Ambulatory phlebectomy is an outpatient procedure that removes superficial veins through small, slit-like incisions in the skin. This is the preferred treatment for large varicose veins visible on the surface of the skin. There is almost always underlying venous reflux disease which causes these varicose veins. For this reason, ambulatory phlebectomy is usually performed after the underlying reflux has been corrected with a different procedure such as endovenous laser ablation (EVLA).

At MD Laser medicine and Surgery, ambulatory phlebectomy (also called micro-phlebectomy) is performed in our surgical suite under local anesthesia. Prior to this procedure the patient will have had a thorough vein evaluation including a duplex ultrasound examination. Any underlying venous reflux will also have already been treated.

Who is a candidate for ambulatory phlebectomy?

Patients who have large bulging varicose veins are best treated this way. Those 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. Infection or rash in the area to be treated needs to be treated before the surgery. Varicose veins that do not bulge through the skin may be treated with a less invasive procedure called foam sclerotherapy.

What to expect the day of ambulatory phlebectomy?

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.

Bruising and swelling is normal and temporary. You are expected to walk immediately after surgery and carry on normal daily activities except for vigorous exercise and heavy lifting. You must follow the activity restrictions and wear the compression stockings as directed.

What can I expect after having had ambulatory phlebectomy?

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.

Temporary bruising and swelling of the treated area is typical and is minimized with compression stockings. The small incisions heal well without sutures and will eventually become practically imperceptible. In darker skinned patients, the incision sites may be darker in color before fading.

It is not always possible 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.

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Clement Banda, M.D., founder and medical director of MD Laser Medicine & Surgery, is a diplomate of the ABVLM (formally known as the ABPh) and the American Board of Laser Surgery.