Avulsions

Avulsions, also known as phlebectomies, are used to physically remove visible varicose veins, rather than destroying them from the inside.

The main advantage of avulsions is the speed of resolution of the varicose veins.

Contents

What are avulsions (phlebectomies)?

Avulsions, also known as phlebectomies, are used to physically remove visible varicose veins. They are an alternative treatment to foam sclerotherapy either alongside or following endovenous laser ablation (EVLA).

Unlike foam sclerotherapy – which involves injections of a chemical (sclerosant) to kill off the damaged veins, which are then slowly absorbed by the body – avulsions are used to physically remove the varicose veins.

Avulsions may be undertaken at the same time as the EVLA, but they do require a considerable volume of local anaesthetic. As such, if the maximum dose of anaesthetic has already been used for the EVLA treatment, it is often necessary to undertake the avulsions during a separate visit.

What do avulsions involve?

An avulsion involves inserting a small medical tool, similar to a crochet hook, through a tiny incision in the skin. This is used to grasp the surface veins and physically remove them. The procedure is performed under local anaesthetic. The nicks in the skin require no stitches but are sealed with steristrips.

Whilst avulsions remove problem veins, they don’t treat the underlying cause of vein problems caused by venous insufficiency, and so are usually used in conjunction with EVLA treatment, as an alternative to foam sclerotherapy.

Although avulsions and foam sclerotherapy each have their own pros and cons, most of our patients are treated with foam sclerotherapy, because it is simpler and quicker, with less likelihood of post-procedure discomfort.

The main advantage of avulsions is the speed of resolution of the varicose veins. It is particularly useful, therefore, if there is a forthcoming event like a wedding that you wish to be ready for in a short timeframe.

A detailed description of the avulsions procedure

Pre-procedure

Following your initial consultation, a colour duplex ultrasound scan will have been performed, identifying the faulty veins in your legs that are to be removed. You may also have had EVLA treatment in the interim, to treat the underlying cause of your varicose veins.

You will have been provided with a full explanation of the available treatment options; including potential complications and success rates. At the start of your appointment for avulsions we will check that you fully understand all the information that has been provided to you. You will then be asked to sign the required documentation prior to the procedure.

You will also be introduced to the nurse who will be at your side throughout the treatment. The vein avulsions procedure will take place in a small treatment room, and music of your choice will be available.

The first stage of the procedure is to mark the positions of the varicose veins on your skin while you are standing up.

The procedure

Once the skin of your leg is cleaned and drapes have been applied, the tissues over the marked varicose veins are injected with a dilute local anaesthetic to make the procedure painless.

Tiny incisions are then made, either with a needle or a fine scalpel blade at intervals of a few centimetres along the course of the varicose veins. A tiny crochet hook is inserted through the incisions, allowing the wall of the vein to be grabbed, and then the vein is teased out through the incision. Using small forceps, the vein is pulled and eventually detached. Your consultant will then move on to the next incision, and then the next, meaning that we can often remove long segments of vein at a time.

Post-procedure

Once all of the varicose veins are removed, small adhesive dressings are applied to close the tiny wounds, a bandage is applied to reduce swelling and bleeding, and finally, a compression stocking is put on over this.

Your nurse will explain how to wear the compression stocking(s) and bathe in them.

You’ll also be provided with aftercare advice, including any post-treatment symptoms to be aware of. 

We will ask you to take a 10 minute walk following your appointment, prior to making your way home, in order to limit the risks of blood clots or deep vein thrombosis (DVT).

Recovery

You will need to wear a class II compression stocking, on the treated leg(s), constantly for seven days following avulsions. This shouldn’t affect your movement, but we discourage you from going swimming with it on. 

We urge you to resume your normal activities as soon as possible. Throughout your recovery period we also advise you to go for a 20-minute walk every day, to prevent clotting and to aid blood flow and healing in the legs. 

We do, however, advise you to listen to your body and give yourself time to heal. Your consultant will advise you if there’s anything you need to avoid following your avulsions procedure. 

We recommend that you avoid driving for 24 hours after having avulsions due to the after-effects and numbness of the local anaesthetic.

Most patients do not find the treatment or recovery painful. Most discomfort can be sufficiently managed with ice packs and over-the-counter medications. Downtime is also minimal, with most patients returning to work and regular activities the day after the procedure.

Treatment risks

As with all medical procedures, it’s important that you weigh up the benefits of having avulsions (phlebectomies), versus the risks of side effects. You can find a full list of risks for all our vein treatments on our treatments FAQs page.

Follow-up

It is very rare that follow-up appointments or treatments are needed after avulsions.

The main advantage of avulsions is the speed of resolution of the visible varicose veins. You should expect to see results within one to four weeks following the procedure. It is particularly useful, therefore, if there is a forthcoming event, like a wedding, that you wish to be ready for in a short timeframe.

On the flip side, the disadvantages of avulsions include an increased risk of bleeding and infection and a greater chance of nerve damage. Your consultant will make sure you are aware of anything to look out for during your recovery period.

Pricing

Information on the total costs involved in the diagnosis and treatment of varicose veins, including vein avulsions, is outlined on our self-funded pricing page. Alternatively, if you have medical insurance, please disregard our self-funding prices and refer to our health insurance page.

Frequently asked questions

What’s the difference between avulsions and foam sclerotherapy?

What’s the difference between avulsions and vein stripping surgery?

You can find the answers to these questions and more in the avulsions section of our treatment FAQs page.

If you have any other questions, please do not hesitate to contact us, and a member of our clinic team will be pleased to help.

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