Transilluminated Powered Phlebectomy Research Articles

Randomized clinical trial of radiofrequency-induced thermotherapy combined with transilluminated powered phlebectomy versus high ligation and stripping for the treatment of lower limb varicose veins

ObjectiveThe objective of this study was to evaluate the efficacy and safety of radiofrequency-induced thermotherapy (RFiTT) combined with transilluminated powered phlebectomy (TIPP) in the treatment of lower limb varicose veins (VVs) in comparison with high ligation and stripping (HLS) combined with TIPP. MethodsThe patients with lower limb VVs were randomly assigned to RFiTT combined with TIPP or HLS combined with TIPP. The primary end point was total closure rate of the great saphenous vein at 12 months. Secondary end points included Venous Clinical Severity Score and 14-item Chronic Venous Insufficiency Questionnaire score changes at 12 months and perioperative complications. ResultsThe total closure rate of the great saphenous vein at 12 months was slightly lower in the RFiTT group (90.9% [90/99]) than in the HLS group (97.0% [98/101]) but not statistically significant (χ2 = 0.068; P = .08). Operation time, intraoperative blood loss, duration in hospital, duration in bed, and resumption of activities were statistically significantly better with RFiTT than with HLS. There were no significant differences between the groups in deep venous thrombosis, phlebitis, hematomas, pain, and infection. However, skin pigmentation and paresthesia were statistically significantly better with RFiTT than with HLS. At 12 months, both groups showed similar improvement from baseline in Venous Clinical Severity Score (1.28 ± 0.57 in the RFiTT group vs 1.33 ± 0.61 in the HLS group) and 14-item Chronic Venous Insufficiency Questionnaire score (67.32 ± 1.29 in the RFiTT group vs 67.45 ± 1.32 in the HLS group); however, neither group was superior to the other. ConclusionsRFiTT combined with TIPP is an effective treatment method for lower limb VVs and had a more satisfactory clinical outcome in surgical data, skin pigmentation, and paresthesia than HLS at the 12-month follow-up.

Pain is a Limiting Factor in Patients Suitable for Transilluminated Powered Phlebectomy.

ObjectivesTo analyze, perioperatively and in follow-up, transilluminated powered phlebectomy (TIPP), a surgical technique for the treatment of varicose veins.MethodRetrospective study in one medical institution of patients undergoing TIPP between July 2015 and December 2017. Data analyzed included demographic data, surgery, and results. Postoperatively, pain was evaluated by a 10-point visual analogue scale. The Venous Clinical Severity Score (VCSS) was assessed 5–8 weeks following surgery.ResultsSixty-six patients with extensive varicosities who underwent TIPP were included. Postoperative pain scores were higher in patients undergoing bilateral compared to unilateral TIPP (visual analogue score 7 versus 5; P=0.031). Following surgery, the VCSS improved in 81.8% (54/66) of the patients. However, 39.7% (25/63; data missing in 3 patients) reported that they would not be willing to undergo a similar procedure in the future. Pain was the most common reason for dissatisfaction.ConclusionsTransilluminated powered phlebectomy was associated with considerable pain and discomfort in many patients included in this study. For this reason, it should be reserved for a select group of patients in whom other treatment options are limited; TIPP could be considered in the following cases: patients with a large number of varicosities, reoperations, after extensive thrombophlebitis, obesity, or following bariatric surgery.

Effects of thrombelastogram on preventing deep venous thrombosis and hemorrhage after surgery for patients with varicosity of lower extremities

Objective To explore the effects of thrombelastogram (TEG) on preventing deep venous thrombosis (DVT) and hemorrhage after surgery for varicosity of lower extremities. Methods Totally 200 patients with varicosity of lower extremities who received exfoliation of great saphenous veins combined with transilluminated powered phlebectomy (TIPP) in a ClassⅢ Grade A hospital in Hebei Province from March 2016 to May 2017 by convenient sampling, and divided into the observation group (n=101) and the control group (n=99) according to the random number table. Patients in the observation group were evaluated with Caprini's DVT Assessment Model 24 hours before surgery. Patients who scored 3 or above received TEG monitoring 24 hours before surgery and on days 1, 3 and 7 post surgery, and received hierarchical interventions. Patients in the control group received conventional nursing care during the perioperative period, and empirical anticoagulation measures were taken based on the results of blood and coagulation routine examinations. Color Doppler ultrasonography was used to observe the incidence of DVT in both extremities in the patients one week post surgery, and the incidence of hemorrhage were also observed in patients in the two groups, including hemorrhage running out of dressings, incision bleeding and subcutaneous hematoma. Results DVT was found in 1 patient in the observation group (0.99%) and 8 patients in the control group (8.08%) ; hemorrhage running out of dressings was found in 3 patients in the observation group, incision bleeding in 2 patients and subcutaneous hematoma in 5 patients, while hemorrhage running out of dressings was found in 10 patients in the control group, incision bleeding in 9 patients and subcutaneous hematoma in 13 patients. There were statistical differences between the two groups (P<0.05) . Conclusions TEG dynamic monitoring combined with Caprini's DVT Assessment Model used in hierarchical interventions for patients with varicosity of lower extremities who receive exfoliation of great saphenous veins combined with TIPP reduces the incidence of DVT and hemorrhage, effectively avoids adverse events postoperatively, and ensures the patients' safety. Key words: Deep venous thrombosis; Varicosity; Postoperative hemorrhage; Thrombelastogram

