Ambulatory Phlebectomy Before and After

March 15, 2012

Ambulatory phlebectomy is one of the vein treatments available for removing large superficial varicose veins. Before you have the procedure done, your doctor will first make sure there are no other veins which are causing the problem and which need to be removed first. The treatment is less painful and has less downtime than vein ligation & stripping. Instead of removing the entire vein in one go this procedure makes tiny incisions and removes the vein piece by piece. Usually you don’t need to go under since in most cases only local anesthetic is needed for the incisions. The cuts are only 2-3mm, which means there’s no scarring after the surgery, so you won’t need to be ashamed of your legs after the treatment. Being an outpatient procedure, you can leave the clinic straight away by walking or driving. You wouldn’t be able to do this if you had the veins stripped. You will still need to wear compression stockings for about a week or two following this vein removal method. After you remove the tights, you will be able to appreciate your legs once again without the raised bulging veins popping out of it. An even less invasive way of getting rid of varicose veins is Endovenous Vein Laser Treatment (ELVT). However this can be much more expensive than ambulatory phlebectomy.

Before and after photo

Right Leg Ambulatory Phlebectomy #1

Photo #1

Martha was referred to a specialist by her local doctor with her large varicose vein protruding from behind one of her hind legs. She states the vein made her leg look utterly disgusting and would have done anything to have it removed. The specialist advised an ambulatory phlebectomy would do the best job removing this large vein. She felt she had no other choice but to go ahead trusting the surgeon. The surgery completely removed the varicose vein.

How it’s performed?

Ambulatory phlebectomy is a relatively safe procedure. First the doctor will examine the patient by listening to the veins. They are looking for the direction of travel of blood in the vein. If the blood is traveling the wrong way, this makes a distinct noise which the doctor is able to pick up and diagnose the varicose vein. Once the condition is confirmed, the doctor uses a special light which enables them to clearly see the vein. The location is mapped using a black permanent marker.

Next, you will need to lie down on the operating table. To make sure you don’t suffer unnecessary pain, the doctor will use antiseptic and inject local anesthesia to numb the necessary areas. You won’t feel the needle, just the fluid entering. Your leg is then cleaned. Once numb, the process to remove the vein itself begins. The procedure doesn’t involve cutting anything open and exposing the inside of the body, so there’s minimal risk of infection.

A tiny scalpel is used to make minute incisions like pin pricks. A petite crochet hook is then inserted into the skin and is used to catch and wind the vein around it. The doctor pulls out the vein, which looks white because it’s devoid of blood. The process is repeated section by section as the vein zigzags up the leg. You should not feel a thing while this is all happening.

Before treatment

You do not need to be in pain or debilitated from your varicose veins before you consider treatment. Many people have them removed to improve the appearance of their legs and to enable them to wear shorts or skirts without being self-conscious about their veins. There’s nothing less feminine about a woman who wears a dress and has big varicose veins bulging from her skin. Once you get to this stage, there’s not much you can really do to make the vein disappear or even to reduce its size and visibility. Some claim that at-home hydrotherapy treatment can make them smaller by stimulating circulation. This could be an option to try..

If you’re only at the verge of starting to get leg veins, you might want to consider trying some natural ways to help prevent their formation. There are diets available, home remedies and other therapies such as acupressure and aromatherapy. They may not work for everyone. If your budget is tight, you may need to consider surgical stripping. Although you will save a few hundred dollars, there’s lots of down time and pain involved with this procedure. In addition to surgical removal, you also have the option of choosing sclerotherapy (injections) and laser therapy. Wearing compression stockings and keeping your leg elevated is not really a cure for leg veins. It won’t make them disappear but it may alleviate some of the discomfort.

More ambulatory phlebectomy before and after photos >>>>

Risks, complications & side effects

During the procedure, there is little risk of pain. Since the cuts are only small (pinprick size), the local anesthesia is enough to numb you from feeling any aching or stinging. Not many patients have discomfort after either. If there is postoperative pain, this is usually alleviated with ibuprofen or other pain medication. Most people don’t need prescription strength meds to numb their senses. You could end up with temporary discoloration at the site of surgery. This is quite rare, but if you do end up getting this side effect, you may want to hide your legs for a little while. If you are concerned about your legs looking awful after the procedure, then it may be best to have the operation in winter so you can conceal your legs with long pants or stockings.

Other risks which are rarely experienced include bleeding, swelling and even infection. You could also end up reacting to the anesthesia. As for sensation, there is a small chance of having patches where you can’t feel very well near the site. This doesn’t seem like a great issue for many patients, since the benefit of having nicer looking legs or removing symptomatic veins far outweighs losing some sensation in parts of the leg. With a qualified vein surgery, there should be no complications during the procedure and side effects are also minimal.

Recovery time

Unlike surgical stripping and ligation (a more invasive surgical vein removal method), the downtime is very minimal after the operation. Most patients are even able to drive home after an ambulatory phlebectomy and go back to work the following day. Whilst it would be nice to have a day off work, those who simply cannot afford to miss a day or workaholics are happy to know they have the option of returning. After returning home from the clinic, patients are often up and about doing their daily thing including cooking dinner and watching tv.

