What is ambulatory phlebectomy?
Ambulatory phlebectomy is a minimally invasive outpatient procedure to remove varicose veins through small punctures or incisions in your skin. Ambulatory phlebectomy is also known as microphlebectomy and phlebectomy.
What are the benefits of ambulatory phlebectomy over other procedures?
Ambulatory phlebectomy is less invasive than surgery, and because it only requires light anesthesia and small punctures or incisions, it can be performed in your doctor's office or in an outpatient surgery center.
Ambulatory phlebectomy has a short recovery time, especially when compared to surgical treatments, and has been known for its low rate of recurrence of varicose veins. Sometimes, however, ambulatory phlebectomy is performed at the same time as other surgical or non-surgical procedures. In this case, recovery from the combination of procedures can take longer.
How is ambulatory phlebectomy performed?
Your doctor will have you stand so your varicose veins can be more easily identified and marked with a felt-tip marker. The treatment area is then sterilized and local anesthetic is injected around your varicose veins. The injected anesthetic numbs the surrounding area, loosens the veins away from the adjacent tissue, and compresses the surrounding capillaries to reduce post-procedure bleeding.
Once the treatment area is numb, tiny incisions or needle pokes are made over your varicose veins, and they are pulled out in sections using special vein hooks. When all the targeted veins have been completely removed, absorbent pads are placed over the incisions and your leg is wrapped tightly in a compression bandage. The incisions that were made are so small that they don't require stitches.
What is the recovery process like?
Recovery after ambulatory phlebectomy is mild, and most people can return to work in a day or so.
You'll have to wear a compression bandage for 24 to 48 hours. It's important to get up and walk around, since the contraction of surrounding muscles helps to rid the treated areas of excess fluid, reduces the risk of blood clots, and contributes to the healing process.
Your doctor will usually remove the bandage and check the incisions a day or two after your procedure. Once the bandage is removed, you will wear compression hose for one to three weeks. Most people can return to work within a day or so. But for the first few weeks, you should avoid prolonged standing, heavy lifting, and aerobic exercise involving your legs.
What are the risks associated with ambulatory phlebectomy?
Ambulatory phlebectomy is generally considered quite safe, but complications can happen with any procedure. The most common minor complications are swelling, bleeding, or infection.
Typically, the incisions heal without scarring, but there can be hyperpigmentation — avoiding sun helps. People with a darker skin tone may require more time for the incision marks to fade.
There can also be blistering or bruising, or telangiectatic matting — reddish or purplish splotches of tiny new veins that can look like a bruise.
There may also be some local numbness in small patches. And with any vein treatment, varicose veins may eventually recur, especially if the underlying health factors that caused them are not addressed.
Is ambulatory phlebectomy approved in the U.S.?
Yes. The Society for Vascular Surgery and the American Venous Forum recommend either ambulatory phlebectomy or sclerotherapy for medium-size varicose branch (or tributary) veins.
How much does ambulatory phlebectomy cost?
The cost of an ambulatory phlebectomy depends on the extent of the varicose veins to be treated. If the procedure is needed because of an underlying medical condition, insurance often covers the cost. Insurers may require several weeks or months of conservative therapy such as compression hose, weight loss, and exercise first before ambulatory phlebectomy will be covered. Your doctor and health insurance provider can help with more specific cost information.
Reviewed February 7, 2017
