What is ambulatory phlebectomy?
Ambulatory phlebectomy is an outpatient procedure that removes superficial veins through small, slit-like incisions in the skin. The procedure involves four different steps:
- Outlining or marking the veins to be treated.
- Injecting local anesthesia into the skin.
- Surgical removal of the bulging veins, segment by segment, through small incisions.
- Wearing compression stockings for one week or more after surgery.
What should first be done before considering ambulatory phlebectomy?
The patient should have a proper vein evaluation, which may include a relevant history and physical, a Doppler and/or a duplex ultrasound examination. These tests evaluate such factors as:
- Are the varicose veins the main problem, or are they connected to other veins that may need to be treated first?
- Are there clots in the superficial or deep veins which may need to be addressed?
- Are other procedures needed in addition to ambulatory phlebectomy?
When is ambulatory phlebectomy appropriate?
Ambulatory phlebectomy may be used to remove both asymptomatic and symptomatic superficial veins from the skin. Typically, treated veins are the larger, bulging (raised) and varicose veins, although smaller veins may also be removed with ambulatory phlebectomy. Ambulatory phlebectomy may be combined with other therapies in the treatment of venous disease.
Who is not a candidate for ambulatory phlebectomy?
Patients who are allergic to the local anesthesia, who are not able to walk on their own and who cannot wear the compression stockings (arterial circulation problems) are not candidates for this procedure. Any active infection or rash in the treated areas needs to resolve before the surgery.
Is ambulatory phlebectomy painful?
Ambulatory phlebectomy is performed under local anesthesia and patients should not feel any pain during the procedure. After surgery, discomfort should also be minimal to none, especially if compression stockings are worn as directed.
What are the complications or potential side effects of ambulatory phlebectomy?
Temporary bruising and swelling of the treated area is typical and is minimized with compression stockings. The small incisions heal well without sutures and after six to 12 months, they are practically imperceptible. (Note: In darker skinned patients, the incision sites may be darker in color before fading.) Although every attempt is made to remove the entire varicose vein, there may be small segments that remain in the skin. These fragments may become inflamed and irritated causing the condition thrombophlebitis. The residual vein may feel like a hard cord and may be tender. Over-the-counter medications, compression stockings and time usually resolve the condition. Rarely, a sensory nerve may be injured and skin numbness results. The skin numbness usually affects a small area only. Movement or leg function should not be affected.
What can I expect after having had ambulatory phlebectomy?
Bruising and swelling is normal and temporary. You can walk immediately after surgery and carry on normal daily activities except for exercise and heavy lifting. You must follow the activity restrictions and wear the compression stockings as directed by your doctor. Your varicose veins are physically removed and therefore should not come back. However, depending on other factors such as family and personal history, new varicose veins may develop over time.
For more information and referrals
For more information on skin conditions and treatments, along with a list of ASDS members in your state, please visit the find a dermatologic surgeon section of our website.