Prospective Randomized Study of Ultrasound-Guided Foam Sclerotherapy Combined with Great Saphenous Vein High Ligation in the Treatment of Severe Lower Extremity Varicosis

To evaluate the effect of ultrasound-guided foam sclerotherapy (UGFS) in a single session combined with great saphenous vein (GSV) high ligation for severe lower extremity varicosis classified as C4-C6, compared with GSV stripping plus multistab avulsion or transilluminated powered phlebectomy (TIPP). From January 2012 to December 2014, 177 patients with primary GSV insufficiency, classified as C4-C6, were randomized into the UGFS group or the control group. The UGFS group was managed by GSV high ligation and foam sclerotherapy in one session under the surveillance of ultrasonography, whereas the control group received GSV high ligation and stripping combined with multistab avulsion or TIPP. The patients were followed up at 1, 6, and 12months after treatment. Outcome assessments included reflux recurrence rate, procedure-related adverse events, hemodynamic parameters, revised Venous Clinical Severity Score (VCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ) score. The medical cost and operating time of the 2 groups were also compared. In total, 73 patients received UGFS, whereas 90 patients underwent traditional surgery. Sixty-five patients in the UGFS group (89.0%) and 74 patients in the control group (82.2%) completed the follow-up. At the end of 12months, the cumulative refluxrecurrencerate was 13.8% in the UGFS group and 13.5% in the control group (P=0.955). In the UGFS and control groups, minor complications (27.7% vs. 21.6%, P=0.406) and major complications (3.1% vs. 2.7%, P=0.895) were not significantly different. Compared with baseline values, obvious improvements of the venous filling index, VCSS, and AVVQ scores after treatment were confirmed in both groups (P<0.001). The average operating and recovery times were much shorter (38.3 vs. 81.2min, 5.4 vs. 9.6days, P<0.001, respectively), and the average hospital cost was much lower ($853 vs. $1,575, P<0.001) in the UGFS group than in the control group. The patient satisfaction rate reached 92.3% in the UGFS group and 89.2% in the control group 12months after operation (P=0.270). Our outcomes indicated that UGFS combined with GSV high ligation was safe and effective for severe lower extremity varicosis.

Treatment Outcomes and Lessons Learned From Transilluminated Powered Phlebectomy for Varicose Veins in 1034 Patients.

Transilluminated powered phlebectomy (TIPP) is a minimally invasive technique of varicose vein removal, which combines irrigated illumination with tumescent anesthesia for ablation of superficial varicosities and endoscopic-powered venous resection. The objective of this study was to analyze treatment outcomes of this treatment modality. A retrospective evaluation of prospectively collected data from all patients undergoing TIPP procedure for symptomatic varicose veins during a recent 12-year period was performed. Pertinent patient demographics, disease classification, perioperative complications, quality of life, and treatment outcomes were collected and analyzed. A total of 1167 limbs in 1034 patients (mean age, 52.4 years) were treated during the study period. The mean procedure time was 18.4 ± 8.9 minutes (range, 6.0-82.0 minutes). The mean number of incisions for TIPP procedure was 6.3 ± 3.6. All TIPP procedures were technically successful, and no patient required conversion to hook stab phlebectomy. Fifteen (1.5%) patients developed residual or recurrent varicosities, which were treated with sclerotherapy during the follow-up period. Postoperative complications included hematoma at 2 weeks (5.8%), ecchymosis at 2 weeks (32.9%), saphenous neuropathy (0.3%), cellulitis (1.0%), and skin pigmentation (1.9%). There was no postoperative deep vein thrombosis or mortality. Transilluminated powered phlebectomy is an effective method for varicose vein removal and is associated with high clinical success and excellent cosmetic results. Meticulous technical steps are critical in achieving successful outcomes while minimizing complications. Technical considerations and lessons learned from our experiences are discussed in this report.

