Phlebectomy: Mechanical avulsion/removal of diseased, superficial varicose vein segment(s)
Small hooks introduced via multiple stab incisions
Hooks superficialize vein segment(s) via stab incisions
Sclerotherapy: Percutaneous injection of sclerosant to thrombose diseased, superficial varicose veins
Foam sclerotherapy: Sclerosant mixed with room 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
Andrews RH et al: Ambulatory phlebectomy and sclerotherapy as tools for the treatment of varicose veins and telangiectasias. Semin Intervent Radiol. 38(2):160-6, 2021
Masuda E et al: The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 8(4):505-25.e4, 2020
Geersen DF et al: Phlebectomy techniques for varicose veins. Surg Clin North Am. 98(2):401-14, 2018
Kishore R et al: A prospective study in comparison of ambulatory phlebectomy and duplex guided foam sclerotherapy in the management of varicosities with isolated perforator incompetence. indian J Surg. 78(5):356-63, 2016
Gillet JL et al: Pathophysiology of visual disturbances occurring after foam sclerotherapy. Phlebology. 25(5):261-6, 2010
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
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
Bunke N et al: Foam sclerotherapy: techniques and uses. Perspect Vasc Surg Endovasc Ther. 21(2):91-3, 2009
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
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
Jung IM et al: Combined endovenous laser treatment and ambulatory phlebectomy for the treatment of saphenous vein incompetence. Phlebology. 23(4):172-7, 2008
Dietzek CL: Sclerotherapy: introduction to solutions and techniques. Perspect Vasc Surg Endovasc Ther. 19(3):317-24, 2007
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
Sadick NS: Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Adv Dermatol. 22:139-56, 2006
Phlebectomy: Mechanical avulsion/removal of diseased, superficial varicose vein segment(s)
Small hooks introduced via multiple stab incisions
Hooks superficialize vein segment(s) via stab incisions
Sclerotherapy: Percutaneous injection of sclerosant to thrombose diseased, superficial varicose veins
Foam sclerotherapy: Sclerosant mixed with room 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
Andrews RH et al: Ambulatory phlebectomy and sclerotherapy as tools for the treatment of varicose veins and telangiectasias. Semin Intervent Radiol. 38(2):160-6, 2021
Masuda E et al: The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 8(4):505-25.e4, 2020
Geersen DF et al: Phlebectomy techniques for varicose veins. Surg Clin North Am. 98(2):401-14, 2018
Kishore R et al: A prospective study in comparison of ambulatory phlebectomy and duplex guided foam sclerotherapy in the management of varicosities with isolated perforator incompetence. indian J Surg. 78(5):356-63, 2016
Gillet JL et al: Pathophysiology of visual disturbances occurring after foam sclerotherapy. Phlebology. 25(5):261-6, 2010
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
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
Bunke N et al: Foam sclerotherapy: techniques and uses. Perspect Vasc Surg Endovasc Ther. 21(2):91-3, 2009
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
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
Jung IM et al: Combined endovenous laser treatment and ambulatory phlebectomy for the treatment of saphenous vein incompetence. Phlebology. 23(4):172-7, 2008
Dietzek CL: Sclerotherapy: introduction to solutions and techniques. Perspect Vasc Surg Endovasc Ther. 19(3):317-24, 2007
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
Sadick NS: Advances in the treatment of varicose veins: ambulatory phlebectomy, foam sclerotherapy, endovascular laser, and radiofrequency closure. Adv Dermatol. 22:139-56, 2006