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Ambulatory Phlebectomy: Minimally Invasive Varicose Vein Removal

Procedure Overview

Ambulatory phlebectomy (also microphlebectomy or stab avulsion) is an outpatient procedure to remove superficial varicose veins through tiny (1–3 mm) incisions.

Step-by-Step

  1. Marking: Standing, map varicosities with skin marker.
  2. Anesthesia: Local tumescent infiltration along vein course.
  3. Incisions: 1–3 mm micro-incisions at 5–10 cm intervals over vein.
  4. Extraction: Phlebectomy hook (Oesch or Müller) retrieves vein segment; vein avulsed in pieces.
  5. Closure: Steri-strips or tissue glue; no sutures needed.
  6. Compression: Gradient stockings (20–30 mmHg) for 1–2 weeks.

Indications

  • Symptomatic varicose veins (pain, swelling, heaviness, itching).
  • Cosmetic concern.
  • Residual/recurrent veins after ablation (EVLT, RFA, VenaSeal).
  • Tributaries too tortuous for catheter-based ablation.

Advantages

  • Minimal scarring (incisions fade to near-invisible).
  • Immediate symptom relief.
  • Local anesthesia only – no OR, no general anesthesia.
  • Rapid return to activity (24–48 hrs).
  • High long-term success (>90% at 5 years).

Contraindications

  • Deep venous thrombosis (acute).
  • Significant arterial insufficiency (ABI <0.8).
  • Infection at site.
  • Inability to tolerate compression.

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