What is ambulatory phlebectomy?

Ambulatory phlebectomy is an outpatient procedure that removes varicose veins through small, micro-incisions in the skin. The small size of the skin incision or puncture usually results in little or no scarring. Only performed under local anesthesia, ambulatory phlebectomy leads to greatly reduced surgical risks compared with traditional surgery for varicose veins.

Am I suitable for ambulatory phlebectomy?

You will have a thorough vein evaluation, which includes a full medical history and physical examination followed by a duplex doppler ultrasound examination. These tests evaluate such factors as:

Are the varicose veins the main problem, or are they connected to other refluxing veins that may need to be treated first? In this case you may have EVLT or Foam Sclerotherapy.
The status of the superficial or deep leg veins which may need to be addressed?

How is ambulatory phlebectomy performed?

The veins to be treated will be marked visually or using ultrasound or trans illumination.
Tumuscent local anesthesia will then be injected around the veins to be treated.
Varicose veins will then be removed through micro-incisions.
A compression bandage or stocking will then be applied.

What are the advantages of tumescent anesthesia?

The use of tumescent anesthesia offers several major advantages. These include
• decreased pain , we have had patients fall asleep during the procedure!
• low toxicity as anesthetic medication is greatly diluted
• pushing the vein for removal closer to the skin
• pre dissection of the vein from surrounding tissue allowing for easy removal
• tumescent solution is antibacterial which reduces possibility of infections
• compression effect for less bleeding and postoperative bruising
• postoperative rinsing and cleansing effect reduces chance of haematoma and swelling
• long-lasting anesthetic properties that make postoperative course comfortable
• early ambulation reduces chances of thrombotic complications

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.

What are advantages of ambulatory phlebectomy over sclerotherapy?

Ambulatory phlebectomy minimizes the risks of intra-arterial injection, air bubble related complications, skin necrosis, and residual hyper pigmentation. The diseased vein is removed by the procedure. Sclerotherapy destroys the vein but does not remove it. Your body will absorb the destroyed vein over time.

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.

What are the complications or potential side effects of ambulatory phlebectomy?

Temporary bruising and swelling of the treated area is typical and is minimised with compression stockings. The small incisions heal well without sutures and after few months, they are practically imperceptible. The residual vein may feel like a hard cord and may be tender. Thrombophlebitis -inflammation and swelling of residual veins can occur. This tends to resolve spontaneously. Temporary skin numbness can also occur.

What can I expect after having had ambulatory phlebectomy?

Bruising and swelling is normal and temporary. You must walk immediately after surgery and carry on normal daily activities except for exercise and heavy lifting. Bed rest is not encouraged. You must wear the compression stockings as directed by your doctor.