Ambulatory Phlebectomy

What is ambulatory phlebectomy?
Traditional hook phlebectomy procedures have been a standard treatment for varicose veins for many years. While this procedure provides adequate relief from the discomfort and unsightly purple bulges of varicose veins, traditional hook phlebectomy vein stripping procedures require general anesthesia in a hospital setting. Ambulatory phlebectomy utilizes local anesthesia and incisions so tiny they do not require stitches. This makes it possible to perform ambulatory phlebectomy procedures in a physician’s office or outpatient surgery setting. Since there are many types of varicose veins and numerous procedures to treat them, the first step of treatment is to schedule a visit with a physician experience in the treatment of varicose veins.

What are varicose veins?

Varicose veins affect one third of the adult population. These are veins in the legs which dilate due to a breakdown of the valves caused by increased intra-abdominal pressure, prolonged standing or heredity. Since pregnancy causes increased abdominal pressure, about three times as many women as men are affected. Varicose veins are often unsightly but they can also cause pain, leg cramping, swelling of the legs and feet along with occasional breakdown of the skin. Ambulatory phlebectomy is an effective treatment for certain types of varicose veins and can be performed on an outpatient basis.

Is ambulatory phlebectomy the best procedure for me?

Ambulatory phlebectomy is an excellent procedure for the treatment of varicose veins, but only a physician who specializes in the treatment of varicose veins and performs this procedure can determine whether this procedure is optimal for a specific patient. Following a comprehensive medical history and a complete physical examination, duplex doppler testing of the legs is performed to determine what veins are involved. With this information the physician will be able to determine if ambulatory phlebectomy is the best procedure.

What should I expect before the procedure?
The ambulatory phlebectomy procedure is performed after first having the patient walk for twenty minutes to dilate the varicose veins. The veins are then marked with a surgical marking pen while the patient is standing. With the patient supine, the area of the varicose veins to be removed is prepared with a surgical scrub solution to prevent infection. This area is then injected with a dilute concentration of local anesthetic solution which also contains epinephrine to constrict the smaller blood vessels and minimize bleeding. The purpose of the solution is for both anesthesia and control of bleeding by compressing and constricting the smaller blood vessels which are left behind.

How is the procedure performed?

Once the local anesthetic has been injected, the ambulatory phlebectomy procedure is begun with tiny incisions over the veins to be removed. The veins are then pulled through the incisions with small phlebectomy hooks. Care is taken to make these incisions along skin lines to minimize scarring. Due to their small size, suturing is not necessary. Once the procedure has been completed on one leg, absorbent bandages are place and the leg is wrapped in a compression dressing. This bandage is an important part of the healing process. The excess fluid will drain from the tiny incisions and the compression bandage will minimize bleeding.

What should I expect from the recovery?
As soon as possible following the ambulatory phlebectomy the patient is allowed to walk. This prevents blood clotting in the areas of the procedure and helps the fluid from the local anesthetic pass out of the legs and into the padded compression dressing. The patient recovers at home for the next two days returning to have the bandage removed and compression hose fitted. These compression hose will be worn for the next two to six weeks until healing is complete.

What is the long term recovery and results like?

Most patients are able to return to work within a few days of an ambulatory phlebectomy procedure. However, no prolonged standing or heavy lifting should be done by patients for a few weeks. Since ambulatory phlebectomy treats varicose veins of a certain size, other varicose veins may need to be treated at a different time with a different procedure. With small incisions, the cosmetic results of ambulatory phlebectomy are excellent.

Is ambulatory phlebectomy approved for use in the U.S.?

Ambulatory phlebectomy is an approved treatment for varicose veins in the United States. Cost of this procedure is determined by the extent of the varicose veins to be treated. Many people with varicose veins require a combination of procedures to achieve both excellent cosmetic results and relief from the pain caused by this condition. While most insurance companies will cover treatment for varicose veins, many insurance companies require a trial of conservative therapy including exercise, weight loss, and compression stockings before allowing invasive procedures such as ambulatory phlebectomy.

Disclaimer: This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.

By OnlineSurgery.com Staff
Updated: October 14, 2009

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