What is the role of the stab-avulsion technique (ambulatory phlebectomy) in the treatment of varicose veins and spider veins (telangiectasia)?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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The stab-avulsion technique (ambulatory phlebectomy) allows removal of short segments of varicose and reticular veins through tiny incisions, using special hooks developed for the purpose. This procedure is extremely useful for treatment of residual clusters after saphenectomy and for removal of nontruncal tributaries when the saphenous vein is competent.

With the patient in a standing position, duplex ultrasonography is used to map the locations of all refluxing vessels to be removed. The vessel locations are marked on the skin using an indelible marker. The position of the veins is confirmed with the patient recumbent using a vein illumination device as the position of the vein relative to the skin may change with positioning of the leg.

The leg is prepped, and the patient is draped for the procedure.

A microincision is made over the vessel using a tiny blade or a large needle.

A phlebectomy hook is introduced into the microincision, and the vein is delivered through the incision.

Using traction on the vein, as long a segment as possible is pulled out of the body, tearing it loose from its tributaries and other attachments.

When the vein breaks or cannot be pulled any further, another microincision is made and the process is begun again and repeated along the entire length of the vein to be extracted.

No ligatures are used in the procedure, and no sutures are used to close the microincisions.

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