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Ambulatory Phlebectomy is a microsurgical technique for the removal of varicose and spider veins. It is performed under local anesthesia in the office.
The procedure was invented by Swiss Phlebologist by the name of Muller and has been used extensively in Europe with great success over the last fifteen years. In view of the fact that it is performed in the office under local anesthesia and is a microsurgical technique, with the majority of patients not requiring skin sutures, means that it is very well tolerated by patients. It is combined with sclerotherapy (approximately 2-8 visits) and ultrasound guided sclerotherapy (approximately 2-5 visits) at some point during the treatment protocol.
The procedure is always preceded by clinical evaluation with venous testing, including a dPPG, ultrasound and venous imaging. Once a comprehensive venous map is obtained, then a patient tailored outpatient approach, in the vast majority of instances, replaces the need for stripping operations, with its high rate of recurrence and scarring. There is always a small group of patients who may still go on to require ligation with or without division of the main venous junction in the groin, but this can be done without stripping.
The procedure itself lasts approximately one and one-half hours, but the patient should allow two to three hours from arriving at the Center. On arrival, after the vital signs have been checked, an IV is placed in the patient's hand in cases of the rare need for sedation. It is view of this that we suggest that the patient have an escort to drive them home after the procedure. The course of the veins to be extracted are then marked on the skin with an indelible dye by duplex ultrasound mapping. The patient then lies down and ultrasound guided sclerotherapy is performed. Local anesthesia is then infiltrated along the course of the vein to be removed. The patient is then instructed to walk for approximately five minutes. Upon return to the operating room, the patient then lies down and is prepped with hibiclens. After a period of approximately twenty minutes, little microincisions are made along the course of the vein and through the vein itself is extracted. The procedure causes minimal, if any, discomfort. Once the veins have been removed, steri-strips are placed and then local dressing and bandaging applied. The patient is given instructions as to the care of these in the post operative period. Once the patient's leg has been bandaged, the patient is then encourage to walk around the center for twenty minutes to check that there is no bleeding and, providing there are no problems with this, the patient is then discharged home. During the remainder of that day, the patient is encouraged to elevate the legs as much as possible and on the second day to continue normal, routine activities. The patient is advised to avoid straining and high impact sports for a period of a month after surgery. At seven days, the patient returns to the Center and bandages are removed. At this time, additional sclerotherapy is begun. This procedure is a well tolerated procedure with a high success rate. Yearly maintenance will be needed. Follow-up visits are at one week , one month, two months, and three months or until the disease process is under control.
Normal post operative sequels are bruising, pigmentation, spider veins and incision scars.