Ambulatory Phlebectomy

A procedure similar to ambulatory phlebectomy was practiced in Ancient Rome and described by Cornelius Celsus (56BC – AD 30). In 1950 Robert Muller a Swiss dermatologist developed this technique. This procedure is done under local anaesthesia. The vein is removed through multiple tiny incisions. The incisions do not require sutures and the procedure is followed by compression and the patient is asked to walk.

Indications

This procedure is used for the following conditions:

  • Varicose veins of the dorsal foot
  • Varicose collateral branches of the great and small saphenous veins
  • Non saphenous varicose veins
  • Veins of the dorsum of the hand
  • Infra orbital veins of the face
  • Some recurrent varicose veins

Contra Indications

This procedure is not recommended when the patient has a known allergy to local anaesthetic, suffers from ischemic heart disease, poor health and other major chronic medical problems.

Potential Complications of Ambulatory Phlebectomy:

  • Bruising and haematoma formation
  • Minor bleeding from the puncture sites
  • Wound infection
  • Damage to the lymphatics- this can cause small lymphatic collections (lymphocele), and lymphoedema nerve damage
  • Blood clots including deep vein thrombosis (DVT) or rarely pulmonary embolism (PE)
  • Growth of new small veins (telangectatic matting)
  • Scars- these may overgrow forming keloid or hypertrophic scars
  • Blisters from bandages
  • Other nerves can be inadvertently numbed causing a foot drop. This may last 2 to 5 hours
  • Allergic reaction or other reactions to the local anaesthetic

Conclusion

Ambulatory Phlebectomy is a useful procedure for the treatment of small varicose veins where the underlying vein has been treated. It is well tolerated by most patients.