Avulsions (phlebectomy): what to expect

What avulsions (phlebectomy) are designed to do

Avulsions (also called phlebectomy) remove bulging surface varicose veins through tiny cuts in the skin. They are often used when veins are large and ropey, or when you want a more immediate reduction in the visible bulge than foam alone is likely to achieve.

Avulsions treat surface branches, not the main trunk reflux

If your duplex scan shows reflux in a main trunk vein (such as the great saphenous vein), treating that trunk vein first (often with radiofrequency ablation) can be important for a durable result. Avulsions are then used to deal with the remaining surface veins.

What happens on the day (step by step)

Most people are surprised by how straightforward avulsions are. They are usually done under local anaesthetic as a walk-in, walk-out procedure.

1. 1
   Your leg is marked while you are standing, so the veins are easy to see and target

2. 2
   Local anaesthetic is injected along the planned areas

   This stings briefly, then the skin goes numb.

3. 3
   Tiny cuts are made (a few millimetres)

   A small hook is used to tease out sections of the vein and remove them.

4. 4
   The cuts are usually closed with small adhesive strips rather than stitches

5. 5
   A dressing and compression stocking are applied, and you are encouraged to walk straight away

What it feels like during and after

During the procedure, most people feel pressure and pulling rather than pain once the local anaesthetic has taken effect. Afterwards, bruising and tenderness are common, and this is usually the main price of getting rid of the bulging veins.

A typical recovery timeline

1. 1
   Days 13

   The leg feels bruised and tight. You can walk normally, but it may feel sore if you overdo it.

2. 2
   Days 4-14

   Bruising can look dramatic, then starts to fade. Tender lumps can be felt where veins were removed.

3. 3
   Weeks 36

   Most bruising settles. Firmness and small lumps soften gradually.

4. 4
   Months 23

   The final cosmetic result becomes clearer as the skin and tissue fully settle.

What the scars are really like

The cuts for avulsions are very small, and most people find the marks heal extremely well. Early on, you may see tiny red dots or faint lines. Over time these usually fade and become difficult to spot unless you are looking for them.

What affects how visible marks are

• Your skin type and how you heal in general.
• How much bruising you get (bruising is common, but varies a lot).
• Whether you are prone to pigmentation after inflammation.
• Following aftercare advice, including compression and regular walking.

When avulsions are a better choice than foam

Foam sclerotherapy is excellent for many veins, but it is not always the best tool for large, bulging surface veins. In those cases, avulsions can give a faster, cleaner result.

Avulsions may be preferred if

• The veins are large and ropey, and you want them gone rather than gradually fading.
• You want a more immediate change in the bulge of surface veins.
• You are happy to accept bruising and tiny marks as part of the trade-off.
• Your scan suggests the underlying reflux is being treated appropriately.

When to seek urgent advice