Ambulatory Phlebectomy for Varicose Veins

Phlebectomy is a minimally invasive surgical removal of all or part of a varicose vein through small incisions in the skin. There are several types of phlebectomy, but the most common one is ambulatory phlebectomy. Learn about this outpatient procedure for removing varicose veins.

When is ambulatory phlebectomy used?

Ambulatory phlebectomy is used to remove smaller branches of the larger surface veins of the leg. It also works for treating varicose veins in the groin and medium-sized (reticular) varicose veins on the back of the knee and the outside of the thigh.

Since ambulatory phlebectomy removes the varicose vein, so it usually only requires one session, compared to other treatments that may require multiple sessions for best results.

Varicose veins that are very twisted are often treated with ambulatory phlebectomy rather than endovenous thermal ablation. This is because endovenous procedures involve inserting a small tube (catheter) into the vein, which is difficult to do when the vein twists a lot.

However, sclerotherapy can sometimes be used on these twisting veins. This procedure involves injecting a liquid or foam chemical into the vein with a needle. This causes the vein to close off and eventually fade away.

Ambulatory phlebectomy can be performed by itself, but may also be used alongside other procedures, either on the same day or at a later visit. For example, endovenous thermal ablation may be used to treat larger varicose veins in the leg and ambulatory phlebectomy may be used to remove smaller superficial varicose veins that may still remain.

How ambulatory phlebectomy is performed

Before the procedure your doctor will mark the route of the vein on your leg with a pen or marker. You will be awake during the procedure, but your doctor will use local anesthesia to numb the area around the vein.

After the area is numb, your doctor will make a series of small cuts (incisions) in the skin using a scalpel or a needle. Your doctor will then remove the vein in sections by pulling the vein out through the incisions using a phlebectomy hook.

The entire procedure should take one to two hours for both legs. Because the incisions are so small, no stitches are needed. After the procedure you will wear compression stockings every day for one to two weeks. This will help the incisions heal on their own.

Recovery after ambulatory phlebectomy

Most people are able to go home on the day of the procedure. To decrease the risk of blood clots, you should walk for 15 minutes 2 to 3 times on that first day. You can increase your activity over the next few days. However, you will need to wait 4 to 5 days before resuming exercise or other strenuous activities.

For the first 48 hours, you will have to wear compression stockings all day. You should also elevate your legs at least 3 to 4 times during this period. After this period, you can remove the compression stockings to shower, but should wear them the rest of the day for 1 to 2 weeks. You should also avoid baths, swimming pools or hot tubs until you are done wearing compression stockings.

It is normal to have bruising and some discomfort after the procedure. This commonly goes away after 3 to 4 weeks. You may also experience swelling, especially when standing for a long time. Your doctor may recommend that you take a non-steroidal anti-inflammatory drug such as ibuprofen for discomfort and to reduce inflammation.

You may also have some oozing or bleeding. This should stop if you apply pressure to the area and elevate the legs. Contact your doctor or go to the emergency room if you have significant bleeding, signs of infection or fever.

Results and risks of ambulatory phlebectomy

Because varicose veins are removed during phlebectomy, the appearance of your legs should be improved right away. In some cases, though, the veins may regrow or new varicose veins may develop.

The incisions from the procedure usually heal on their own and fade away within a couple of months. However, you may notice lumps under the skin after the procedure. These are segments of the vein that are left behind and filled with clotted blood. These are not dangerous and should go away on their own.

Potential complications of ambulatory phlebectomy include:

  • Swelling, bleeding or bruising
  • Scarring
  • Infection in the treated area
  • Blisters from the wound dressings
  • Darkening of the skin (hyperpigmentation)
  • Red or purple splotches of tiny spider veins (telangiectatic matting)
Your doctor can evaluate these complications and offer further treatment options if necessary.

Updated Nov. 2, 2017

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