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Ambulatory Phlebectomy - Indications, Contraindications, Procedure, and Complications

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Ambulatory phlebectomy is a surgical procedure for removing varicose veins found near the skin surface. Refer to this article to know in detail.

Medically reviewed by

Dr. Shivpal Saini

Published At December 16, 2022
Reviewed AtFebruary 6, 2023

Introduction:

The reflux generates venous insufficiency in the circuit due to the defect in the primary valves in the location of the saphenofemoral junction, and thus this causes superficial varicose veins. Varicose veins that separate from a saphenous vein, which is incompetent, are known as branch veins; this condition is called secondary varicosities. Ambulatory phlebectomy is a procedure done in an outpatient procedure mainly done by the surgeon to extract the superficial veins. This procedure is done via a slight skin slit-like incision.

The occurrence rate of varicose veins is approximately twenty-five percent in the white population. Also, its occurrence rate is more with older age and with the hormonal condition in women. In the histological examination of these extracted varicose veins, specimens illustrate characteristics of veins that had an active reaction to hypertension of veins.

Varicose veins are enlarged and have a tortuous course with particularly bigger areas of the wall and more elevated levels of collagen. The treatment of varicose veins is included openness tracked by avulsion with a blunt hook or by the use of cautery defined by Celsus. Other names for this procedure include stab avulsion and microextraction. These procedures explain the local anesthesia and outpatient ambulatory procedures.

What Are the Principles of Ambulatory Phlebectomy?

It is a surgical technique that allows the extraction of varicose vein bulge on an emergency basis. This is done to extract varicose vein branches if it is superficial and can be palpated on the skin. Thus, it is a hassle-free procedure that can be done with other treatment procedures. Identifying if the bulge in the veins is related to venous hypertension and management of the source is significant.

Before this procedure, an assessment should be done using duplex ultrasound imaging to recognize the origin of venous hypertension. To control recurrence, the source of reflux is eradicated before this procedure. The origin of hypertension is commonly an incompetent superficial system, the great saphenous vein. If the origin of hypertension is found before the phlebectomy procedure, it should be treated preoperatively or during the phlebectomy. Shortly, surgical, thermal, or chemical norms are used to treat the reflux in the superficial axial vein.

What Are the Indications for Ambulatory Phlebectomy?

The indications of ambulatory phlebectomy include varicose and reticular veins, asymptomatic or symptomatic, to treat difficulties in varicose veins.

What Are the Contraindications for Ambulatory Phlebectomy?

The contraindications include dermatitis, which is infectious, or the patient has cellulitis in the adjacent site, intense edema peripherally, critically diseased patients, and a patient taking anticoagulants like Warfarin or drugs like Coumadin, and a hypercoagulable state.

What Are the Preoperative Measures Taken for Ambulatory Phlebectomy?

Varicose veins are marked fully before the procedure. This is done in a standing position because it is difficult to locate. This step is done using a permanent marker. Otherwise, it would be washed off while preparing the site for the procedure. The duration of this procedure relies on the character and additional venous methods being executed. When this procedure is related to intervention on the great or small veins of the saphenous, phlebectomy down the knee is done as the initial step. During saphenous therapy, there is a quick boost in endoluminal pressure in the caudal veins, which leads to bleeding if the phlebectomy procedure is executed afterward. Naturally, correction is done in the great or small saphenous vein foremost, heeded after a few weeks by ambulatory phlebectomy. The approach permits the current truncal varicosities to reduce in dimension earlier to advance methods.

How Is Ambulatory Phlebectomy Performed?

After administering anesthesia to the perivenous areas, a small incision is created adjacent to the vein. They are vertically lined, excluding those close to the knee. An unsharpened-tip spatula is introduced into the entrance. It allows a hook to be introduced easily from nearby tissues without broadening the entry slot. This is followed by the vein being held and fetched up and outside the opening. Then the vein is gripped between clamps and extracted using scissors.

Using traction softly on the hemostat in windshield wiper movement, an end of the varix is teased out of the puncture site. Successive hemostats are applied to the varix as it is removed from its place. Lengthy components can be withdrawn via one injected area. After the component is removed, the surgeon will move throughout the vein and create a new incision, and the procedure is repeated.

The doctor is prompted to clear all aspects of varix to decrease the inflammatory reaction that occurs from thrombosis. Hence as the component is extracted, there will be better results. Punching veins are identified as a unit in the vein and are connected with a feeling of pulling by the patient. The opened sites are wrapped with Steri-Strips.

What Are the Precautions to Be Followed After Ambulatory Phlebectomy?

Patients who had done the ambulatory phlebectomy drug are prescribed Oxycodone-Acetaminophen, familiarizing the patient with test Acetaminophen in origin. Orient the patient to return to the hospital the next day for bandage removal and seating class two compression hose. Instruct the patient to wear a compression hose for a minimum of two weeks. Orient the patient to return to everyday activities without strenuous exercise involving the lower extremities for at least two weeks. The review is done in two weeks, eight weeks, six months, and one year.

What Are the Complications of Ambulatory Phlebectomy?

There are only a few complications associated with ambulatory phlebectomy, but they do exist.

  • Anesthetic Complications - Due to techniques like injection-related complications.

  • Skin Complications - Includes blister formation, keloid formation, infection, hypopigmentation, and hyperpigmentation.

  • Compression Bandage Complications - Includes swelling, necrosis, and ischemia.

  • Vascular Complications - Bleeding, deep vein thrombosis, and embolism (pulmonary).

  • Lymphatic Complications - Includes lymphorrhea and lymphocele.

  • Neurological Complications - Include injury to the saphenous nerve, sural nerve, etc., and traumatic neuroma.

Conclusion:

Ambulatory phlebectomy is a procedure done to remove superficial varicose veins. This procedure is done in an outpatient setup. Thus the patient can leave home on the same day as the procedure. Preoperative assessment is mandatory for this procedure. There are a few complications related to ambulatory phlebectomy. However, the outcome is better in this procedure, and the length of recovery is quicker.

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Dr. Shivpal Saini
Dr. Shivpal Saini

General Surgery

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