Retrospective long-term evaluation of the quality of life and the results of a modified transilluminated powered phlebectomy (TPP) technique

ZusammenfassungEinleitung: Transilluminierte Powered Phlebektomie (TPP) mit der Trivex-Methode ist mittlerweile eine etablierte Methode zur Behandlung der Seitenastvaricosis. Untersuchungen mit Follow-up-Zeiten bis zu 2 Jahren zeigen, dass die TPP mit weniger Inzisionen auskommt und eine reduzierte Operations-zeit sowie verbesserte kosmetische Ergebnisse aufweist, als die herkömmliche Häkchenphlebektomie. Bisher lassen sich in der Literatur keine langfristigen Follow-up-Untersuchungen/Ergebnisse von mehr als 2 Jahren finden, zudem wurde bisher noch keine systematische Evaluation der gesundheitsbezogenen Lebensqualität nach TPP-Phlebektomie mittels SQOR-V Score durchgeführt.Material und Methode: Zwischen 2001–02 und 2009–05 wurden 627 Patienten mit Varizen mittels TPP, unter Verwendung einer modifizierten Operationstechnik, in der Praxisklinik Zollikerberg operiert. Insgesamt 141 Patienten dieser Patienten hatten bereits zuvor Krampfadernoperation mit verschiedenen nicht-TPP-Operationsmethoden erlebt. Diese 141 Patienten wurden im Rahmen einer retrospektiven Evaluation angeschrieben. SQOR-V und ein zusätzlicher neuer hausintern entwickelter TPP-Fragebogen wurden verwendet. 69 Patienten erklärten sich mit der Datenerhebung einverstanden (Informed Consent), beantworteten die Fragebögen und wurden in die Analyse inkludiert. Ergebnisse von TPP-Operation und nicht-TPP-Operationen wurden explorativ verglichen. Der postoperative Verlauf (6 Wochen) wurde analysiert, einschließ-lich Prä- und Post-OP-Foto-Dokumentation. Die Patienten wurden für eine Follow-up-Fotodokumentation und klinische Beurteilung in die Klinik eingeladen. 18 Patienten folgten dieser Einladung.Ergebnisse: Der Follow-Up-Zeitraum betrug maximal 8 Jahre und 2 Monate, minimal 2 Monate (Durchschnitt: 4,58 Jahre, Median: 4,25 Jahre). Der ästhetische Eindruck hatte sich bei 70 % der Patienten nach der TPP-OP mäßig bis sehr verbessert. 87 % der Patienten hatten keine oder lediglich eine minimale Reduktion der Aktivitäten nach der TPP-OP. Keine oder minimale Ödeme wurden von 60 % der Patienten nach der TPP-OP berichtet. Zwei Patienten mit peripherer Thrombose wurden nach TPP-OP beobachtet, aber keine tiefen Venenthrombose. Hingegen erlitten 6 Patienten bei der nicht-TPP-OP tiefe Beinvenenthrombosen. Nach der eigenen Erfahrung mit beiden Arten von Krampfader-Operationen berichteten die Patienten über signifikant weniger Schmerzen nach der TPP-OP (p=0,001). Sie waren statistisch signifikant häufiger mit den Ergebnissen des TPP-OP (82 %) als mit der nicht-TPP-OP (7 %) (p&lt;0,001) zufrieden. Nach nicht-TPP-OPs hatten mehr Patienten Rezidiv-Varizen und venöse Ulzera als nach der TPP-OP (Rezidiv: nicht-TPP 100 % vs. TPP 42 % bzw., Ulcus: nicht-TPP 3 % vs. TPP 1,4 %). Hämatome waren nach der TPP-OP stärker ausgeprägt (starke 35,3 %, moderate 38,2 %) und dauerte länger an (&gt;4 Wochen 39,4 %), als nach der nicht-TP-OP (23,9 %, 43,3 %, &gt;4 Wochen 32,4 %). Pigmentierungen wurden häufiger nach der TPP-OP (31 %) als nach nicht-TPP-OP (18 %) beobachtet.Diskussion: Die Zufriedenheit mit den ästhetischen Ergebnissen der TPP-OP und die geringeren Schmerzen nach der TPP-OP waren statistisch signifikant besser als bei nichtTPP-OP. Klinisch wichtig ist die reduzierte Anzahl der Rezidiv-Varizen und die kleinere Zahl von Komplikationen nach der TPP-OP. Nachteilig sind die Hämatome und die Pigmentierungen, die jedoch überraschend gut toleriert wurden. Um diese vielversprechenden Ergebnisse zu bestätigen, sollten randomisierte klinische Studien durchgeführt werden.

