Ambulatory Phlebectomy FAQ

What is ambulatory phlebectomy?

Ambulatory phlebectomy is a minimally invasive procedure to remove medium-size varicose veins just under the surface of the skin of the legs through tiny incisions or needle punctures. An alternative to traditional ligation-and-stripping surgery, your vein specialist uses just a local anesthetic to numb the affected area when performing ambulatory phlebectomy.

Treatment for varicose veins ranges from conservative, non-invasive approaches such as exercise and compression therapy to laser and radiofrequency treatments to surgical vein stripping under general anesthesia. Ambulatory phlebectomy is less invasive than surgery. Due to the reduction in anesthesia and small incision size, these procedures can be performed in your doctor's office or in an outpatient surgery center.

What are the benefits of ambulatory phlebectomy over other procedures?

Ambulatory phlebectomy can effectively eliminate medium-size varicose veins. Compared to ligation and stripping surgery, the procedure is safer and involves a shorter recovery time. Sometimes, however, ambulatory phlebectomy is performed at the same time as other surgical or non-surgical procedures.

There are now more recent alternatives to ambulatory phlebectomy, such as endovenous laser ablation or endovenous radiofrequency ablation. The conventional wisdom was that abulatory phlebectomy provided the best protection against the recurrence of varicose veins in the same spot, but the American Venous Forum and the Society for Vascular Surgery, in their clinical practice guidelines, say the matter isn't so clear and that more study is needed.

How is ambulatory phlebectomy performed?

Ambulatory phlebectomy begins with the patient standing, since that's the position where varicose veins are most easily identified. The doctor marks the veins to be removed with a surgical marker. Then with the patient lying down, the leg is prepared with an antiseptic solution and local anesthetic is injected around the veins to be treated. The fluid not only numbs the surrounding area for the ambulatory phlebectomy procedure, but it helps to pull the veins away from the adjacent tissue and compresses the surrounding capillaries to reduce post-procedure bleeding.

Once the entire area to be treated has been numbed, tiny incisions or needle pokes are made over the veins, which can then be pulled out in sections using special vein hooks. The incisions for ambulatory phlebectomy procedures are so small they don't require stitches — if anything is even needed, they're closed with thin adhesive strips. When all the targeted veins on one leg have been completely removed, absorbent pads are placed next to the skin and the leg is wrapped tightly in a compression bandage.

What is the recovery process after ambulatory phlebectomy like?

The compression bandage is an important part of ambulatory phlebectomy and must be worn for 24 to 48 hours. Someone else will have to drive the patient home, but it's important to get up and walk around soon and often, since the contraction of surrounding muscles help to rid the treated areas of excess fluid, reduce the risk of blood clots, and contributes to the healing process.

Your doctor will usually remove the bandage and check the incisions a day or two after your procedure. Once the bandage is removed, you will wear compression hose for one to three weeks as your legs completely heal. With a minimally invasive ambulatory phlebectomy, most patients are back to work within a day or so. For the first few weeks, you should avoid prolonged standing, heavy lifting, and aerobic exercise involving the legs.

What are the risks associated with ambulatory phlebectomy?

Ambulatory phlebectomy is generally considered quite safe, but complications can happen with any procedure. The most common minor complications are swelling, bleeding, or infection. Typically the incisions heal without scarring, but there can be hyperpigmentation — avoiding sun helps. People with darker skin may require more time for those areas to fade.
There can also be blistering or bruising, or telangiectatic matting — reddish or purplish splotches of tiny new veins that can look like a bruise.

There may also be some local numbness in small patches. And with any vein treatment, varicose veins can eventually recur, especially if the same factors causing them remain unchanged after treatment.

Is ambulatory phlebectomy approved in the U.S.?

Ambulatory phlebectomy is not only approved for the treatment of varicose veins in the United States, phlebectomy is the standard of care to which all other varicose vein treatments are compared. The Society for Vascular Surgery and the American Venous Forum recommend either ambulatory phlebectomy or sclerotherapy for medium-size varicose branch (or tributary) veins.

It is an accepted alternative to surgical vein stripping for appropriate patients. To find out if ambulatory phlebectomy is the right treatment option for you, a vein specialist mus evaluate you. Many people who have varicose veins need a combination of procedures and more than one treatment session to eliminate all of the affected veins and achieve the desired cosmetic result.

How much does ambulatory phlebectomy cost?

The cost of an ambulatory phlebectomy depends on the extent of the varicose veins to be treated. If the procedure is needed because of an underlying medical condition, insurance often covers the cost — but not when it's for cosmetic reasons. Also, insurers may require several weeks or months or conservative therapy such as compression hose, weight loss, and exercise first before surgical therapy can be covered.

Updated: October 6, 2014

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