What is Ambulatory Phlebectomy?

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Veins doctor consultation check up

Ambulatory phlebectomy is the surgical removal of bulging varicose veins in the office under local anesthesia. With very little down time needed for recovery and a good cosmetic result, this is definitely NOT your grandmother's vein stripping!

Vein-stripping, a once widely used “cure” for bulging veins, is now commonly recognized as an obsolete method of treating varicose veins. This procedure would normally require down-time for recovery, the use of general anesthesia, and sometimes a hospital stay. Those who experienced vein-stripping twenty years ago often find this procedure made their vein health worse overall.

Modern out-patient vein treatment options allow patients to be looking and feeling good much faster at a lower cost and risk of recurrence without having to “go under.” One treatment option, called Ambulatory Phlebectomy, is used to surgically remove veins but in a minimally invasive way.

Deep & Superficial, Different Veins, Different Issues

Veins in the legs return blood to the heart and lungs to replenish oxygen in the blood. There are two categories of veins in the legs: deep and superficial.

The deep veins are inside the muscle and because of the pumping action of the muscles, they return blood to the heart very efficiently. The superficial veins are above the muscles, closer to the skin, and rely only on their one-way valves to keep blood moving upward to the heart.

If there is a blockage in either the deep or superficial veins, blood may flow back down the leg in the wrong direction, which can lead to varicose veins, leg pain, and ankle swelling, and other associated symptoms.

A much more common reason for varicose veins is the failure of the one-way valves in the super veins, allowing for backward blood flow, which may also lead to varicose veins, swelling, and other symptoms. This occurs most commonly in the superficial veins, especially the great and small saphenous veins, as well as their tributaries.

In that kind of case, effective treatment involves getting rid of the abnormal superficial veins. Doing so will result in blood being redirected into normal veins which, instead of blood remaining in the leg for prolonged periods of time, returns the blood more efficiently to the heart and lungs for re-oxygenation. This is why we can expect the varicose veins and the symptoms associated with them to improve after appropriate treatment.

Ambulatory Phlebectomy vs. Vein Stripping

The old vein removal procedure known as “vein stripping” which is now obsolete. For the saphenous veins that were stripped in the past, we can now leave them there but close them permanently using heat (radiofrequency or laser energy), foamed chemicals, adhesive, and other minimally invasive methods.

For the saphenous vein tributaries (branches), formerly radical removal was the treatment method. Now, Ambulatory Phlebectomy is often performed in conjunction with other treatment methods to control the underlying sources of backward blood flow. Ambulatory phlebectomy refers to minimally invasive removal of large, bulging, unsightly varicose veins through 2mm micro-incisions, like the image below.

Ambulatory Phlebectomy is usually performed in an office setting under local anesthesia - or sometimes with mild sedation. Once adequate anesthesia has been injected, the removal of the veins is generally painless.

After the ambulatory phlebectomy, the patient is placed in bandages for one-to-two days, followed by wearing a compression hose for a brief time. Activity is limited on the day of the procedure, but patients return to routine activity the following day, and to more vigorous activity in a few days. The small degree of pain is treated successfully with over-the-counter anti-inflammatory medication (such as Ibuprofen). Complications are uncommon, but when they occur, are usually readily treated in the office and will resolve over time.

Choosing the Right Leg Vein Treatment

In skilled hands, ambulatory phlebectomy is a very good alternative to sclerotherapy for large, bulging varicose veins. Recovery is usually quicker than sclerotherapy, the veins disappear immediately, and the cosmetic result is often better.

One week after ambulatory phlebectomy

At Center for Vein Restoration, myself and my colleagues are all trained in every modern modality of vein treatment, so you can trust the appropriate treatment will be chosen for you based on your medical history, insurance, and preferences. Call to schedule at a center near you.

Author: Nick Morrison, MD, FACS, FACPh

Dr. Nick Morrison is a leader in phlebology research. He has presented at hundreds of medical conferences, and written dozens of papers that have been published in medical and scientific journals. Beyond that, he has served several years on the Program Committee for the Annual Symposium of the American Vein and Lymphatic Society (AVLS – Formerly known as the American College of Phlebology) and was the Program Chair for the organization’s 16th Annual Symposium. He has also served on the Board of Directors of the AVLS and as the Co-Chair of the Steering Committee of the Foundation for Vein and Lymphatic Disease (formerly American College of Phlebology Foundation). Currently, he practices in Mesa, Arizona.

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