Comment to: Combined endovenous laser therapy and pinhole high ligation in the treatment of symptomatic great saphenous varicose veins, by Zhu H-P, Zhou Y-L, Zhang X, Yan J-L, Xu Z-Y, Wang H, Zhao Q-M, Jing Z-P. Ann Vasc Surg 2013. [Epub ahead of print

Recanalization and DVT/PE are two major complications of ELTV, To prevent them minimally invasive pinhole high ligation (PHL) has been added to EVLT for the treatment of saphenous vein reflux in 200 patients (254 limbs) from February 2011 to May 2012. Sixty-eight of them had concurrent TriVex suction for clusters of varicose veins (VV). After conscious sedation and local anesthesia, venous access puncture was made using a Seldinger needle under US guidance. The tip of the sheath was placed approximately 1 cm distal to SFJ, and the location was marked on the skin. A 600-mm laser fiber was introduced through the sheath and advanced to the skin mark. Local anesthesia was achieved by injecting 1% lidocaine around the proximal GSV under US guidance with laser beam marking of the skin. Two 2-mm pinholes 1 cm distal to SFJ using an ophthalmic scalpel, approximately 5 mm from the laser fiber on each side were performed. A cutting needle with a 2-0 silk suture was passed through the pinholes underneath the GSV, but superficial to the femoral vein, which was confirmed by US. The needle and suture were then passed backward through the original two needle holes, but stayed in the subcutaneous space between the GSV and the skin.. A single knot was made first. Reinsertion of the laser fiber was gently attempted, and resistance indicated that ligation of the GSV was satisfactory. US was performed to confirm femoral vein patency, and then two more knots were tied down and buried in the subcutaneous space. If US showed that the femoral vein was captured, the needle and suture were removed and direct pressure was applied for 5 minutes to prevent bleeding. Then high ligation of GSV was performed again. EVLT was started immediately distal to the pinhole ligation, which was approximately 1 cm distal to the SFJ. An 810- nm diode laser system was used. In the 68 patients with venous clusters, transilluminated powered phlebectomy (TIPP) was performed using a TriVex system. After the procedures, compression pads were applied over the treated GSV and venous cluster areas. Elastic bandages were placed starting from the foot to the upper thigh. The technical success rate was 100%. Total occlusion of GSV was achieved in all treated limbs. There was no GSV recanalization during the 3 - 20 months of follow-up. No reintervention was needed for any patient. There were no cases of DVT. Use of PHL avoids the complications after open high ligation, and can be performed within 5-10 min in &gt;90% of patients.

Treatment of Varicose Veins by Transilluminated Powered Phlebectomy Surgery: A 9-Year Experience

Transilluminated powered phlebectomy (TIPP) is a minimally invasive technique for varicose vein removal that addresses some limitations of traditional procedures. The study objective was to analyze perioperative and follow-up outcomes after TIPP and present modifications gleaned over 9 years of performing the technique. Four hundred and thirty-one patients who underwent TIPP performed between June 2002 and April 2011 were included in this retrospective review. Descriptive statistics were used to describe demographic, treatment, and outcome data. The mean procedure time was 20.2 minutes. The majority (50.5%) of cases involved 10 to 20 incisions. No significant varicosities were reported at a follow-up of 12 weeks. Postoperative complications included 2 (0.5%) deep vein thromboses, 8 (1.9%) cellulitis episodes, 16 (3.7%) hemosiderin staining cases, 2 (0.5%) abscesses, and 2 (0.5%) cases of excessive or hypertrophic scarring. All but one patient reported good outcomes and were satisfied with the procedure. With proper training and experience, TIPP with a lower oscillation frequency and secondary tumescence results in good outcome and high patient satisfaction.

