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Is ambulatory phlebectomy a common varicose veins treatment?

This question was asked in Creve Coeur, Illinois and has 11 answer(s) as of 04/30/2013.
Is ambulatory phlebectomy a common varicose veins treatment? I was told that ambulatory phlebectomy may be best for my varicose veins in my legs. Is this procedure outdated like vein stripping? Couldn't sclerotherapy or another operation be used?


Doctors Answers (11)

Ambulatory Phlebectomy (AP) is acceptable for varicose vein treatment. Like sclerotherapy into surface veins, if an underlying cause of these surface veins isn't treated, then the outcome will not be good and recurrences are quite common. Once the underlying vein problem is addressed (via surgery, laser or sclerotherapy), then the surface veins can either be cut out or injected (AP or sclerotherapy, respectively).

For large varicose veins I recommend phlebectomy. It is not outdated by any means. When done with small micro punctures it leaves minimal to no scarring at all. Stripping is when an incision is made in the groin and ankle and the saphenous vein is literally stripped out of the leg. This has been replaced by endovenous ablation with EVLT or RF closure procedures. Sclerotherapy works well but if the veins are very large then they will become hard tender and lumpy following sclerotherapy. What I would normally do for these veins is a phlebectomy with foam sclerotherapy at the same time. This would provide optimal results.

In certain situations where a varicose vein is large and near the surface of the skin, sclerotherapy would produce inflammation (phlebitis) and brown colored staining (hemosiderin) resulting in a less cosmetically improved result. Phlebectomy may be the best treatment choice in this case. Ambulatory phlebectomy is a common and comfortable office procedure that has replaced older stripping techniques to remove varicose veins at or near the skin surface though several 1mm openings along the side of the anesthetized vein which heal rapidly without requiring sutures and usually leaves no visible marks on the skin by 1 month after the procedure. In addition, the vein is removed so there is no trapped blood to be drained or staining of the skin so you usually can not tell where the vein was by 2-4 weeks after the procedure.

In vein centers that are staffed by surgeons that have the skill, ambulatory phlebectomy is a common procedure. In my practice, it is the preferred treatment for most varicose veins. "Ambulatory", means that the patient walks to and from the procedure (i.e. no general anesthesia, no hospital admission). "Phlebectomy" means excision of veins. At VEINatlanta, ambulatory phlebectomy is performed in an office setting under local anesthesia. Tiny 1/8 inch slits are made in the skin to remove the vein. The patient can resume normal daily activity immediately. Usually there is no post-procedure discomfort. Ambulatory phlebectomy is not vein stripping. EVLT (endovenous laser therapy) and RF ablation (Venefit, Closure) have made vein stripping obsolete. In my practice, sclerotherapy is not used for bulging varicose veins, as it will cause the varicose vein to turn into a hard bulging cord. In most cases, EVLT or RF ablation is necessary to close the underlying "feeder" vein prior to performing ambulatory phlebectomy.

Ambulatory phlebectomy still has a role in treatment of varicose veins. Especially for large varicose veins very close to the surface, ambulatory phlebectomy has a lower risk of hyper-pigmentation . Abulatory phlebectomy often leaves incisonal scars has a longer recovery. On the other hand sclerotherapy can also treat varicose veins well.sclerotherapy has a bigger risk for hyper-pigmentation and it takes longer to see results. However , sclerotherapy is simpler procedure , does not have an incision scar and can be done on any type veins . In summary they can both treat varicose veins and both have some advantages.

Yes, ambulatory phlebectomy is a common varicose veins treatment.

Ambulatory phlebectomy is definitely not out dated. We do it with the tip of a knife and a hook to pull out the vein. There is minimal to no scarring after. Often depending on the size of the vein it works better than foam or sclerotherapy. With foam or sclerotherapy if the vein is larger then the person often gets a superficial phlebitis and discoloration of the vein for several months. The vein goes away quicker with phlebectomies.

The important issue is the size of the incision. If a physician performs microphlebectomy using tiny incisions, then it's a great way to remove varicose veins. I prefer this to sclerotherapy as it can be done in one setting. Sclerotherapy often requires multiple sessions. It's very important to treat the underlying cause of the varicose veins which can be accomplished with either endovenous laser ablation or radiofrequency ablation.

Ambulatory phlebectomy when done through tiny 2 to 3 mm incisions is an elegant technique to remove large varicose veins and the legs will look better faster than with sclerotherapy.

I recommend sclerotherapy and/or ablation procedures over phlebectomy. They are more effective and less invasive than phlebectomy.

Ambulatory phlebectomy, which is the removal of surface varicose veins through small incisions, is very useful as an adjunctive treatment to endovenous laser or radiofrequency ablation of saphenous veins. Ambulatory phlebectomy can genrally be done, such that the incisions may only need a steri-strip. Endovenous laser or radiofrequency ablation has largely replaced vein "stripping". However, the surface varicose veins often times still need to be treated. One can use foam sclerotherapy or phlebectomy for this. In my practice, for larger varicosities, I find phlebectomy to be a more efficient treatment, with generally superior cosmetic outcomes to sclerotherapy. Phlebectomy, combined with sclerotherapy, can also be useful for the treatment of recurrent varicose veins following prior intervention.

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