and Deep Vein Thrombosis
Avulsion Phlebectomy/Hook Phlebectomy
Avulsion Phlebectomy/Hook Phlebectomy
Avulsion phlebectomy, also known as hook phlebectomy, ambulatory phlebectomy or small incision avulsion, is a surgical procedure performed alone or together with vein stripping. During avulsion phlebectomy, the surgeon makes a series of tiny incisions in the leg to remove varicose veins with a hook.
NYU vascular surgeons have found the avulsion phlebectomy procedure highly effective in treating varicose veins.
Historically, hook phlebectomy has been performed as a blind procedure involving multiple incisions, extended surgery time, and often repeat surgeries. To address these disadvantages, vascular surgeons at NYU implemented the Trivex© System, a type of "liposuction" for certain varicose veins.
The Trivex© transilluminated phlebectomy technique increases surgeons’ ability to visualize the varicose vein removal. During the Trivex© procedure, the surgeon:
- targets the vein with an irrigated illuminator device (light passes through the skin)
- ablates (destroys) the vein with a powered resector
- visually confirms the vein’s removal
Benefits of Trivex© surgery include less pain and trauma, shorter surgery time, 50–60% fewer incisions, less anesthesia, and less chance of post-operative infection than traditionally performed avulsion phlebectomy.
More information about varicose vein treatment is available on the Society for Vascular Surgery website.
Compression Stockings
Compression stockings are strong elastic stockings that squeeze your leg to prevent excess blood from flowing backward and pooling in your veins.
Compression stockings are used for the following purposes:
- To relieve pain and swelling and help heal skin ulcers caused by varicose veins
- To manage lymphedema (limb swelling due to fluid buildup) in the legs
More information about varicose vein treatment is available on the Society for Vascular Surgery website.
Sclerotherapy
Sclerotherapy, also known as injection sclerotherapy, is a process in which the surgeon injects chemicals to irritate and scar the veins to prevent them from carrying blood. Sclerotherapy does not disturb the circulation process. Blood returns to the heart through other veins, and the body eventually absorbs the destroyed veins.
Vascular surgeons at NYU have found that varicose veins do not typically respond well to sclerotherapy. Stripping, phlebectomy, and ablation are more effective vein removal procedures. Sclerotherapy is also used to treat spider veins.
More information about varicose vein and spider vein treatment is available on the Society for Vascular Surgery website.
Vein Ablation Surgery: the VNUS Closure System
The VNUS Closure is a radiofrequency ablation system specifically designed for venous ablation (vein removal surgery). Vascular surgeons at NYU have found the VNUS Closure highly effective in treating varicose veins.
VNUS Closure surgery takes the place of surgical vein stripping. VNUS surgery is a less invasive procedure performed in the outpatient setting, with fewer incisions and shorter recovery time.
During the VNUS procedure, the surgeon:
- locates and maps the saphenous vein (main leg vein)
- inserts a catheter into the saphenous vein
- flushes the blood out of the vein with an injection of anesthetic fluid and saline
- delivers radiofrequency ablation (RF) energy through the catheter to heat the vein walls, shrinking the vein
- removes the catheter
Once the catheter is removed, the varicose vein closes and redirects blood flow to healthy veins.
See an animation of the endovenous ablation procedure (1.9MB, requires Apple Quicktime Player)
More information about varicose vein and spider vein treatment is available on the Society for Vascular Surgery website.
Vein Stripping
In traditional varicose vein surgery, the surgeon cuts and ties off the varicose veins connected to the saphenous vein (main leg vein), then removes the saphenous vein from the leg.
The procedure is less painful than it sounds, and does not disturb the circulation process in the leg. Blood circulates to the heart through other veins, and the disconnected varicose veins eventually die off and are absorbed by the body.
Varicose vein stripping is performed alone or with avulsion phlebectomy.
Incisions
Varicose vein stripping is a cosmetic procedure. Surgeons make a half-inch incision at the ankle, a 1-inch incision at the groin, and a series of other microincisions along some of the branches of the veins on the leg. Incisions are approximately 1/8 inch and heal virtually without scarring.
Day of Surgery
Varicose vein stripping is performed in the outpatient surgery unit on the 10th floor of Tisch Hospital. Patients are admitted early in the day, and the surgery takes approximately 1.5 hours. A tight dressing is applied to the treated leg.
Following surgery, patients spend approximately 1 hour in the recovery room and then discharged home. Patients typically stay in bed the rest of the day of surgery.
After Surgery
The day after surgery, most patients are up and walking normally, and the dressing is removed from the leg.
More information about varicose vein treatmen is available on the Society for Vascular Surgery website.
