Ambulatory phlebectomy is a minisurgical treatment for superficial

varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. These veins typically develop in the legs, just under the skin. Varicose veins usually cause few symptoms. However, some indiv ...

and so-called side branches.

History

This technique has been attributed to Dr Robert Muller a Swiss dermatologist who started experimenting with this technique in the mid-fifties of the last century because he was unsatisfied with the results of sclerotherapy. Moreover, he wanted an alternative for the large eyecatching scars patients were left with after classical varicose vein surgery. After ten years of experience he demonstrated this technique during the annual meeting of the French Phlebology Society.

Indications

General accepted indications for this technique are side branch varicose veins (semicirculatory varicose veins), varicose veins of the foot, around the ankle and the knee pit. It has been successfully used in arm varicosities and peri-ocular veins (around the eyes).

Technique

The procedure involves the removal of the varicose veins through multiple small 2–3 mm incisions in the skin overlying the varicose veins. First the veins are marked with the patient in standing position. Then the patient is positioned on the operating table and local anesthesia is applied. Incisions are made using a surgical blade. The most important instrument for this technique is the vein retractor or phlebectomy hook. There are two ways by which the veins can be grasped. Into the vein itself with a sharp instrument or around the vein with a blunt instrument. The phlebectomy hook is inserted through an incision and the varicose veins is hooked, extracted, and subsequently fixed with a clamp (e.g. Mosquito clamp). Next the vein is pulled out by turning or "wenching" the exteriorized part of the vein and moving the clamps as the vein is pulled out further. Dependent on the amount of varicose vein that has been removed the next incision is made 5 to 10 cm. along the pre-operative markings.

Results

The procedure may be performed with tumescent or local anesthesia, such as with lidocaine. It is called ambulatory phlebectomy because patients usually return to normal daily activity immediately after the procedure which therefore may be performed in hospital or outpatient settings. Ambulatory phlebectomy is considered to be more effective than

sclerotherapy Sclerotherapy (the word reflects the Greek ''skleros'', meaning ''hard'') is a procedure used to treat blood vessel malformations (vascular malformations) and also malformations of the lymphatic system. A medicine is injected into the vessels, wh ...

Post-operative care

Graded compression stockings are usually worn for 1–2 weeks after the procedure but compression bandages may also be used. This procedure is often used as an adjunct to

endovenous laser treatment Endovenous laser treatment (ELT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy commonly performed by a phlebologist, interventional radiologist or vascular surgeon. Methods Endovenous las ...

or other endovenous ablations of the greater saphenous vein.

Complications

Complications are uncommon, but include paresthesia,

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

and hematoma.

References

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