Ambulatory Phlebectomy

Ambulatory phlebectomy is a minor surgical procedure often performed at same time as laser ablation of abnormally functioning connections between the deep and superficial systems in order to remove abnormally enlarged varicose veins. Performance of an ambulatory phlebectomy at the same time as laser ablation should be 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.

The first image demonstrates normal function of the venous system, the second demonstrates venous "reflux" as blood within the deep system (marked as the CFVor Common Femoral Vein) is "leaked" 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.

Once 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 therefore reduced to the normal workload.  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.

Varicosities are marked prior to
Ambultory Phlebectomy.

Depending on the number of vessels and the skill of the operator, the number of incisions will usually range from 10 to 20 small incisions, none of which require sutures.

Ambulatory 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 days
when on their feet after both laser ablation and ambulatory phlebectomy in order to get the best results.

Small steri-strips are applied after
Ambulory Phlebectomy.

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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