Ambulatory phlebectomy is a safe, effective and valuable technique to remove larger varicose veins.

Phlebectomy is also known as microphlebectomy, stab avulsion of varicose veins or ambulatory phlebectomy.

Phlebectomy means the removal of veins.

Phlebectomy should not be confused with stripping which was done under general anesthesia.

Stripping involved removal of the saphenous veins and multiple large incisions over the surface varicose veins which resulted in ugly scars and significant pain.


Ambulatory phlebectomy is a safe, effective and valuable technique to remove larger varicose veins.

A needle is used to make mini incisions over the bulging surface vein after it has been numbed with local anesthesia.

This procedure is done in the comfort of our office. It was developed in Europe over fifty years ago.

It was only recently gained wide acceptance adapted into practice in the United States after introduction of minimally invasive techniques including laser and radiofrequency.

Its main advantages are superior cosmetic results and minimal discomfort afterwards.

The offending veins are first marked in the standing position.

laser vein treatment

Marking the veins with transillumination can further help localize their position.

Tumescent anesthesia is used to numb the varicose veins and the surrounding tissues.

It involves the subcutaneous infiltration of large volumes of dilute lidocaine and epinephrine buffered by sodium bicarbonate.

The resulting vasoconstriction along with Trendelenburg positioning with elevation of the legs allows for minimal blood loss during the procedure.

Occasionally, oral sedation is given if requested.

The phlebectomy technique involves the removal of varicose veins through tiny mini incisions that if done properly result in no scarring at all.

After local anesthesia is applied around the veins, the varicose veins are grasped with a tiny hook that looks like a crochet hook.

The varicose veins are exteriorized, grasped with a hemostat and then avulsed. The varicose veins are removed in pieces from one needle hole to the next.

It is a tedious procedure. It takes patience on the part of the doctor especially when there are large amounts of veins.

Sometimes with extensive varicose veins, the procedures may need to be staged.

Phlebectomy can only remove veins on the surface of the skin. Deeper abnormal veins may be closed by heat using laser or radiofrequency only if they are long and straight enough to allow the introduction of a catheter.

Afterwards compression support stockings are worn for about a week sleeping in them only on the night of the procedure in most cases.

Patients tolerate the procedure very well and recover faster than after sclerotherapy of large varicose veins.

With phlebectomy, afterwards there is little or no irritation of the surrounding veins, phlebitis, or hyperpigmentation which is typical with sclerotherapy.

With sclerotherapy, the alternative method of treating surface varicose veins, these complications are more common to varying degrees.

Complications are rare.

They include most commonly bruising, new spider veins in less than 2%, and occasionally pigmentation which eventually resolves.

There is no chance of recurrence when the offending veins are completely removed.

Normal activities can be resumed the following day.

Pain is minimal and most patients do not require any pain medication at all.