Ambulatory phlebectomy is the “gold standard” outpatient procedure for varicose veins if a thermal or chemical ablation are not feasible. It is also indicated if there are residual or recurrent tortuous varicosities following ablation of the saphenous veins. It involves the removal of superficial varicose veins via extremely small incisions under local anesthesia. Although this technique can be used to treat veins of any size, it is primarily used on larger veins that bulge from the surface of the skin. Patients remain able to walk around immediately after the procedure and use compression stockings to aid blood flow and reduce discomfort.
Venous insufficiency is the inability of veins in the lower extremities to efficiently allow blood to flow back to the chest and heart. This commonly results in the formation of varicose veins in the legs. It is an extremely common problem in the United States, and some studies cite it as the seventh most common reason for medical referral in the United States. (1) These vascular structures can be asymptomatic for some people, while for others they can cause significant discomfort. However, there is always a risk of worsening skin damage and venous ulceration if left untreated.
Dr. David Naar is a board-certified vascular surgeon who specializes in varicose vein removal. He has helped thousands of patients find relief from venous insufficiency and addresses their varicose veins via straightforward in-office procedures. Call Premier Vein Clinic in Westlake at (440) 641-0433 to book an individual consultation with Dr. Naar. You can also submit your appointment inquiry via our online form.
- 1 About Varicose Veins
- 2 Benefits of Ambulatory Phlebectomy
- 3 Candidates
- 4 Personal Consultation
- 5 Ambulatory Phlebectomy Preparation and Procedure
- 6 Recovery
- 7 Results
- 8 Cost of Ambulatory Phlebectomy in Westlake, OH
- 9 FAQ
- 10 References
About Varicose Veins
Venous disease affects nearly 30 million Americans. (2) It can present in the form of smaller reticular veins and spider veins, and more severe, twisted varicose veins, which are usually larger and more prominent. Varicose veins can appear anywhere on the legs, ankles, and feet. They’re characterized by their raised, winding, river-like patterns on the surface of the skin and can be blueish-green to purple in color.
Varicose veins occur because of increased blood pressure in the veins. This damages the walls of the vein and the special one-way valves that allow blood to flow back up to the heart for reoxygenation. As a result, blood can pool, or even flow backward, causing irregularities in the shape and size of the vein over time.
Common Causes of Varicose Veins
- Hormonal birth control
- Heritable traits
Conditions that put strain on the vascular system increase the likelihood of varicose veins developing. Venous disease is classified as more clinically severe in obese patients, and pregnancy is considered to be a major contributing factor to varicose vein formation. (3)(4)
Varicose Veins: What to Look Out For
- Aching legs and leg heaviness
- Bruising and swelling
- Leg cramps, particularly at night
- Increased pain from sitting or standing for long periods
- Itching, burning, or throbbing in the legs
- Bulging, rope-like veins
- Veins are raised and blueish-purple
Benefits of Ambulatory Phlebectomy
An ambulatory phlebectomy procedure permanently removes the target vein through a small incision in the skin. This method differs from those found in other treatment techniques such as sclerotherapy and chemical foam ablation, where an irritant is injected into the vein, causing it to collapse and be gradually reabsorbed by the body. Ambulatory phlebectomy is advantageous because it:
- Is a fast, in-office procedure
- Involves small, minimally-invasive incisions
- Provides relief from discomfort
- Permanently removes unsightly veins
- Improves the appearance of the skin’s surface
- Has a short postoperative recovery period
Ambulatory phlebectomy is suitable for men and women with symptomatic or asymptomatic varicose veins and reticular veins. Patients who are experiencing discomfort and fatigue due to varicose veins should consider this form of treatment, as it can drastically reduce symptoms and improve quality of life. Ambulatory phlebectomy may not be suitable for patients with the following conditions:
- Infectious dermatitis or cellulitis in the affected area
- Severe peripheral edema
- Diseases that inhibit blood clotting
- Diseases that cause overcoagulation of blood
- Seriously ill patients(5)
Dr. Naar meets with each patient to discuss their condition before their varicose vein treatment is scheduled. There are multiple procedural options to choose from, and he will use this session to determine which course of treatment is best for your circumstances. He will discuss your medical history with you and ask you to provide some details of your lifestyle. You will also have the opportunity to detail how your varicose veins are affecting your daily life. After he has examined the area you wish to treat, he will determine the best treatment for your needs and schedule your procedure date.
Ambulatory Phlebectomy Preparation and Procedure
Preparing for Surgery
The ambulatory phlebectomy procedure does not require extensive preparation. You will not be required to fast, but Dr. Naar may ask you to take certain medications, such as muscle relaxers, before you come to your appointment, and advise you to buy compression stockings for your recovery.
