Ambulatory Phlebectomy / CTEV
Vein Treatment Options
An ambulatory phlebectomy is an outpatient procedure performed to remove varicose veins through small micro-incisions in the skin. Since veins are extremely collapsible, even the largest affected veins can often be removed through tiny incisions using the ambulatory phlebectomy procedure. This minimally invasive treatment does not require sutures or general anesthesia and can easily be performed in the doctor’s office with minimal downtime. It also has fewer risks and less associated pain than with traditional surgical treatment.
Some patients seek treatment for their varicose veins for cosmetic purposes, while others are concerned about the potential risks of their damaged veins. Untreated veins can lead to pain, inflammation and discoloration. They can also affect the flow of oxygen-depleted blood between the lower legs and the heart. Ambulatory phlebectomy treats symptomatic and asymptomatic veins and can relieve both cosmetic and medical concerns in one simple procedure.
The ambulatory phlebectomy procedure is performed under local anesthesia on an outpatient basis. Dr. Brar will first identify the veins to be treated to ensure precise removal and to help preserve the health of surrounding veins and tissue. Multiple tiny 2 to 3 mm incisions will be made in the targeted areas, and a surgical micro-hook will be inserted to extract the varicose veins section by section. Patients generally do not experience any discomfort during the procedure. Compression stockings will then be worn on the treated leg for the next 3 weeks to help minimize swelling and discomfort and to help ensure an excellent cosmetic outcome. This procedure takes 30 minutes to 2 hours to perform depending on the amount of varicosities that are being removed.
After damaged veins have been removed, other healthy veins in the leg will absorb the excess blood and reinstate a normal blood flow. Functioning will not be affected by removing the damaged veins, as there are many surrounding veins to take over.
Recovery & Results
Patients will be able to walk and carry on with normal low-impact activities immediately after the ambulatory phlebectomy procedure. Patients can return to work 1 to 2 days after the procedure, but vigorous exercise and heavy lifting should be avoided for at least one week. The incisions from this procedure do not require sutures, heal on their own, and are often barely visible after 6 to twelve months and often even sooner.
Most people see effective results from an ambulatory phlebectomy, with damaged veins being completely removed. Any associated symptoms such as pain or discoloration should be relieved immediately after the procedure. Ambulatory phlebectomy offers permanent effective results for most patients, although it is possible for new varicose veins to develop. You can help minimize the risk of varicose veins by losing weight and maintaining an active life.
Although an ambulatory phlebectomy is considered a safe procedure, there are certain risks and complications associated with any surgical procedure. Some of these complications include bruising, swelling, and incomplete removal of damaged veins, which may lead to further inflammation and irritation. Temporary swelling and bruising can be minimized with compression stockings, icing, and over-the-counter medications. The most serious complication of this procedure is the development of a blood clot in a deep vein, but this risk is extremely rare and is minimized by wearing compression stockings and by staying active.
Patients who are allergic to local anesthesia, those who cannot wear prescription-strength compression stockings, and those who are not able to walk for at least 30 minutes per day should not undergo the ambulatory phlebectomy procedure. Any active infections or rashes should be thoroughly treated before this procedure as well.
CoolTouch Endovenous Laser Ablation
Treatment of dysfunctional source veins under the skin’s surface with an endovenous laser fiber procedure has revolutionized the field of phlebology, making it possible to treat these veins with a minimally-invasive, low risk office procedure that is extremely effective, very well tolerated, and has minimal downtime for the patient. The CoolTouch Endovenous (CTEV) Laser, which has a 1320 nm wavelength, is used most commonly to treat the great saphenous vein in the thigh, which is often the cause of varicose and spider veins on the front or inside of the leg. The endovenous laser procedure has taken the place of the stripping and ligation procedure, which carries with it general anesthesia, greater risks, and more downtime.
With the CoolTouch laser, a single micro-incision is made on the leg (usually near the inner knee), and the laser fiber is inserted into the abnormal source vein under the skin’s surface. The target vein is then numbed with local anesthetic, and the laser fiber is then activated and slowly and painlessly removed from the vein, during which time it gently heats and seals up the vein. The procedure takes approximately 45 minutes to an hour to perform. Patients experience minimal if any pain, bruising, or post-op complications and the success rate is 98 to 100%.
Recovery & Results
Patients will be able to walk and carry on with normal low-impact activities immediately after the CTEV laser procedure. Patients can return to work the same day, but vigorous exercise and heavy lifting should be avoided for at least one week. All that is required for post-operative pain, if anything, are over-the-counter anti-inflammatory medications. Any pre-treatment symptoms such as throbbing, aching, and leg fatigue should be immediately improved. Once the source vein is closed, the blood that was circulating through this vein is simply re-routed to other healthy veins, and often the varicose veins that were fed by this vein will greatly diminish in size and symptoms. (However, for patients with large varicose veins, immediately after the laser is performed, the varicosities are treated at the same appointment with an ambulatory phlebectomy procedure.)
Similar to the ambulatory phlebectomy, the most serious but extremely rare complication of this procedure is a blood clot in the deep vein, for which the risk is minimized by the use of compression stockings for 3 weeks and daily walking for at least 30 minutes. Therefore, patients who are unable to tolerate stockings, unable to walk for 30 minutes, or who are allergic to the local anesthetic should not undergo this procedure.