This involves removing surface tributaries through tiny incisions under local anaesthesia as an outpatient. The incisions are left open and no sutures are used. This may be advised if the ultrasound scan has shown that there is no involvement of the saphenous veins. It is also occasionally used if the saphenous vein has been controlled by EVLA. However, the larger proportion of patients in this situation are advised to have treatment by ultrasound-guided sclerotherapy.
What are the advantages and disadvantages for ambulatory phlebectomy?
Advantages
- The procedure involves minimal discomfort.
- Large surface tributaries are suitable for either ambulatory phlebectomy or ultrasound-guided sclerotherapy (UGS).
- Both are performed as an outpatient.
- Phlebectomy gets rid of the veins more quickly with less surface reaction.
Disadvantages
- Phlebectomy requires multiple injections of local anaesthetic. UGS does not require injections of local anaesthetic.
- Phlebectomy requires surgical incisions with scars although these are small. UGS avoids incisions but does cause a reaction in the veins that takes several weeks to settle.
- There is little difference in the subsequent discomfort from either procedure and there are satisfactory long-term results with each.
What should you do before ambulatory phlebectomy?
- Advice will have been given about the type and use of stockings.
- Do not apply moisturiser to your legs on the day of treatment.
- Wear slacks or loose trousers and sandals or loose shoes to hospital to allow for the thickness of the bandages or stockings.
What happens during ambulatory phlebectomy?
- You will be lying down.
- Initial injections of local anaesthetic are made with a fine needle.
- The leg will be bandaged after the procedure.
What should you do after ambulatory phlebectomy?
- Walk for 15 minutes immediately after treatment.
- Arrange for someone to drive you home or go by public transport – it is essential that the patient does not drive on the day of treatment. Driving can resume on the following day.
- Walk or keep the leg elevated as much as possible for the first 24 hours and walk for 30 minutes each day.
- Wear the bandages and stocking continuously for 48 hours. Then wear stockings only through the day, remove them at night and replace them in the morning after the shower. Some find it easier to wear them continuously and wash the stockings in the shower. Continue this for approximately 7-10 days or longer if pain develops after they are discarded.
- Maintain normal daytime activities and avoid standing still for long periods.
- Avoid strenuous physical activity such as aerobics for three weeks after treatment although swimming is acceptable from about 3 days after treatment.
- Bring your stockings to every follow-up visit.
What can you expect and what are the possible complications after Ambulatory Phlebectomy?
Complications are rare. Infection in the small skin incisions occasionally occurs. Minor scarring can be seen in these incisions. Collections of lymph fluid at an incision is occasionally encountered and this may require surgical excision.
