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Ambulatory Phlebectomy
Target Veins
Larger varicose veins that are usually main tributaries off of the greater saphenous vein. These may be raised above the level of the skin causing lumps or 'twisted' veins.
How it works
This procedure involves actually removing small segments of the vein. This in turn causes clotting and scarring to occur in the remainder of the vein segments. Blood flow is disrupted and the vein scars down and essentially dries up. Ligation (tying the vein with absorbable suture) is commonly performed with phlebectomy. This helps to ensure that blood flow does not return to the vein giving it the opportunity to re-open.
Treatment Technique
This is an office procedure. The vein may be carefully marked before beginning. The leg is then cleansed with some surgical prep. Local anesthetic is then injected along the course of the vein. Following this, several small 3-4 millimeter incisions are made along the vein at roughly 5-6 centimeter intervals. Using special instruments the vein is then hooked and brought up and out of the incisions. Short segments up to 5-6 centimeters in length are segmentally removed. Ligation may be performed at this point or pressure is applied to control bleeding.
The incisions can be closed with suture or (more commonly) sticky strips called steri strips. A bulky compression dressing is then applied to the leg. Some providers will add a compression sock to this bandage as well.
Treatment Tolerance
There is some mild to moderate discomfort during the injection of the local anesthetic. However, after this there should be no pain. The patient is usually aware of some pushing and pulling or pressure sensations, but it should not be painful. Some patients find that the thought of removing veins is too much for them. In these rare cases some mild sedation is helpful.
Post Treatment Care
The compression dressing is usually left in place for around 48 hours. Following this compression hose are worn for about 7-10 days. Elevating the leg frequently for 24 hours is recommended. Return to normal daily activities is then allowed. High impact exercise is best avoided for 1 week. This is an invasive procedure so bathing, hot tubs, and swimming pools should be avoided for 1-2 weeks as well. Most patients are back to work in 2-3 days.
Results
Usually quite good with excellent patient satisfaction. The large veins treated in this fashion resolve within 2-4 weeks.