Ambulatory Phlebectomy

HOW IS AMBULATORY PHLEBECTOMY PERFORMED?

Ambulatory phlebectomy begins with the patient standing since this is the position where the varicose veins are most easily identified. The veins to be removed are marked with a surgical marker. 

Then with the patient supine, the leg is prepared with an antiseptic solution and local anesthetic is injected along the veins to be treated. 

A common anesthetic used with this procedure is a large volume of a low concentration local anesthetic. The fluid not only numbs the surrounding area for the ambulatory phlebectomy procedure, but it helps to pull the veins away from the adjacent tissue and compresses the surrounding capillaries to reduce post procedure bleeding.

Once the entire area to be treated has been injected with the anesthetic solution, tiny incisions are made over the veins, which can then be removed using vein hooks. The incisions for ambulatory phlebectomy procedures are so small they do not require sutures.

 These incisions allow the excess fluid to drain post operatively. When all the veins targeted for treatment on one leg have been completely removed, pads to absorb the fluid are placed next to the skin and the leg is wrapped tightly in a compression bandage.

WHAT ARE THE RISKS ASSOCIATED WITH AMBULATORY PHLEBECTOMY?

Complications can occur with any procedure, the most common being bleeding or infection. With the small incisions used for ambulatory phlebectomy these complications are much less common than with traditional vein stripping. Typically the incisions heal without scarring. Darker skinned individuals may require more time for these areas to fade. Other postoperative problems which typically resolve are discoloration of the surrounding skin, numbness, and tingling. With any treatment procedure long term recurrence of varicose veins can occur, especially if the same factors causing them remain following treatment.

HOW MUCH DOES THE PROCEDURE COST?

The cost of an ambulatory phlebectomy depends on the extent of the varicose veins to be treated. Insurance often covers the cost of treatment but may require more conservative options such as compression hose, weight loss, and exercise be initiated first before surgical therapy is undertaken. Since each patient is different, consultation and evaluation by a physician experienced in ambulatory phlebectomy is the best way to determine if this procedure is appropriate.

TREATMENT OF SPIDER VEINS

Sclerotherapy is often used to treat varicose and spider veins. Using a tiny needle, veins are injected with a solution that irritates the lining of the vein wall, causing them to collapse and gradually fade away. This procedure is performed in office, usually lasting approximately 30-60 minutes. Multiple treatments may be needed to reach desired results. For optimal results, reticular veins associated with spider veins also need to be sclerosed. Compression stockings are worn for about one week post procedure. Most patients resume normal activities immediately. An allergic reaction to a sclerosant is rare, but has been reported. Staining, or brown discoloration on the skin is a possible side effect of sclerotherapy. This staining may take six months or longer to fade. Rarely sclerotherapy may result in the breakdown of a small area of skin resulting in an open wound (an ulcer). Some patients may develop lace-like matted webs of tiny, dilated, red, blue, or purple capillaries, arterioles, or venules visible just below the skin surface after sclerotherapy. Despite appropriate treatment, spider veins may recur later in life, possibly due to the underlying genetic predisposition that led to the development of spider veins in the first place. Treating spider veins does not keep new ones from appearing, but treating new ones every few years may be appropriate to keep them from becoming too extensive. After childbearing years, which are associated with hormonal swings, spider veins may develop more slowly.