Ambulatory phlebectomy is a minor surgical procedure often performed at same time as laser ablation to remove abnormally enlarged varicose veins. Performance of an ambulatory phlebectomy at the same time as laser ablation is performed in order improve the overall function of the venous system. Treatment of the abnormal varicose veins at the same time as laser ablation can result in better results in a shorter timeframe.


When abnormal veins (with malfunctioning valves) are present, the blood does not travel in a direct manner from the legs back to the heart, instead “refluxing” (flow in an opposite direction from normal) back down the legs. This abnormal direction of flow results in recirculation of blood within the leg veins and requires any normally functioning deep veins to work harder as they are called upon to move venous blood up the length of the legs again and again.


varicose_diagramThe first image demonstrates normal function of the venous system, the second demonstrates venous reflux as blood within the deep system (marked as the CFV or Common Femoral Vein) is leaked¬Ě back down the leg into the superficial system (GSV) or greater saphenous vein. This requires the deep system to perform more work on a larger volume of blood since the same blood is repetitively transported from the feet and legs back to the thigh where a certain percentage then leaks back down the leg.



ambulatory-01Once the abnormal reflux has been resolved with laser ablation (also known as EVLT) and the ambulatory phlebectomy has been performed, the abnormal circuit of reflux has been effectively removed and the work of the deep veins is returned to normal. This results in improved venous circulation and an overall decrease in the amount of blood stored in the venous system of the legs at any given time.


To perform an ambulatory phlebectomy, the varicosities are marked with the patient in a standing position prior to the procedure. The patient is then prepared and draped for the procedure in a sterile fashion and the area over the varicose veins is anesthetized with dilute (0.1%) Lidocaine to help compress the abnormally enlarged vessels and to numb the skin and adjacent tissues. Very small incisions (2-3 mm) are made over the varicosity and a special instrument is used to hook the veins underneath the skin. The varicosity is then gently pulled above the skin surface and the vein is then removed with steady, firm retraction.*

ambulatory-02Depending on the number of vessels, the number of incisions will often range from 10 to 30 small incisions, none of which require sutures.


Ambulatory phlebectomy is usually very well tolerated when performed with good technique. Mild to moderate bruising can occur, especially with large varicosities. Good compression dressings are helpful in achieving the best results. Small bandages known as steristrips are placed over the incision sites and allowed to stay on for 5-7 days. We have patients wear compression dressing for 3 days straight (72 hours without removing compression hose) and then for an additional 10-13 days when on their feet after both laser ablation and ambulatory phlebectomy in order to get the best results.


Different techniques (sclerotherapy for instance) can also result in excellent results and Dr. Long discusses all available treatment options with his patients at the time of their initial ultrasound and clinical evaluation.*


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*All text and images are the property of The Vein Center.  Individual patient treatment results may vary.