Phlebectomy – Ambulatory and Micropuncture
What does the word “Phlebectomy” mean? The word comes from combining the following Greek words.
- “phleb-” or “phlebo-“: meaning “vein” (from the greek verb “phlein” meaning “to flow)
- “ek”: meaning “out of, away from”
- “tome”: meaning “cutting”
Phlebectomy literally means “cutting out vein”, or “removing vein” (Pronounced: Flee•bek•to•mee) and is used to treat phlebitis.
At Advanced Vein Care Center, we perform phlebectomy on an outpatient basis with local anesthetic which is sufficient. Phlebectomy is performed through a small 1 mm to 3 mm needle punctures in the skin rather than the traditional half-inch to one inch scalpel incisions for veins stripping, hence the term, “Ambulatory Micropuncture Phlebectomy.” After removing larger varicose veins, the puncture marks are so small, they do not require stitches. Our phlebectomy scars are barely visible for some people, and for others, they blend in with their natural skin freckles. They are noticeable only on patients who have pale skin color with no freckles or skin pigmentation.
It is very important to note that Ambulatory Phlebectomy is a supplemental procedure to EVLT. Varicose veins on the skin surface arise from an underlying vein source that is refluxing. In other words, varicose veins that are treated by phlebectomy are only the surface manifestation of an underlying venous insufficiency. As such, it does not make sense to simply remove the varicose veins without treating the underlyling refluxing veins. For this reason, most insurance companies cover ambulatory phlebectomy only after the EVLT procedure is performed. Therefore, ambulatory phlebectomy should be considered as an associated procedure to EVLT. And as one might expect, the benefits and risks of ambulatory phlebectomy are very similar to those of EVLT.
Ambulatory Micropuncture Phlebectomy: Questions & Answers
Before, During, and After Questions & Answers
Before the Procedure: Preparation
However, some patients have taken that responsibility to drive themselves to and from their Phlebectomy appointment. If you intend to do so, we advise the following:
- If your leg is in significant pain following the Endovenous Laser Treatment, do not drive.
- If your driving is potentially impaired by significant pain and discomfort in your leg or by the use of compression stockings following the initial procedure, do not drive.
- If you have chosen to take the sedative (Ativan) and therefore your driving is potentially impaired, do not drive.
- If you are currently using any narcotic pain medication (oxycodone, Percocet, or Tylenol #3, or other opioid medication: check with your pharmacist), do not drive.
- If you have any other condition or circumstance that might impair your ability to drive, please do not drive yourself.
As is the case with the initial procedure, the purpose of EMLA cream is to “dull the skin to decrease discomfort during the procedure. While it is not expected to render the leg completely numb, it will make the skin slightly less sensitive to injections and manipulation of the vein during removal.
If you have a prior history of inability to take over-the counter anti-inflammatory medications because of stomach ulcer or reflux condition, please let us know. If you have a kidney condition or are prone to inadequate kidney function, or if you are aged 65 years or greater, also let us know. If these cases apply to you, you may take Extra Strength Tylenol instead. If you have a liver condition, do not take Tylenol. Please consult with us.
If you are taking a “baby-aspirin” daily as part of your usual regimen, you should stop taking them for the days you are taking the anti-inflammatory medications. You should also stop taking Vitamin E pills, herbal or home remedies. Multivitamin pills are okay. If you have any question on these points, please call us.
Phlebectomy CANNOT be performed if your blood is still anti-coagulated on Coumadin.
Daily low-dose aspirin: While we have performed Phlebectomy safely on patients with daily aspirin regimen, we prefer that this be stopped for at least 10 days prior to the Phlebectomy procedure.
Do I have to avoid drinking coffee or other caffeine-containing food/drink products before Phlebectomy?
Bring loose clothing to the procedure and remove all foot/toe jewelry because these steps make the task of undressing and dressing in the procedure room much easier. Also bring an extra pair of underwear because sometimes the sterile solutions used to prep the groin area can stain or wet the underwear.
During the Procedure
You can bring iPad, Kindle, or even a paperback. During the EVLT procedure, our patients have been known to do all kinds of parallel activities, including Googling on their iPad, internet shopping, reading an e-Book, even catching up on their office e-mails, texting or Tweeting. One patient even studied for her state licensure exam during our procedure. (She passed 3 days later.)
