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: the skin is infiltrated by local anaesthetic; a 1-2mm 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 with suture material with the vein being left in situ. Sometimes several of these small incisions need to be made. There is minimal bleeding which is 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, which are small “band-aids”. Both legs may be treated at the one session. This may depend of various factors; including patient’s wish, the extent and type of venous disease. 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 30-40 minute walk immediately after treatment. If extensive Phlebectomy has been performed then you may be asked to return home and rest, and start your 30-40min walks the next day. It is essential that you arrange for someone to drive you home. Keep the leg elevated as much as possible for the first 24 hours and walk for 30-40 minutes each day for 2 weeks. Maintain normal daytime activities and avoid standing still for long periods. Avoid strenuous physical activity such as aerobics for three to four weeks after treatment since this increases the risk of blood flow returning into the treated veins.
You are required to avoid any flights of 2-4 hours duration for 2 weeks and any flights of greater than 4 hours duration for 6 weeks after treatment. If travel is unavoidable, then the flight should be covered by subcutaneous Clexane for anticoagulation given before departure and daily for about 5 days after arrival.
A bandage and stockings are worn continuously for three days. Stockings are then worn continuously for 4 days. Stockings are then worn through the day, removing them at night and replacing them in the morning after the shower for another 7 days. It is routine practice to perform a check ultrasound scan 1 week after treatment to ensure that the treated vein is occluded 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.