Transilluminated Powered Phlebectomy in an Office Setting:Procedural Considerations and Clinical Outcomes

To report a series of non-sedated patients treated with transilluminated powered phlebectomy (TIPP) under tumescent anesthesia in an office setting. Thirty-six patients (31 women; mean age 54.8±11.8 years) with a mean body mass index of 25 kg/m(2) were selected for the in-office TIPP procedure between January 2009 and September 2010. Medical conditions included hypertension, asthma, hypothyroidism, and gastrointestinal problems. Twenty-eight had prior surgical procedures, 10 of which were for vascular abnormalities. Symptom duration was a mean of 19 years. Twenty-five had a family history of venous disease. The CEAP classification ranged from 2 to 4, but the majority were class 2. Seven patients had conditions that made the TIPP procedures more challenging. Medical data, preoperative venous status, postoperative findings, and patient-reported satisfaction were reviewed. All procedures were completed as planned and without complications. The mean TIPP procedure time was 13.5±3.7 minutes. Thirty-three patients underwent concurrent endovenous ablation. Patient satisfaction measured on a scale from 0 to 10 ranged from a mean of 8.8 at 48 hours to 9.6 at 3 months. At the 3-month follow-up, there were no reports of hematoma, deep venous thrombosis, or extended paresthesia. Appropriately selected patients with a variety of clinical presentations can safely undergo the TIPP procedure in an office setting utilizing only local tumescent anesthesia.

Transilluminated Powered Phlebectomy Surgery for Varicose Veins: A Review of 339 Consecutive Patients

Transilluminated powered phlebectomy (TIPP) is a promising alternative to traditional ambulatory phlebectomy procedures. This retrospective review of 339 patients represents the senior author's first consecutive series of 400 cases performed using TIPP for the treatment of varicose veins in a 6-year period. Patients were followed for 12 weeks postoperatively. Data analyzed included operative time, intraoperative complications, stab incision ranges, postoperative complications, and patient satisfaction. The mean operative time was 19.7 minutes, and 246 (61.5%) cases involved 10 to 20 incisions. Postoperative complications included an episode of symptomatic deep vein thrombosis in one (0.3%) patient, excessive or hypertrophic scarring in two (0.6%) patients, discoloration of the lower extremity skin due to hemosiderin staining in eight (2.3%) patients, and cellulitis in one (0.3%) patient. No recurrences were observed at a follow-up of 12 weeks. Three hundred thirty-eight (99.7%) patients reported good outcomes and were satisfied with the procedure. This review by an individual surgeon is beneficial in analyzing the outcomes and complications associated with TIPP, as a standard protocol was followed and an adequate volume was performed to advance past the learning curve associated with the technique. When concomitant saphenous vein incompetence is present, staged treatment of varicosities with TIPP after endovenous laser ablation is recommended. With proper training and experience, utilization of TIPP with a lower oscillation frequency and secondary tumescence results in good outcome and high patient satisfaction.

Clinical effects of endovenous laser therapy plus transilluminated powered phlebectomy in treatment of primary varicose veins

To evaluate the clinical and cosmetic effects of endovenous laser therapy (EVLT) plus transilluminated powered phlebectomy (TIPP) in the treatment of primary varicose veins. The clinical effects of EVLT plus TIPP in treatment of 82 patients of primary varicose vein with 105 extremities were evaluated. The procedure-related parameters, clinical outcomes, and complications were recorded. The venous function was assessed by venous photoelectric plethysmography (VPPG). Aberdeen Varicose Veins Questionnaire (AVVQ) and Venous Clinical Severity Score (VCSS) surveys were used to appraise the quality of life and symptomatic alleviation. The successful rates of EVLT and TIPP was 98.1% (103/105) and 100% (105/105) respectively. The average operating time was 53.8 min (35 approximately 108 min). The average number of wounds was 4.4 (3 approximately 7). The postoperative hospitalization time was 4.8 d (2 approximately 6 d). The follow-up rates 3, 6, and 12 months after operation were 100%, 93.9%, and 35.4% respectively. Obvious symptom alleviation or entire disappearance was noticed in all the limbs 3 months after operation. The hemodynamic parameters, such as venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) were significantly ameliorated 1 month after the operation compared with those measured preoperatively (all P<0.01). No further improvements were noticed from then on (P>0.05). Disease specific quality of life was greatly improved after operation (P=0.000). 91.5% of the patients were satisfied with the postoperative appearance of the involved limbs. EVLT plus TIPP is an efficacious minimally invasive strategy for the treatment of primary varicose veins, resulting in approving cosmetic effect as well.

