Ambulatory Phlebectomy
1 to 2 mm
the size of each incision in an ambulatory phlebectomy, closed without stitches
Muller–Varady technique, ESVS 2022 Chronic Venous Disease guidelines
30 to 60 min
typical total appointment time for a routine phlebectomy under local anaesthetic
NICE CG168 · varicose veins, day-case pathway
Same day
most patients walk out, drive home (where not sedated) and resume light activity
ESVS 2022 + Cochrane review on ambulatory venous procedures
People search for “ambulatory phlebectomy”, “phlebectomy”, “phlebitis treatment” or “thrombosed vein removal” because they have a specific, often very visible problem in the leg that they would like sorted in a single appointment, without going to hospital and without a general anaesthetic.
That is exactly the kind of work KONCEPT® is set up to do. This page covers the day-case vein procedures we perform under local anaesthetic at the Kingston clinic:
Skin lesions and the procedures around them vary widely, from routine moles, cysts, lipomas, skin tags and sebaceous lesions, through lesions with a vascular element (haemangiomas, venous malformations, glomus tumours, angiokeratomas), to standard-looking lesions made more complex by surrounding clinical factors. At KONCEPT®, the vascular surgery service and the Dermatology / GP minor-surgery service work closely together, so each patient receives the assessment and treatment best suited to their specific case.
also called “hook phlebectomy”, “stab avulsion” or “mini phlebectomy”
This is the gold-standard technique for removing visible, bulging varicose veins that lie close to the skin. The vein is hooked out through a 1 to 2 mm stab incision using a fine instrument (Muller or Varady hook), in short segments, under tumescent local anaesthetic. The incisions are so small they are closed without stitches, just steri-strips. Most patients have between 5 and 25 stabs in a leg, depending on how widespread the varicosities are.
Ambulatory phlebectomy can be performed:
Recovery: walk the same day, compression stocking for 2 weeks, light activity from day 1, return to work within a few days, full activity at 2 to 4 weeks. Bruising over the treated segments is normal and settles over 2 to 4 weeks.
See varicose vein treatment for the full algorithm of how phlebectomy combines with EVLA, RFA, VenaSeal and foam sclerotherapy.
If a varicose vein has clotted off (superficial thrombophlebitis), you usually feel a hard, hot, painful cord under the skin. Most cases settle with a compression stocking, anti-inflammatories and time. A small number remain painful for weeks because the clot is large and trapped in a thick-walled vein.
In those cases, the surgeon makes a small incision under local anaesthetic and expresses the clot. Pain relief is usually immediate.
This is offered only after a duplex ultrasound has confirmed that the deep veins are clear. If there is any concern about a deep vein thrombosis on the same side, the safer route is the NHS DVT pathway, where treatment is started in hours, not days.
See post-thrombotic syndrome for the longer-term picture after any deep clot.
A small leg wound that is not healing can need more than dressings. Under local anaesthetic, in the clinic, the surgeon can:
The first step is always a leg circulation assessment and a full ABPI · never apply compression or sharp debridement to a foot or leg with undiagnosed arterial disease.
See leg ulcers for the wound-care pathway.
Skin lesions vary widely. Some are straightforward, moles, cysts, lipomas, skin tags and sebaceous lesions. Others have a vascular element themselves, haemangiomas, venous malformations, glomus tumours and angiokeratomas. And some standard-looking lesions become more complex because of surrounding clinical factors:
At KONCEPT®, the vascular surgery service and the Dermatology / GP minor-surgery service work closely together on skin-lesion procedures. Each patient is assessed by the right clinician for their specific case, so the treatment plan reflects the lesion itself and any vascular factors around it.
A small number of procedures sit outside what we offer at the Kingston clinic. We arrange specialist referral, with second-opinion support, for:
The NHS provides comprehensive care for vascular disease, and remains the right route for many patients. KONCEPT® is designed to complement, not replace, that care.
| Step | Standard NHS approach | What KONCEPT® adds |
|---|---|---|
| Access to a consultant | GP referral, then waiting list to a vascular outpatient clinic. Timing varies by region, specialty and clinical urgency | Direct booking with a consultant vascular surgeon. Same-week appointments subject to availability |
| Consultation + diagnostic scan | Consultation and duplex ultrasound often in separate visits, depending on local availability | Consultation, ABPI and duplex on the same visit where clinically indicated |
| Day-case procedure | Day-case theatre slot allocated when reached on the list. Timing varies by local provider | Procedure scheduled with the same consultant who saw you in clinic, in our local-anaesthetic procedure room |
| Compression stockings and follow-up | Provided where local-formulary guidance applies. Collection from local outlets | Class 2 stocking fitted on the day. Wound check at 1 to 2 weeks. Written plan to take to your GP |
| Cost | Free at the point of use | Self-pay or insurer-funded. Transparent pricing on the pricing page |
| Continuity with your NHS GP | Hospital letter to your NHS GP after each visit, subject to local processes | Clinical summary letter to your NHS GP on request, with your consent, after each KONCEPT® visit |
NHS provision varies by region and clinical context, and the NHS pathway remains appropriate for many patients. KONCEPT® encourages continued NHS GP involvement and shares clinical summaries with your NHS GP on request.