Prior to your procedure, Dr. Naar will map the veins he will treat and may photograph them for postoperative comparison. For accuracy, he will ask you to stand, then carefully mark the venous structures he will target. Usually, the procedure itself is performed using local anesthesia in sterile conditions. He will administer the anesthesia to the target area and wait for it to take effect. Once the area is fully prepared, he will begin the process of vein removal using specialized tools.
For each vein, he will make a small incision to reveal the venous structure, then use a hooked instrument to expose the vein. He will then use fine-tipped clamps to grip and extract the vein carefully and accurately. Using small scissors, Dr. Naar cuts the vein and then teases it out of the body on either side. Finally, using clamps, he will remove the vein segment. Patients may experience a deep pulling sensation as the structure is excised from the body.
After this, he will move further down the vein, make another small incision, and repeat the process. The aim of the treatment is to remove all parts of the vein in question to reduce the chance of inflammatory response. (5) Where particularly large varicose veins are removed, Dr. Naar may ligate, or close off the ends of the vein, though this is not usually necessary for most veins. When the vein has been successfully removed, Dr. Naar will use surgical tape, gauze and bandages to secure and wrap the area.
Adhering to postoperative instructions is vital for your successful recovery. Dr. Naar will ask you to follow these directions after your ambulatory phlebectomy procedure:
- Take one or three days off work if required.
- Leave the dressing on for 24-48 hours before removal, unless otherwise instructed.
- Wear compression stockings for the first two weeks following treatment.
- Walk every day to promote good circulation to the treatment area.
- Resume light activities after two or three days.
- Resume more strenuous activities after about a week.
Discomfort following ambulatory phlebectomy differs from patient to patient. It is important to elevate your legs as much as possible after your varicose vein procedure to alleviate pain. Apply heat to the area and take acetaminophen to improve comfort levels. You should expect to see some swelling and bruising in the days that follow, and although rare, some patients may experience mild fluid drainage. Additionally, Dr. Naar advises patients to drink a lot of water, take frequent walks to encourage blood flow. He recommends 30 minutes of light walking per day. For the first two weeks following your treatment. Please avoid using hot tubs, lifting heavy loads, and exercise that involves standing for the duration of your recovery.
Dr. Naar will order a follow-up appointment after a few weeks to ensure your recovery is progressing as expected. Once the treatment area has healed completely, swelling and bruising will dissipate and skin that was once rippled with veins will be smoother and healthier-looking. You may continue to wear your compression stockings until otherwise directed by Dr. Naar.
Cost of Ambulatory Phlebectomy in Westlake, OH
Each ambulatory phlebectomy treatment is tailored to the needs of the patient. Because of this, there is no set cost. Dr. Naar will discuss the scope of your treatment, and pricing at your individual consultation. Most insurance will cover part of the cost.
Which treatment is better for varicose veins; sclerotherapy or ambulatory phlebectomy?
The choice of procedure for varicose veins depends on the patient. Both sclerotherapy and ambulatory phlebectomy are effective treatments for varicose veins. Where patients have noticeable clusters of veins and minor venous insufficiency, surgeons may choose sclerotherapy to shrink and eventually remove them. For larger, bulging veins and increased venous insufficiency, ambulatory phlebectomy may be more appropriate.
How painful is ambulatory phlebectomy?
Ambulatory phlebectomy is performed under local anesthetic, so discomfort during treatment is minimal. Patients might experience a pulling sensation as each segment of vein is removed. After the procedure, bruising and swelling in the area may infrequently require pain relief, which is prescribed as necessary by your surgeon.
- Fan, C.-M. (2005). Venous Pathophysiology. Seminars in Interventional Radiology, 22(3), 157–161. https://doi.org/10.1055/s-2005-921949
- Attaran, R. R. (2018). Latest Innovations in the Treatment of Venous Disease. Journal of Clinical Medicine, 7(4), 77. https://doi.org/10.3390/jcm7040077
- van Rij, A. M., De Alwis, C. S., Jiang, P., Hil, G. B., Dutton, S. J., & Thomson, I. A. (2008). Obesity and Impaired Venous Function. European Journal of Vascular and Endovascular Surgery, 35(6), 739–744. https://doi.org/10.1016/j.ejvs.2008.01.006
- Smyth, R. M., Aflaifel, N., & Bamigboye, A. A. (2015). Interventions for varicose veins and leg oedema in pregnancy. The Cochrane Database of Systematic Reviews, 2015(10). https://doi.org/10.1002/14651858.CD001066.pub3
- Kabnick, L. S., & Ombrellino, M. (2005). Ambulatory Phlebectomy. Seminars in Interventional Radiology, 22(03), 218–224. https://doi.org/10.1055/s-2005-921955