Ambulatory Phlebectomy for Treatment of Varicose Veins Workup

  • Author: Albert-Adrien Ramelet, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

Laboratory Studies

  • Hematologic or other laboratory investigations are not typically normally required, unless indicated by previous disorders revealed by patient history
  • If previous episodes of venous thrombosis have occurred, testing for a factor V Leiden and/or prothrombin 20210 mutation is recommended as these patients are poor surgical candidates.
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Imaging Studies

  • Duplex ultrasound mapping: Preoperative clinical and ultrasonographic detection and mapping of all types of varicosities and their origins are essential. Evaluation of the integrity of the deep venous system and calf muscle pump should be assessed.
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Histologic Findings

Histologic specimens of removed varicose vein typically demonstrate features of varicose veins that have had a dynamic response to venous hypertension. Varicose veins are dilated and tortuous veins with significantly larger wall areas and higher amounts of collagen. Varicose veins have a higher content of smooth muscle and elastin.

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Contributor Information and Disclosures
Author

Albert-Adrien Ramelet, MD  Specialist in Dermatology and Angiology, Switzerland

Disclosure: Servier Honoraria Speaking and teaching; OM Honoraria Speaking and teaching

Coauthor(s)

Robert Weiss, MD  Associate Professor, Department of Dermatology, Johns Hopkins University School of Medicine

Robert Weiss, MD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Dermatological Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, and MedChi

Disclosure: Angiodynamics Honoraria Speaking and teaching; CoolTouch Corp Intellectual property rights Consulting; Cynosure Grant/research funds Independent contractor; Palomar Grant/research funds Independent contractor

Specialty Editor Board

Désirée Ratner, MD  Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital

Désirée Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Phi Beta Kappa

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

John G Albertini, MD  Consulting Staff, Dermatologic Surgery, The Skin Surgery Center; Program Director, ACGME Accredited Fellowship in Procedural Dermatology

John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Tumescent anesthesia placed subcutaneously pushing the vein closer to the skin for easier removal.
Instrumentation, various hooks used in ambulatory phlebectomy.
Before and 2 months after ambulatory phlebectomy. Reflux at the saphenofemoral junction was treated with radiofrequency endoluminal ablation during the same procedure.
This vein on the calf represents a major varicose tributary of the lesser saphenous vein that was removed by means of ambulatory phlebectomy.
Instruments used for the extraction of veins by means of ambulatory phlebectomy include Ramelet, Muller, Oesch, and Varady hooks.
 
 
 
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