultrasonic marking and extraction from less convenient areas - therefore their removal is assessed separately.
Degrees of difficulty
The gradation reflects the amount of work: the length and number of veins removed, their tortuosity, depth and area of damage. The first degree is a limited area with several veins, the third is a widespread lesion, requiring dozens of punctures and much more time.