This technique has been attributed to Dr Robert Muller a Swiss dermatologist who started experimenting with this technique in the mid-fifties of the last century because he was unsatisfied with the results of sclerotherapy. Moreover, he wanted an alternative for the large eyecatching scars patients were left with after classical varicose vein surgery.[1] After ten years of experience he demonstrated this technique during the annual meeting of the French Phlebology Society

The procedure involves the removal of the varicose veins through multiple small 2–3 mm incisions in the skin overlying the varicose veins. First the veins are marked with the patient in standing position. Then the patient is positioned on the operating table and local anesthesia is applied. Incisions are made using a surgical blade. The most important instrument for this technique is the vein retractor or phlebectomy hook. There are two ways by which the veins can be grasped. Into the vein itself with a sharp instrument or around the vein with a blunt instrument. The phlebectomy hook is inserted through an incision and the varicose veins is hooked, extracted, and subsequently fixed with a clamp (e.g. Mosquito clamp). Next the vein is pulled out by turning or “wenching” the exteriorized part of the vein and moving the clamps as the vein is pulled out further. Dependent on the amount of varicose vein that has been removed the next incision is made 5 to 10 cm. along the pre-operative markings.

The procedure may be performed with tumescent or local anesthesia, such as with lidocaine. It is called ambulatory phlebectomy because patients usually return to normal daily activity immediately after the procedure which therefore may be performed in hospital or outpatient settings. Ambulatory phlebectomy is considered to be more effective than sclerotherapy

Ambulatory phlebectomy is a good choice for treating both asymptomatic and symptomatic superficial veins from the skin. It is usually performed on larger veins that bulge above the surface of the skin and varicose veins. It also rarely is used on smaller veins.

Ambulatory phlebectomy may be combined with other therapies in the treatment of venous disease. The procedure is not recommended for patients unable to walk on their own or wear compression stockings.

The procedure is performed under local anesthesia and patients should not feel any pain during treatment. The procedure involves four steps:

The veins to be treated are outlined or marked.

Local anesthesia is injected into the skin.

Bulging veins are surgically removed, segment by segment, through small incisions.

Graduated compression stockings are worn for a week or more after surgery.

An ambulatory phlebectomy is an outpatient procedure that can help to successfully remove the superficial veins in the legs that are twisted and bulging by using small incisions in the skin. This treatment option is a good choice for those who want to treat both asymptomatic and symptomatic varicose veins. It is often used for larger veins and rarely used for smaller veins such as spider veins.

Ambulatory phlebectomy is a great option for bulging veins that are close to the skin’s surface. That is because the vein can be completely removed from the body during the treatment. When that occurs, all the symptoms associated with the bulging veins are immediately resolved.

An ambulatory phlebectomy procedure is minimally invasive. The surgical procedure only requires a small incision to be made and the use of a local anesthetic. Because it is minimally invasive, the treatment can be provided at our office so that you don’t have to visit a surgical center. There is no use of general anesthesia required. And there is no need for an overnight stay at the hospital. Patients are able to return home the same day as the procedure.

The recovery time for an ambulatory phlebectomy is generally very quick. Patients are able to go back home the same day as their treatment. It is common to experience some slight pain following the procedure. It is also likely for patients to notice some swelling or bruising nearby the incision site. Those who have ambulatory phlebectomy are advised to wear compression socks or stockings after they return home. Most patients are able to return back to their usual activities within 24 hours after the procedure.

While it is non-invasive, ambulatory phlebectomy is still a surgical procedure. And with all surgical procedures, there are some risks involved. This treatment carries a small risk of risks and complications. The possible issues that patients may have following the treatment include having an allergic reaction to the anesthetic that was used, bruising and infection at the site, nerve injury, or inflammation. Patients who have any of these complications will need to report them to us here at BASS Vein Center immediately.

Regards,

Richard Potvin

Editorial Assistant

Genral Surgery: Open Access