KONCEPT® serves patients across Kingston upon Thames, Surbiton, New Malden, Wimbledon, Richmond upon Thames, Putney, Teddington, Hampton, Esher, Cobham, Walton-on-Thames, Thames Ditton and Twickenham. The clinic sits opposite Kingston railway station (Waterloo 28 minutes direct), with parking nearby and easy access off the A3 from Wimbledon, Putney and central London. Ambulatory phlebectomy and day-case vein procedures are routinely booked on a Saturday or out-of-hours where availability allows, so you can keep your week as usual.
Ambulatory phlebectomy is the removal of visible, bulging varicose veins through tiny (1 to 2 mm) skin incisions under local anaesthetic. The vein is gently hooked out in short segments using a fine instrument (Muller or Varady hook). The incisions are so small they close without stitches. You walk out the same day, hence “ambulatory”.
The local anaesthetic stings for a moment as it goes in, similar to a dental injection. After that, the procedure itself is not painful · you may feel pressure or tugging, not sharp pain. Most patients describe the next day as bruised but comfortable, and take simple paracetamol or ibuprofen if anything at all.
Most appointments are 30 to 60 minutes in the room. A simple cluster of varicosities on one leg can be 30 minutes. A wider area combined with same-session truncal ablation can be 60 to 90 minutes. The exact time is discussed at the consultation.
Walking the same day is encouraged. Most patients return to office work within a few days. Light activity (walking, cycling) is fine from day 1. Heavy lifting, gym work and running are usually fine from 2 to 4 weeks. A class 2 compression stocking is worn for 2 weeks.
The 1 to 2 mm stab incisions usually heal as small dots that fade over 6 to 12 months. In darker skin types, a small risk of pigment change exists and is discussed at consent. Sun protection of the treated area for the first 3 months reduces that risk.
A thrombosed (clotted) superficial vein presents as a painful, hard cord under the skin, usually over an existing varicose vein. Most cases settle with a stocking, anti-inflammatories and time. If it remains painful for weeks, the surgeon can make a small incision under local anaesthetic and express the clot, giving immediate relief. A duplex ultrasound is always done first to make sure the deep veins are clear.
Yes. KONCEPT® offers skin lesion excision under local anaesthetic with histopathology as standard for moles, cysts, lipomas, skin tags, sebaceous lesions and lesions of vascular origin (haemangioma, venous malformation, glomus tumour, angiokeratoma). The vascular surgery service and the Dermatology / GP minor-surgery service work closely together, so each patient is assessed and treated by the right clinician for their specific case, especially where vascular factors such as anticoagulation, peripheral arterial disease or a prior DVT in the same leg are part of the picture.
For most ambulatory phlebectomy or small skin-lesion procedures under local anaesthetic, anticoagulation does not need to be stopped. The decision is made on the day, by the surgeon, depending on the medication, the indication, your kidney function and the specific procedure. Never stop an anticoagulant without medical advice.
Tumescent local anaesthetic · a dilute solution of lidocaine with adrenaline, delivered along the path of the vein or around the lesion. No general anaesthetic, no sedation needed for the majority of cases.
For any tissue excision (skin lesion, biopsy of a non-healing wound, excised varicose vein where the appearance is atypical), the specimen is sent for histopathology. Results are usually returned within 2 to 5 working days, with a written outcome letter to you and to your NHS GP on request.
Many patients come expecting surgery and leave with a non-surgical plan · compression stocking, a foam sclerotherapy session, conservative management of phlebitis, or a referral to dermatology, podiatry or a TVN clinic. The consultation is the diagnostic step, not a commitment to operate.
Most major UK private medical insurers cover vascular surgery procedures with a clinical indication. Call 020 8129 1011 with your insurer and policy details and we will check what your insurer needs from us before any appointment is booked.
Self-pay fees for the consultation, ABPI, duplex, ambulatory phlebectomy and related procedures are published on the vascular surgery pricing page. A written quote is provided before any procedure is booked.
46–48 Wood Street, Kingston upon Thames, KT1 1UW. Opposite Kingston railway station (Waterloo direct, 28 minutes). Parking is available nearby. The clinic is on the ground floor and step-free.
Book a vascular consultation in Kingston and leave with a confirmed diagnosis, a written plan and a clear quote.