Ambulatory Phlebectomy is also termed microphlebectomy and was introduced, developed, and popularized by Robert Muller, MD, who used tumescent anesthesia and tiny incisions. Specially designed hooks (Muller, Ramelet, and Varady) are used to extract the vein, which is then grasped by mosquito forceps and removed by gentle dissection and traction.
The Vein Institute of Toronto™ Technique
Ambulatory Phlebectomy is a minimally invasive surgical method used to remove surface varicose veins in the office by applying tumescent local anesthesia.
Tumescent local anesthesia is one of the major advances in vein surgery. It was developed by Klein. It has been used most commonly by dermatologists and plastic surgeons for liposuction. Recently, it has been applied to other procedures including, particularly, vein surgery.
Tumescent means swelling or distention. When we administer tumescent anesthesia, the tissues are flooded with dilute liquid anesthetic and become distended, giving an appearance resembling the outside of an orange. The French term for this is “peau d'orange”. The unique feature of tumescent anesthesia is that it involves the use of a very low concentration of local anesthetic. The large volume of fluid causes vessels to be compressed, resulting in minimal bleeding. The anesthesia achieved by this technique is excellent and has a prolonged duration, allowing the patient to get home long before the anesthesia wears off. Additionally, the post-operative discomfort seems remarkably diminished.
The incisions with the ambulatory phlebectomy procedure are tiny (stitches are generally not necessary) and typically leave nearly imperceptible puncture mark scars. After the vein has been removed by phlebectomy, a bandage and/or compression stocking is worn for a two-week period.
Ambulatory phlebectomy is most commonly utilized in the setting of failed varicose vein stripping with recurrent or remaining branch varicose veins. The second most common indication is for the removal of incompetent branch varicose veins of the greater or lesser saphenous vein with no underlying venous reflux.
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