Large, bulging varicose veins can also be effectively removed in the office using an outpatient procedure known as ambulatory phlebectomy. You’ll be given a local anesthetic. Then the doctor makes a number of tiny needle punctures in the skin along the affected vein. A small surgical hook is then inserted to grab the vein and remove it from the leg. The procedure typically takes less than an hour. You can return to normal activities immediately after treatment and there is no scarring from the procedure. Ambulatory phlebectomy can be used alone to remove affected veins from the legs, or in combination with endovenous laser ablation or sclerotherapy. Ambulatory phlebectomy is particularly effective for large, superficial veins that are easily visible on the skin’s surface. It may be performed for cosmetic reasons, or to relieve uncomfortable symptoms caused by large varicose veins.