Surgical techniques to treat varicose veins include ligation (tying off of a vein), stripping (removal of a long segment of vein by pulling it out with a special instrument), and ambulatory phlebectomy (removal of veins through tiny incisions).
Ambulatory phlebectomy, introduced in the 1960's, is a minor surgical method to remove surface varicose veins. This is usually done in the office using local anesthesia.
Patients who present with infectious dermatitis or cellulitis of the area to be operated upon, severe peripheral edema, severe cardiovascular and/or pulmonary problems as well as uncontrolled diabetes and immunocompromise would not be immediate candidates for ambulatory phlebectomy.
Sometime prior to the scheduled phlebectomy procedure, the patient will undergo a lower extremity ultrasound exam to determine the status of the venous system.
Procedure
Precise preoperative varicose vein markings will be done by the physician. Local anesthesia will then be administered via injection. Vertical tiny (micro) incisions are made in the areas of interest. A surgical hook device is then introduced through the incisions to help remove the faulty veins. After the veins have been removed, the leg is washed and bandaged (incisions are tiny and stitches are generally not necessary) A compression stocking is then worn for a short period. The procedure typically leave nearly imperceptible puncture mark scars.
All patients are sent home immediately after the procedure. They usually are allowed to walk in or around the office for 10-15 minutes to check for postoperative bleeding and to be sure that the wrapping is comfortable and tolerable.
Patients are encouraged to walk as much as possible and it is recommended that everyone should bring a driver. Pain control is usually accomplished with Ibuprofen. If larger segments of veins have been removed, Tylenol with Codeine or Hydrocodone is used.
Patients usually return to the office in 7 days to have the dressings removed.
