Ambulatory phlebectomy

Ambulatory phlebectomy is a surgical treatment for visible small to large tortuous varicose veins. The vein is removed through keyhole incisions under local anaesthetic, in segments, rather than being closed off and left in place.

It is performed as an outpatient procedure. The duration varies with the number of varicose veins being treated. Recovery times vary, and some patients are able to return to work the next day.

How the procedure works

A local anaesthetic is injected around the vein.
A 1-2 mm incision is made adjacent to the vein.
A phlebectomy hook is used to extract the vein through the incision. In some cases the vein is tied off and left in place instead.
A series of small punctures allows the vein to be removed in small segments along its length.

Several small incisions are usually required. Other vein treatments can be performed at the same session where appropriate. Both legs can sometimes be treated in the same session, though your individual situation determines whether that is possible or whether follow-up treatment is needed - often two to four weeks later.

When it is used

Ambulatory phlebectomy suits visible varicose veins that need physical removal rather than closure from the inside. It is one of two forms of varicose vein surgery, the other being traditional vein stripping, and it is the less invasive of the two.

It is frequently combined with endovenous laser ablation or sclerotherapy, where a refluxing trunk vein is closed first and the remaining surface veins are then removed or injected.

Common questions

Do I need the vein being removed? No. A varicose vein is already doing a poor job of transporting blood, and is causing the pain and discomfort. Once removed, the body naturally redirects blood through other veins.

Will the procedure hurt? Local anaesthesia is used so you should not feel pain during the treatment.

Will I need stitches afterwards? No. The incisions are very small, so thin adhesive strips are usually the only bandaging required.

Can both legs be done at once? Sometimes. It depends on the number and extent of the veins. Your doctor will advise whether a single session or staged treatment is appropriate.

What to expect afterwards

Some situations commonly develop after the procedure and are part of normal healing rather than complications:

Mild pain or discomfort in the treatment area.
Discolouration, or tender lumps and red raised areas over treated veins. This is generally trapped blood, and typically resolves within four to six weeks.

Where trapped blood is present, your surgeon may prick the area at a review appointment to release it. Do not attempt this yourself under any circumstances. This does not occur in every patient, and where it does occur it is a normal part of the treatment process.

General vein aftercare applies: walk up to 30 minutes daily, continue normal activities, avoid vigorous exercise in the first 24 hours, and wear compression stockings as directed by your doctor.

Risks and complications

All surgical procedures carry risks and potential complications. Complications associated with ambulatory phlebectomy include:

Minor postoperative bleeding.
Bruising.
Deep vein thrombosis (DVT) - a blood clot in a deep vein, which is a serious complication requiring prompt medical attention.
Wound infection.
Lymphatic disruption - the seeping of lymph through a puncture site.
Pigmentation.
Brown marks along a treated vein, caused by iron from the blood. These generally disappear on their own within three to twelve months.
Nerve injury causing numbness - reported in approximately 0.05% of cases.
Development of a small network of new veins, most commonly on the inside of the knee in women.
Hypertrophic scars.

Risks are discussed with you in detail during the consultation process, and you are given written information to take home. Please read our information on the risks and complications of cosmetic surgery before proceeding.

Individual responses and results may vary. Any surgical or invasive procedure carries risks, including complications, side effects and the possibility of unsatisfactory results. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.

Costs

The cost of ambulatory phlebectomy depends on the extent of the veins being treated, and is determined at consultation. You receive a full, no-obligation quote after assessment.

As at September 2024 and including GST, a vein consultation with a doctor - which may include ultrasound - is $230. Varicose vein surgery typically costs more than the less invasive treatments such as sclerotherapy (from $470) and EVLT (from $4,200). See varicose vein treatment costs.

Medicare

You may be able to claim a Medicare rebate for vein treatment. Your physician will discuss any applicable rebates at your initial consultation, and you can contact Medicare directly for further detail. A valid GP referral supports a claim.

Who performs ambulatory phlebectomy

Dr Tim French (MED0001790529) is a phlebologist with AHPRA specialist and general registration and over a decade of clinical experience in venous medicine. He holds an MBBS, a Diploma of Surgical Anatomy (University of Melbourne), and further qualifications in phlebology and ultrasound in phlebology.

See varicose vein surgery, varicose veins, or all vein treatments.