Ambulatory Phlebectomy

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Today, there are many treatments for varicose veins, including ambulatory phlebectomy. Which one is right for you? That depends on where the troublesome veins are.  We use the right treatment depending on your specific situation. Rest assured, no matter what treatment you receive at RIA Endovascular, this won’t be the vein stripping treatment of your Mother’s era!  Our procedures are minimally invasive and do not involve surgery.

What is ambulatory phlebectomy?

Sometimes called microphlebectomy, ambulatory phlebectomy is a minimally invasive procedure generally used for ropey varicose veins at the surface of the skin.  It is generally used on veins too large to treat with sclerotherapy, yet too small to treat with laser ablation.

In this procedure, the area around the vein is numbed using a local anesthetic. Through a series of tiny incisions, the troublesome vein is removed in segments. Ambulatory phlebectomy may be performed at the same time as laser treatment for a more comprehensive treatment of  your varicose veins.

Am I a candidate for ambulatory phlebectomy?

Find out if ambulatory phlebectomy— or another procedure such as sclerotherapy, foam sclerotherapy, radiofrequency ablation or laser ablation — is appropriate to treat your varicose veins. Schedule an appointment to evaluate your legs and possibly recommend a treatment plan. Should you decide to proceed, we will do:

  • A history and physical exam
  • A detailed assessment and diagnostic ultrasound of your legs
  • Photos of your legs, including pictures of varicosities for our records and for the insurance company, if applicable
  • A prescription, if needed, for compression hose
  • Explanation of potential procedures

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Before and After Varicose Vein Treatment

Before and After Varicose Vein Treatment


Why is an ultrasound performed first?

An ultrasound, called a Non-Invasive Vascular Assessment (NIVA), is used to evaluate how blood flows throughout your legs. This ultrasound, also called sonography, uses high-frequency sound waves to obtain continuous real-time images of leg blood flow. The procedure takes approximately 45 minutes per leg. The results of this test enables your RIA Endovascular physician to determine what the best treatment procedure, or combination of procedures, will serve you best.

If an ultrasound of the legs is required,  it is charged as a diagnostic procedure.  The NIVA is usually covered by insurance when ordered by a physician, so long as it is not for a cosmetic-only procedures.



Next, you will consult with RIA Endovascular medical staff.


Next you will meet with an RIA Endovascular physician or nurse practitioner to plan your treatment.  Our doctors are board-certified and fellowship-trained in interventional radiology. Our physicians are highly experienced and skilled in leg vein procedures, as well as other venous and arterial procedures (endovascular procedures) throughout the body.  We take a comprehensive whole-body approach so that we first determine, and then treat, the source of the problem before treating any resultant legs problems.Physician With Patient

We will review the ultrasound and explain the results of the test, discuss a possible plan for treatment, and provide you with a prescription for compression stockings if you decide to proceed with treatment. Once approved, the physician will perform your treatment.



Does insurance cover ambulatory phlebectomy?

Ambulatory phlebectomy is generally covered by most insurance providers, as is diagnostic testing such as the ultrasound (Non-invasive Vascular Assessment, or NIVA) exam. Compression hose are sometimes covered, but not always.  Check with your insurance provider to see what your specific insurance policy covers.

Prior to scheduling your procedure, our in-house precertification specialist will work with your insurance company to obtain precertification for your procedures.

By compressing the surface veins, arteries and muscles, the circulating blood is forced through narrower circulatory channels. As a result, the arterial pressure is increased, which causes more blood to return to the heart and less blood to pool in the feet.

By compressing the surface veins, arteries and muscles, the circulating blood is forced through narrower circulatory channels. As a result, the arterial pressure is increased, which causes more blood to return to the heart and less blood to pool in the feet.



A few words about compression hose.

Please obtain your compression stockings as soon as possible. Practice putting them on,  We recommend using an assistive device. There are many types. Such donning devices make putting on compression hose much easier! Learn more about compression hose here.



How do I prepare for the procedure?

  • Please allow one-and-a- half (1 1/2) to two (2) hours for each procedure.
  • Please bring the compression stockings with you. This is very important.
  • Plan on signing consent forms.
  • You will have the option of taking Valium for your procedure, which we will provide at the time of your treatment.  If you plan on taking the Valium, you must have someone drive you home.
  • After the consent forms are signed, we will give you the Valium.
  • We will then prep and drape the leg.  The room will be darkened during most of the procedure.
  • At the end of the procedure, we will assist you in putting on the stocking.
  • You will be given home-care instructions and a prescription if necessary.
  • An office visit will be scheduled 7 to 10 days after your procedure.



How is ambulatory phlebectomy performed?runner

The microphlebectomy procedure itself takes only about 45 minutes to an hour.

It is performed under mild sedation (Valium). During the ambulatory phlebectomy procedure, the veins are numbed with a local anesthetic. Tiny 2-3mm skin punctures are made so that the veins can be removed.  The punctures are small, so there are no stitches. Instead, a small steri-strip bandage is used; this small bandage can be removed the next day.



What is recovery like?

Most patients can usually stand and walk after the procedure, and can return to work the next day. Patients are usually asked to wear compression hose for two weeks. The marks left by the punctures usually do not leave a permanent scar and fade away in a few months.



Why choose RIA Endovascular for your vein care?

RIA Endovascular Waiting Room

Our office is modern and comfortable. You will always be treated by a medical provider — never an aesthetician or incentive-motivated staff. At RIA Endovascular, we use the latest technologies.

RIA Endovascular offers a complete range of minimally invasive, clinically proven treatment options for varicose veins — both cosmetic and symptomatic — including laser ablation, ambulatory phlebectomy, foam sclerotherapy and radiofrequency (RF) ablation procedures.  Our experienced endovascular surgeons, when not in the office, have performed thousands of image-guided procedures in hospital settings.

Our medical clinic is more than a leg vein center; our physicians practice a full range of venous and arterial procedures.  If your leg vein problem is actually a symptom of a greater endovascular issue, our physicians are able to assess and treat the problem at its originating point.

You’ll be in good, steady hands!



Schedule your appointment now.

We will help you to assess your legs to determine what the best treatment is for you among a variety of vein treatment options.

Call 720.496-3406.