What is a phlebectomy?

Phlebectomy, also known as ambulatory phlebectomy or avulsions, physically removes the bulging veins you can see and feel on the leg. The incisions used are only a few millimetres long, so stitches are not normally required and scarring is minimal.

Because the veins are removed at the time of the procedure, the improvement is immediate. Phlebectomy is very often carried out at the same visit as EVLA, which treats the underlying vein feeding the varicose veins.

Who is suitable?

Phlebectomy may be recommended if you have:

  • Large, bulging varicose veins on the surface of the leg.
  • Visible veins that remain after treatment of the underlying vein.
  • Veins that are too large or too close to the skin for foam sclerotherapy to give the best result.
  • Your consultant will confirm whether phlebectomy is right for you following your ultrasound scan.

At a glance

Procedure time: 30 to 60 minutes. Anaesthetic: Local. Hospital stay: Day case, walk in and walk out. Time off work: 1 to 3 days for most patients. Compression stockings: As advised by your consultant. Exercise: Walking from day one, strenuous exercise after 1 to 2 weeks.

How does phlebectomy work?

  1. The veins to be removed are marked on the skin while you are standing, when they are easiest to see.
  2. Local anaesthetic is placed along the marked veins to numb the area.
  3. A series of tiny incisions, usually two to three millimetres long, are made over the veins.
  4. The veins are gently removed in sections through these incisions using a fine surgical hook.
  5. The incisions are closed with paper strips or left to heal naturally, and a dressing and compression stocking or bandage are applied.

Aftercare and recovery

You will be able to walk immediately after your procedure, and regular walking is encouraged during your recovery. You will be asked to wear compression on the treated leg, and your consultant will advise how long this is needed and when dressings can be removed.

Bruising is expected after phlebectomy and can look quite marked for the first couple of weeks before fading. Some tenderness or firm areas beneath the skin are also normal. Over-the-counter pain relief is generally sufficient. We recommend arranging for someone to take you home.

Risks

Phlebectomy is a safe procedure and serious complications are uncommon. Risks include bruising, a collection of blood beneath the skin (haematoma), small patches of numbness caused by irritation of a skin nerve, brown discolouration of the skin, infection of an incision, and small scars. Uncommonly, a blood clot can form in the deep veins of the leg (deep vein thrombosis). Occasionally a segment of vein remains and needs further treatment. Your consultant will discuss all risks with you at consultation.

Frequently asked questions

Is phlebectomy painful?

You will feel the local anaesthetic injections, which can sting briefly. After this you may be aware of some pulling or pressure, but you should not feel pain. Soreness and bruising afterwards are common and manageable with over-the-counter pain relief.

Will I have scars?

The incisions are very small and usually heal to fine marks that fade over several months and become difficult to see.

Will I need stitches?

Stitches are not normally required. The incisions are closed with paper strips or simply covered with a dressing.

Why is phlebectomy often combined with EVLA?

EVLA closes the underlying vein that is causing the problem, and phlebectomy removes the visible veins it was feeding. Treating both at the same visit gives a more complete result with a single recovery.

How is phlebectomy different from foam sclerotherapy?

Phlebectomy removes the vein, so the result is immediate, and it is well suited to larger bulging veins. Foam sclerotherapy closes the vein with an injection and avoids incisions, but the vein takes time to fade and more than one session may be needed.

When can I return to work and exercise?

Most patients return to work and normal daily activities within one to three days. Walking is encouraged straight away. Strenuous exercise, heavy lifting and swimming are usually avoided for one to two weeks.

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