Ambulatory Phlebectomy

Ambulatory Phlebectomy

Surface varicose veins are branches or tributaries of the deeper veins.

When we refer to vein stripping or endovenous techniques that have replaced vein stripping, we are referring to treatment of the main truncal vein that varicose veins come off.

The varicose veins that are visible are branches off these long veins, so they also need to be treated in order for them to disappear.

The deeper (saphenous vein) always needs to be treated if it is dysfunctional as it is the core of the problem; even though this vein may not be visible. Varicose branches are treated with different methods according to different sizes

If they are very small they may just require ultrasound guided foam sclerotherapy (Ultrasound Guided Foam Sclerotherapy).
If larger, in addition to the ultrasound guided foam sclerotherapy, a procedure called microphlebectomies or ambulatory phlebectomies will be performed.
This means removal of the vein. It is not vein stripping.

In this procedure, varicose veins are marked pre-operatively and local anaesthetic is given.
Tiny incisions are made and the branch is disconnected, or some of the branch may be removed.
The incisions are tiny and no stitches are necessary. There will be some bruising, but this will go with time. It is necessary to do this to larger branches in order to get the leg flat and smooth in these areas. Foam alone will result in hard lumps, or the possibility of the veins re-opening.

What veins are removed in this manner?

Varicose veins that are unsightly or that may not decompress after an endovenous technique may be removed in this manner. Smaller veins are occasionally removed this way. Ambulatory phlebectomy is often combined with other procedures for venous disease, e.g. if the ultrasound investigation shows the saphenous vein to be abnormal and you have many varicose veins, an endovenous procedure may be done. This may not be enough to decompress the varicose veins and so we remove these veins at the same time.

What does the treatment involve?

The varicose veins that will be removed are marked whilst you are standing. You will then lie down and the leg will be cleaned and prepared in a sterile fashion. If an endovenous procedure is being performed, this will be done first. Local anaesthetic is injected into the skin over the varicose vein using a very fine needle. A tiny incision is then made and the vein is disrupted as part of it is removed. Depending on the size of the vein, the vein may be tied off. The incision will then be dressed with a plaster. A compression bandage will be placed around the leg for a period of 24 hours.