Ambulatory Phlebectomy (AP) is a surgical procedure allowing outpatient removal of visible veins. Essentially, almost all sizes of veins can be treated with this method.
Originally described by Cornelius Selsus (56 BC – 30 AD)!
Method: local anaesthetic is injected into the skin and a 1-2 mm incision is made. A specially designed Phlebectomy hook is utilised to grasp the vein, which is then extracted through the small incision. Part or whole of the varicose vein is extracted. Sometimes the vein will be ligated (tied off) with suture material and the vein left in place. Sometimes several of these small incisions need to be made. Bleeding is minimal and can be controlled by local pressure.
Complementary methods of venous treatment, including foam injection sclerotherapy and endovenous laser ablation sclerotherapy may be performed at the same time if necessary. The incisions are either left open or are closed by using steri-strips (small “band-aids”). Both legs may be treated in the one session but this depends on various factors, including patient’s wishes, and the extent and type of venous disease present. If follow-up therapy is needed, this would usually be performed two to four weeks later.
What should you do after phlebectomy / vein ligation?
You may be asked to go for a 20-30 minute walk immediately after treatment. If extensive Phlebectomy has been performed then you may be asked to return home and rest, and start your 20-30 minute walks the next day. You may be asked to keep the leg elevated as much as possible for the first 24 hours and walk for 20-30 minutes each day for one week. Maintain normal daytime activities and avoid standing still for long periods. Avoid strenuous physical activity such as aerobics for 2-3 days after treatment since this increases the risk of blood flow returning into the treated veins.
You are required to avoid any flights of longer than 2-4 hours duration for 4 weeks and any flights of greater than 4 hours duration for 6 weeks after treatment. If travel is unavoidable, then anticoagulants should be administered prior to the flight.
Stockings are worn continuously for 4 days and nights. They are then worn continuously for 3 days but removed at night. It is routine practice to perform an ultrasound scan 1 -2 weeks after treatment to ensure that the treated vein has been treated 100% successfully and to exclude the very small risk of DVT. If follow-up therapy is necessary to treat residual veins, this is performed about 2-4 weeks later.
What can you expect following phlebectomy / vein ligation?
The following features are expected. They are not a cause for concern although they should be reported at review:
What are the possible complications from phlebectomy / vein ligation?
Complications can occur even with perfect technique.