Ultrasound Guided Ambulatory Phlebectomy

Ambulatory Phlebectomy is a surgical technique that was popularised by Swiss dermatologist Dr Robert Muller in 1960's because he was unsatisfied with the results of sclerotherapy (in the time before foam sclerotherapy was invented) and unhappy with the large scars patients were left with after classical varicose vein surgery.

The procedure involves the physical removal of the varicose veins through multiple small (2–3 mm) incisions in the skin overlying the varicose veins. First the veins are marked with the patient in standing position. The patient is then positioned on the operating table and local anesthesia applied. Incisions are made using a surgical blade. A “hook” is then used to grasp the vein and remove it via the incision. The procedure is repeated at various intervals.

The main problem with this technique is that is rarely possible to remove all of the abnormal veins beneath the skin and impossible to see how much remains using this standard approach.

Dr Matar has modified this technique using his extensive experience and knowledge of procedural ultrasound guidance.

Ultrasound is used to precisely place the anaesthetic and directly visualise the veins beneath the skin to be removed and guide accurate "hook" placement.

This modified technique greatly facilitates vein removal and improves success over the standard surgical procedure. The small incisions are generally closed with "steri-strips" and usually heal with virtually no scaring.

The procedure combines the best of all technologies for vein removal and whilst it sounds awful is usually very well tolerated and allows for the most effective treatment of large varicose veins with the least chance of additional follow up treatments being required.

The procedure is performed on a "walk in – walk out" basis and patients return to normal activities immediately with strenuous activity avoided for around 1 week.

Amazing results using The latest breakthrough treatment

The vein clinic is at the forefront of vein treatments in WA and has the greatest experience of multiple vessel and combined Venaseal (glue) treatments. These amazing results were achieved with two new techniques we have pioneered. Firstly Venaseal adhesive (medical super glue) and secondly Ultrasound Guided Phlebectomy.

This 59yr man presented with large symptomatic varicose veins.

He had 20 yrs of discomfort and heaviness in his legs particularly towards end of day, night cramps and itchiness.

In view of his occupation as a cabinet maker and desire to have as little time off work and as fast a recovery as possible, a tailored two stage “walk in- walk out” treatment approach was employed.

The first stage utilised the latest virtually painless endovenous technology of Venaseal medical adhesive (as recently featured on TV) for closure of the main malfunctioning veins through a single needle puncture on each leg. Treatment of both legs was completed in under 1.5hrs.

The second stage utilised combined sclerotherapy and ultrasound guided phlebectomy of the branch vessels under local anaesthetic. The use of ultrasound allows us to identify and remove residual vein fragments that may be left behind using traditional surgical techniques.

These combined techniques allowed him to have the best of both non-surgical and surgical methods greatly reducing the need for further follow up treatments.

Symptomatic and cosmetic improvement was immediate and cosmetic improvement will continue as minor bruising settles.

A follow up is scheduled for 3 months time to ensure that these excellent results are maintained.

Pre - large veins prior to treatment

Post - 6 days following completed treatment.

  • University of Melbourne