The phlebectomy of varicose veins procedure involves the removal of the varicose veins through multiple small 2–3 mm incisions in the skin overlying the varicose veins. First the veins are marked with the patient in standing position. Then the patient is positioned on the operating table and local anesthesia is applied. Incisions are made using a surgical blade. The most important instrument for this technique is the vein retractor or phlebectomy hook. There are two ways by which the veins can be grasped. Into the vein itself with a sharp instrument or around the vein with a blunt instrument. The phlebectomy hook is inserted through an incision and the varicose veins is hooked, extracted, and subsequently fixed with a clamp (e.g. Mosquito clamp). Next the vein is pulled out by turning or “wenching” the exteriorized part of the vein and moving the clamps as the vein is pulled out further. Dependent on the amount of varicose vein that has been removed the next incision is made 5 to 10 cm. along the pre-operative markings.

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