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Ambulatory Phlebectomy and Sclerotherapy
Joseph A. Ronsivalle, DO, FSIR; Suvranu Ganguli, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          TERMINOLOGY

          • Synonyms

            • Ambulatory phlebectomy, microsurgical phlebectomy, office phlebectomy, stab avulsion phlebectomy, Müller phlebectomy, percutaneous miniphlebectomy
          • Definitions

            • Phlebectomy: Mechanical avulsion/removal of diseased, superficial varicose vein segment(s)
              • Small hooks introduced via multiple stab incisions
              • Hooks used to avulse/remove vein segment(s)
            • Sclerotherapy: Percutaneous injection of sclerosant to thrombose diseased, superficial varicose veins
              • Foam sclerotherapy: Sclerosant mixed with air/carbon dioxide to create injectable foam
                • Can use to ablate great saphenous vein (GSV), small saphenous vein (SSV), perforating veins
            • Superficial veins: Lower extremity veins located superficial to fascia surrounding muscle compartments
              • Include innumerable venous tributaries known as collecting veins, GSV, SSV
            • Superficial venous insufficiency: Usually caused by primary degenerative disease of superficial vein wall
              • Resultant valvular dysfunction
                • Leads to venous reflux/venous hypertension
            • Venous reflux: Retrograde flow within veins in which valves fail
              • Clinically significant reflux in truncal veins lasts > 0.5-1.0 seconds following release of compression on muscular mass below vein

          PREPROCEDURE

          • Indications

            • Contraindications

              • Getting Started

                PROCEDURE

                • Procedure Steps

                  POST PROCEDURE

                  • Things to Do

                    OUTCOMES

                    • Complications

                      • Expected Outcome

                        Selected References

                        1. Gillet JL et al: Pathophysiology of visual disturbances occurring after foam sclerotherapy. Phlebology. 25(5):261-6, 2010
                        2. Kundu S et al: Multi-disciplinary quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with ambulatory phlebectomy from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol. 21(1):1-13, 2010
                        3. Schanzer H: Endovenous ablation plus microphlebectomy/sclerotherapy for the treatment of varicose veins: single or two-stage procedure? Vasc Endovascular Surg. 44(7):545-9, 2010
                        4. Bunke N et al: Foam sclerotherapy: techniques and uses. Perspect Vasc Surg Endovasc Ther. 21(2):91-3, 2009
                        5. Carradice D et al: Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg. 96(4):369-75, 2009
                        6. Franz RW et al: Transilluminated powered phlebectomy surgery for varicose veins: a review of 339 consecutive patients. Ann Vasc Surg. 23(3):303-9, 2009
                        7. Jung IM et al: Combined endovenous laser treatment and ambulatory phlebectomy for the treatment of saphenous vein incompetence. Phlebology. 23(4):172-7, 2008
                        8. Dietzek CL: Sclerotherapy: introduction to solutions and techniques. Perspect Vasc Surg Endovasc Ther. 19(3):317-24, 2007
                        9. Sadick NS et al: Combined endovascular laser plus ambulatory phlebectomy for the treatment of superficial venous incompetence: a 4-year perspective. J Cosmet Laser Ther. 9(1):9-13, 2007
                        10. Sadick NS: Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Adv Dermatol. 22:139-56, 2006
                        11. Olivencia JA: Minimally invasive vein surgery: ambulatory phlebectomy. Tech Vasc Interv Radiol. 6(3):121-4, 2003
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Preprocedure

                            • Procedure

                              • Post Procedure

                                TERMINOLOGY

                                • Synonyms

                                  • Ambulatory phlebectomy, microsurgical phlebectomy, office phlebectomy, stab avulsion phlebectomy, Müller phlebectomy, percutaneous miniphlebectomy
                                • Definitions

                                  • Phlebectomy: Mechanical avulsion/removal of diseased, superficial varicose vein segment(s)
                                    • Small hooks introduced via multiple stab incisions
                                    • Hooks used to avulse/remove vein segment(s)
                                  • Sclerotherapy: Percutaneous injection of sclerosant to thrombose diseased, superficial varicose veins
                                    • Foam sclerotherapy: Sclerosant mixed with air/carbon dioxide to create injectable foam
                                      • Can use to ablate great saphenous vein (GSV), small saphenous vein (SSV), perforating veins
                                  • Superficial veins: Lower extremity veins located superficial to fascia surrounding muscle compartments
                                    • Include innumerable venous tributaries known as collecting veins, GSV, SSV
                                  • Superficial venous insufficiency: Usually caused by primary degenerative disease of superficial vein wall
                                    • Resultant valvular dysfunction
                                      • Leads to venous reflux/venous hypertension
                                  • Venous reflux: Retrograde flow within veins in which valves fail
                                    • Clinically significant reflux in truncal veins lasts > 0.5-1.0 seconds following release of compression on muscular mass below vein

                                PREPROCEDURE

                                • Indications

                                  • Contraindications

                                    • Getting Started

                                      PROCEDURE

                                      • Procedure Steps

                                        POST PROCEDURE

                                        • Things to Do

                                          OUTCOMES

                                          • Complications

                                            • Expected Outcome

                                              Selected References

                                              1. Gillet JL et al: Pathophysiology of visual disturbances occurring after foam sclerotherapy. Phlebology. 25(5):261-6, 2010
                                              2. Kundu S et al: Multi-disciplinary quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with ambulatory phlebectomy from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology and Canadian Interventional Radiology Association. J Vasc Interv Radiol. 21(1):1-13, 2010
                                              3. Schanzer H: Endovenous ablation plus microphlebectomy/sclerotherapy for the treatment of varicose veins: single or two-stage procedure? Vasc Endovascular Surg. 44(7):545-9, 2010
                                              4. Bunke N et al: Foam sclerotherapy: techniques and uses. Perspect Vasc Surg Endovasc Ther. 21(2):91-3, 2009
                                              5. Carradice D et al: Randomized clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins. Br J Surg. 96(4):369-75, 2009
                                              6. Franz RW et al: Transilluminated powered phlebectomy surgery for varicose veins: a review of 339 consecutive patients. Ann Vasc Surg. 23(3):303-9, 2009
                                              7. Jung IM et al: Combined endovenous laser treatment and ambulatory phlebectomy for the treatment of saphenous vein incompetence. Phlebology. 23(4):172-7, 2008
                                              8. Dietzek CL: Sclerotherapy: introduction to solutions and techniques. Perspect Vasc Surg Endovasc Ther. 19(3):317-24, 2007
                                              9. Sadick NS et al: Combined endovascular laser plus ambulatory phlebectomy for the treatment of superficial venous incompetence: a 4-year perspective. J Cosmet Laser Ther. 9(1):9-13, 2007
                                              10. Sadick NS: Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Adv Dermatol. 22:139-56, 2006
                                              11. Olivencia JA: Minimally invasive vein surgery: ambulatory phlebectomy. Tech Vasc Interv Radiol. 6(3):121-4, 2003