Principles of Ambulatory Phlebectomy

JOSE I. ALMEIDA and JEFFREY K. RAINES

Ambulatory phlebectomy (AP) is a surgical procedure designed to allow outpatient removal of bulging varicose veins. This treatment originally was described and performed by Aulus Cornelius Celsus (56 bc-30 ad) in ancient Rome.1 However, the art of AP was revived, redefined, and practiced by the sagacious Swiss dermatologist Robert Muller in 1956. Prior to Muller's reintroduction of AP, veins were removed with relatively large incisions and ligation of venous ends. Muller developed the stab avulsion method that is now in widespread use. Characteristics of Muller's AP technique are absence of venous ligatures, exclusive use of local infiltration anesthesia, immediate ambulation after surgery, 2-mm incisions, absence of skin sutures, and a postoperative compression bandage kept in place for two days, then replaced with daytime compression stockings for three weeks.

It is of interest that after its introduction, the medical-scientific community exhibited minimal interest in Muller's AP procedure. Muller published his first manuscript on AP in 1966;2 however, AP did not gain popularity in the United States until the American surgeon Gabriel Goren published his findings in 1991.3 In contemporary vein centers, AP is a common office-based procedure performed with local anesthesia. Unless the patient's history suggests other comor-bidities, hematologic or other laboratory investigations are not generally required.

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