Ambulatory phlebectomy (AP), or microphlebectomy, for varicose veins is a minimally invasive form of varicose surgery performed to remove bulging varicose veins. This procedure is typically performed when a vein in the leg becomes so enlarged that it causes visible bulging veins, which may be associated with symptoms such as leg pain, heaviness, leg fatigue, swelling, discoloration or even leg ulceration. Ambulatory phlebectomy is often done in conjunction with other vein treatments offered by vein centers, such as sclerotherapy and/or endovenous laser or radiofrequency ablation. But because large varicose veins on the surface of the leg cannot typically be treated with these procedures alone, ambulatory phlebectomy is a common technique used by vein specialists at most vein centers to treat such veins.
Ambulatory phlebectomy is performed on patients if they have bulging varicose veins located near the surface of the skin. Compared to other forms of varicose surgery, ambulatory phlebectomy is a low-risk procedure, whether it is performed for medical or cosmetic purposes. Patients who undergo ambulatory phlebectomy are less likely to experience complications with bleeding and scarring compared to older methods of varicose surgery. This is often the case because the size of the incision made during microphlebectomy is usually very small.
After a patient’s legs are prepped with disinfectant solutions and local anesthesia, the ambulatory phlebectomy procedure can begin. Small incisions, usually smaller than 2-4 millimeters in length, are made into the skin near a bulging varicose vein. A small surgical hook is then inserted into the opening and hooked around the vein that needs to be removed. While the doctor pulls the vein out, the patients typically feel a mild pulling sensation rather than any pain. The incision is so small that it does not require stitching after the procedure.
Recovery time after ambulatory phlebectomy is short. During the recovery process patients wear compression stockings for about 1-2 weeks. These compression stockings are designed to promote good blood flow in the legs as the varicose veins heal. People can typically resume normal activities soon after the procedure, and aerobic activities such as walking, biking or treadmill are often recommended starting right after the procedure. Simple over-the-counter medications are generally all that are required for pain management. The patient may have some bruising and skin pigmentation, which are usually temporary. After an ambulatory phlebectomy has been performed, it is common for a vein specialist to also recommend sclerotherapy injections to treat any remaining veins. Ambulatory phlebectomy has a low risk of scarring because the punctures are so small. Because of this, some centers even refer to ambulatory phlebectomy as miniphlebectomy.
If you want to learn more about ambulatory phlebectomy or microphlebectomy for varicose veins, find a vein specialist in your community by searching in our medical directory.
Reviewed by Steven E. Zimmet, MD, RVT, FACPh
Editor of Phlebology
President, Zimmet Vein & Dermatology
Past-President, American College of Phlebology