Ambulatory Phlebectomy

Ambulatory phlebectomy (AP) is a minor surgical procedure designed to remove varicose vein clusters located close to the skin surface.

In many office-based venous surgery practices in the United States, AP is performed with the use of local tumescent anesthesia.

Complete surgical removal of varicose veins may be achieved in a single session or in separate sessions.

All procedures are guided with duplex ultrasound to get a “roadmap underneath the skin.” The advantage of this combination technique is that patients can expect all varicose veins to disappear after a 1-hour procedure.

Bulging varicose veins on the surface of the skin can originate from different sources. Identification of these sources is important because the source influences the treatment plan. Varicosities on the medial aspect of the thigh and calf are usually the result of great saphenous vein (GSV) incompetence.

Varicosities on the anterior thigh usually result from anterior accessory saphenous vein incompetence. These veins usually course over the knee and into the lower leg. Small saphenous vein (SSV) reflux produces varicosities on the posterior calf.

In cases where no “feeding source” is found, phlebectomy of the varicosities may be all that is required.

Imaging

We prefer mapping these veins using visual inspection and palpation; other investigators might prefer transillumination mapping using specialized vein lights. Ultrasound-guided vein hooking is useful for deeper veins.