Ambulatory Phlebectomy
Ambulatory phlebectomy is a minor surgical procedure often
performed at same time as laser ablation of abnormally functioning
connections between the deep and superficial systems in order to
remove abnormally enlarged varicose veins. Performance of an
ambulatory phlebectomy at the same time as laser ablation should
be performed in order improve the overall function of the venous
system.  Treatment of the abnormal varicose veins at the same time
as laser ablation can result in better results in a shorter timeframe.

When abnormal veins (with malfunctioning valves) are present, the
blood does not travel in a direct manner from the legs back to the
heart, instead "refluxing" (flow in an opposite direction from normal)
back down the legs.  This abnormal direction of flow results in
recirculation of blood within the leg veins and requires any normally
functioning deep veins to work harder as they are called upon to
move venous blood up the length of the legs again and again.
Varicosities are
marked prior to
Ambulatory
phlebectomy.
Small steri-strips
are applied after
ambulatory
phlebectomy.
Depending on the number of vessels and the skill of the operator, the number of
incisions will usually range from 10 to 20 small incisions, none of which require
sutures.  

Ambulatory is usually very well tolerated when performed with good technique.  
Mild to moderate bruising can occur, especially with large varicosities.  Good
compression dressings are helpful in achieving the best results.  Small bandages
known as steristrips are placed over the incision sites and allowed to stay on for
5-7 days.  We have patients wear compression dressing for 3 days straight (72
hours without removing compression hose) and then for an additional 10 days
when on their feet after both laser ablation and ambulatory phlebectomy in order
to get the best results.
Once the abnormal reflux has been resolved with laser ablation (also known as
EVLT) and the ambulatory phlebectomy has been performed, the abnormal
circuit of reflux has been effectively removed and the work of the deep veins is
therefore reduced to the normal workload.  This results in improved venous
circulation and an overall decrease in the amount  of blood stored in the venous
system of the legs at any given time.
The first image demonstrates normal function of the venous system, the second
demonstrates venous "reflux" as blood within the deep system (marked as the CFV or
Common Femoral Vein) is  "leaked" back down the leg into the superficial system (GSV) or
greater saphenous vein.  This requires the deep system to perform more work on a larger
volume of blood since the same blood is repetitively transported from the feet and legs
back to the thigh where a certain percentage then leaks back down the leg.
To perform an ambulatory phlebectomy, the varicosities are marked with the
patient in a standing position prior to the procedure.  The patient is then prepared
and draped for the procedure in a sterile fashion and the area over the varicose
veins is anesthetized with dilute (0.1%) Lidocaine to help compress the
abnormally enlarged vessels and to numb the skin and adjacent tissues.  Very
small incisions (2-3 mm) are made over the varicosity and a special instrument is
used to "hook" the veins underneath the skin.  The varicosity is then gently pulled
above the skin surface and the vein is then removed with steady, firm retraction.
The Vein Center
11219 Financial Centre Parkway
Suite 215
Little Rock, Arkansas  72211
(501) 225-8346  (225-VEIN)
Fax  (501) 217-9819
Different techniques (sclerotherapy for instance) can also result in
excellent results and Dr. Long discusses all available treatment options
with his patients at the time of their initial ultrasound and clinical evaluation.
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