Most of the wounds will take about two to three weeks to heal, however you may be waiting two to three months before you see the final cosmetic results. This may sound like a long time, but you will actually see an improvement in how your legs look immediately after the operation. The preoperative symptoms also improve instantaneously.

As for exercise, you shouldn’t be doing any significant activity which involves the legs for at least 48 hours after the procedure. So whilst you can go home and move about, don’t go jogging or booking in a spin bike lesson for when you get home. You should be waiting at least two to three weeks before attempting vigorous activity. You’ll need to wear your dressing on until the second postoperative day. Compression stockings help the recovery process. Most surgeons will recommend that you wear them for the first fortnight to three weeks. This is another incentive to have this surgery in the colder months.

After surgery

There’s nothing like getting brand new legs to flaunt around. If your veins caused you pain and made walking hard, you will feel like a new person after the surgery. Living with pain is not pleasant and it’s nice to know you have options to remove it from your life. Eliminating aching will give you a new burst of life, with increased energy and vitality. If you had the veins removed for cosmetic reasons, this will also make your everyday life easier in addition to boosting your self-love. You will no longer be searching for longer garments just for the sake of hiding your legs and veins won’t be a consideration when dressing up for work or even a date.

After this operation, you can remain confident that the problem vein won’t return to haunt you again. However, you need to be aware of the possibility that other veins can emerge and become raised and problematic. There is no guarantee of preventing more veins from appearing, the ambulatory phlebectomy only deals with the ones which are removed, not future veins. The blood which originally ran through the dead removed veins still needs to pass through the network. This is why doctors check for sufficient deeper veins to take on the extra blood flow before doing the operation. Sometimes new sources of varicose veins can occur and this is why you could see a recurrence of bulging veins a few years after the original operation. You may end up never getting any more, or it could take ten years or perhaps even two, depending on your lifestyle and your propensity for varicose veins.


This procedure usually costs between $1,000 and $2,000. The price will depend on the clinic’s charges, how many varicose veins need to be removed, their complexity and severity. It typically includes an ultrasound to ensure necessary blood flow following the operation. The cost of compression stockings is normally not part of the overall price and you’ll need to purchase them separately.

Symptomatic veins which cause you pain and discomfort and debilitate you are covered by most health insurance plans. You need to look at your insurance coverage carefully to see what’s required. Usually you will need to try an alternative treatment first such as wearing a support hose for at least six weeks. The cost is definitely not covered if you just want to make your legs look better (cosmetic reasons).


I had very bulging varicose veins in my calves, running up to my thigh. I had these removed with surgical ligation and stripping about 11 years ago. The recovery wasn’t pretty. I couldn’t walk for three weeks. It was difficult to do anything really. My husband didn’t help out, which made looking after my small children extremely hard. I didn’t have insurance and I didn’t have the funds to choose a procedure with lighter side effects. I’m grateful that the veins were removed but I would never go through that recovery again. In the past year blue veins has started to rise in the calves again. Ambulatory phlebectomy seems like a much better option than stripping the whole vein in one go. I am booked for a consult next week but I’m still freaking out about the downtime. At least I have a more understanding and helpful partner now to help me move around the house or even make me a nice meal or two J

Submitted by Cassandra on April 30, 2012

YouTube video

This YouTube video is by Endovenous Associates explains the ambulatory phlebectomy procedure to remove varicose veins.  The process starts with vein mapping. Using a magic marker, the veins are marked properly because they flatten out once the patient lays down. They appear because the blood is not moving properly through the veins. Local anesthesia is used. The veins is removed through tiny incisions and there’s no scarring with smaller veins. Bigger veins usually need larger incisions (but typically not more than 2mm in length). The procedure may be covered by insurance.

More before and after photos

Before and After Varicose Vein Ambulatory Phlebectomy #5

Photo #2

Marge suffered from varicose veins on both her legs from years of hard work working as a cleaner at a local hotel. A cosmetic surgeon recommended removal via ambulatory phlebectomy which she happily agreed to. The surgery removed all the large veins poking out of her legs and she’s satisfied with her decision to go ahead with it.

Photo #3

Sammy developed large bulging unsightly veins pushing out of one of her legs and needed surgery. Several weeks after the scars healed the after photo was taken and as you can clearly see there is a massive difference.

Ambulatory Phlebectomy of Leg Before and After Photo #7

Photo #4

As Nathan aged varicose veins developed on only one of his hind legs which a friend pointed out making him very embarrassed and wanting help. The veins looked like worms under his skin making him look unhealthy. The ambulatory phlebectomy he was advised to have helped him a great deal. After the scars healed there’s almost no trace of the veins.

Before and After Picture of an Ambulatory Phlebectomy #10

Photo #5

One of Joshua’s legs developed unsightly varicose veins at the age of 58. His insurance paid for the entire treatment saving him hundreds of dollars. The procedure completely removed all the large veins on his affected leg.

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