A medical assistant will instruct you to stand on your feet for prolonged period of time before the procedure starts. This is in order for your varicose veins (small and large) to enlarge as much as possible so that we can see it readily to mark them for removal. You should bring reading material to keep you occupied during this time. After 5-15 minutes of standing on your feet, a medical assistant will return and discuss with you to mark the areas of the leg to be treated.
Our surgical physician assistant, Marianne Langlois, PA-C, will then come in, ask questions to update and confirm clinical information as needed, and proceed with the procedure.
- Sterile prepping and draping of the treatment leg.
- Injecting local anesthetic to the skin and subcutaneous tissue directly over the varicose veins that are to be removed.
- Removal of varicose veins that are marked.
- Afterward, your treated leg will be cleaned and bandaged, and you will receive verbal instructions on post-procedure care. You will continue the same pain medication as given for EVLT. The subsequent appointments will also be confirmed with you at this time.
- And you will walk out of the room to your friend or family who is awaiting to drive you home.
After Procedure Care
At any point after the EVLT procedure, if wearing the CS causes one of the following “problems,” then CS should be removed and worn again only if the problems disappear. They are:
- Numbness/tingling of toes, foot/ankle, or any part of lower leg
- Skin blisters, or skin discoloration or pressure marks
- Severe focal pain in the toes, foot/ankle, heel, or any part of lower leg
- Undue difficulty or complications of arthritic pain in other areas incurred while donning and doffing the stockings with physical hardship
- Other problems (call us with concerns…)
We believe that wearing the compression stockings following the procedure helpful, but it is to be considered in the context of the overall post-procedural experience of discomfort.
More moderate bleeding (larger than two inch sized staining) may require additional gauze. First, simply add additional gauze pad on top of the existing gauze pad and tape them on the wound(s) tightly. (Avoid total circumferential taping of the leg.) Second, raise your leg more than 45 degrees with pillows or lie on the floor with leg elevated against the wall. Third, put direct pressure over the area. Fourth, you may call our office if the oozing does not stop. Most important is to elevate your leg at more than 45 degrees (straight vertical against a wall if need to), so that the gravitational pressure empties blood out of the vein while the blood gets a chance to clot under direct manual pressure.
When I stood up, there was enough oozing that it soaked right through the gauze pad and stained the compression stockings. Should I be concerned?
- Simply resume recumbent (lying down) position.
- Elevate your leg to a 45-degree to 90-degree angle position on multiple pillows or against a wall.
- Reapply a bulky pressure-dressing directly over the area of bleeding and hold pressure manually for ten to twenty minutes. You can do this even over the compression stockings when removal of the stockings may be cumbersome.
- After ten to twenty minutes, stand up again to see if the bleeding has stopped. If it has not, then change the dressing and simply repeat the steps.
- If the bleeding continues despite repeated attempts of twice or more then please call our office or go to the nearest emergency department. To be sure, the chance of this occurrence is rare, but it is a potential possibility.
Importantly, if you wish to undergo cosmetic treatment of your spider veins, please let us know at the end of your Phlebectomy appointment, so that we can make an arrangement to schedule your Sclerotherapy treatment so that you do not have to pay for a separate consultation fee.
In practical terms, you should wear sunscreen products with SPF-50 (which blocks 97% of ultraviolet-B rays), and with ingredients that also help to block ultraviolet-A rays (e.g., zinc oxide, titanium dioxide, avobenzone, ecamsule, and oxybenzne). Such sunscreens usually are labeled “multi-spectrum,” “broad spectrum,” or “UVA/UVB protection.” Even better would be to wear capri pants under the sun.
The rest are the same as for AFTER-Endovenous Laser Treatment in terms of the following:
- Pain management
- Return to work
- Return to activity and exercise
- Concerns about bruising and redness
- Travel by car or airplane for prolonged periods
We look forward to answering any remaining questions you may have about vein removal and ambulatory phlebectomy. Our friendly and informed Springfield, MA office can be reached by phone at (413) 732-4242 or fill out the form below.