Transilluminated powered phlebectomy accomplished by local tumescent anaesthesia in the treatment of tributary varicose veins: preliminary clinical results

Transilluminated powered phlebectomy (TIPP) is a minimal invasive method of varicose vein surgery that is often performed with spinal or general anaesthesia following the removal of the greater saphenous vein (GSV). The use of exclusively local tumescent anaesthesia (TA) during TIPP has never been reported in the literature. To introduce and evaluate the use of TIPP under TA in the treatment of tributary varicose veins. Twenty patients with tributary varicose veins were treated with TIPP using the TriVex System. According to duplex scanning, patients had a competent or previous ligated saphenofemoral junction. All patients were clinically classified atleast as C2 according to the clinical, aetiological anatomical, pathological elements (CEAP) classification. The postoperative follow-up was at one week, one month and three months. The mean operative time was 40.5 (+/- 10.8) min, associated with an average number of 3.6 (+/- 0.7) incisions. The mean pain score (10-point visual analog scale) during the procedure, at one and three months after treatment were 2.0 (+/- 1.1), 1.6 (+/- 0.9) and 1.2 (+/- 0.5), respectively. Thigh haematoma and complications such as discolouration, indurations and paraesthesia were reported. Fifteen (75%) patients were satisfied with the cosmetic result (based on a 4-point visual analog scale) after three months and 13 (65%) patients were satisfied with the performed treatment. The mean venous clinical severity (VCS) scores among the patients before treatment, one week, four weeks and three months after treatment was 2.7 (+/- 1.5), 3.9 (+/- 1.6), 2.4 (+/- 2.0) and 1.7 (+/- 1.9), respectively. The use of TA resulted in adequate anaesthesia during TIPP. The pain, during and post-treatment, was minimal and acceptable for the patients. TIPP was associated with a high incidence of haematoma and reduction of the number of incisions. Patients were satisfied with the cosmetic result.

Randomized clinical trial comparing multiple stab incision phlebectomy and transilluminated powered phlebectomy for varicose veins

The aim was to compare early postoperative subjective outcome measures in a randomized trial of multiple stab incision phlebectomy (MSIP) and transilluminated powered phlebectomy (TIPP) for the treatment of varicose veins. Patients having surgery for varicose veins were randomized to receive either MSIP or TIPP for local avulsion of varicose veins. Operating time, number of incisions and postoperative outcome were analysed in both groups. Quality of life (QoL) was analysed before and 1 and 6 weeks after surgery using domain-specific (Burford pain scale), disease-specific (Aberdeen Varicose Vein Questionnaire) and generic (Short Form 36 and EuroQol 5D) instruments. Sixty-six patients consented to participate in the trial but four withdrew before surgery, so 33 patients underwent MSIP and 29 patients had TIPP. All patients had symptomatic or complicated varicose veins. There was no significant difference between groups in the total duration of surgery or the time taken for the avulsions. The number of incisions was significantly lower with TIPP. However, skin bruising at 1 and 6 weeks, and Burford pain score at 6 weeks were significantly higher in the TIPP group (P < 0.01 for bruising and P = 0.019 for pain). TIPP also had a greater adverse impact on generic QoL, resulting in a more prolonged recovery. TIPP had the advantage of fewer surgical incisions, but was associated with more extensive bruising, prolonged pain and reduced early postoperative QoL.

Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: Early results

Objectives: to compare Transilluminated Powered Phlebectomy (TIPP) (TriVexTM System) with Muller's hook phlebectomy. Materials and Methods: between January and April 2001, 40 patients (group 1) undergoing TIPP were non-randomly compared to 40 patients undergoing Muller's hook phlebectomy (group 2) in the course of conventional vein stripping and perforator ligation. All patients had at least C2 CEAP disease. Results: hospital stay averaged 2 days (range 1-3 days; median 2 days) and was similar for the two groups. TIPP took significantly longer (56 ± 12 vs 45 ± 10 min, p < 0.001) but was associated with significantly fewer incisions (6 [2-8] vs 8 [4-21], p < 0.001). The mean pain score (out of 10) at 2 and 7 days and 6 weeks was 5, 2 and zero after TIPP and 4, 2 and zero after hook phlebectomy. The incidence of postoperative haematoma formation was significantly higher after TIPP (45 vs 25%, p = 0.06), especially in the calf region (25 vs 2.5%, p = 0.003). Conclusion: TIPP was slower (although speed increased with practice) associated with more haematoma (although this reduced with practice) and fewer incisions. In other respects (pain, cosmetic satisfaction, other complications, residual varices) it was not significantly different from hook phlebectomy. Greater clinical experience with the technique and randomized studies are required to determine whether TIPP is a valuable addition to our armamentarium.Eur J Vasc Endovasc Surg 25, 473-475 (2003)

Varicose veins: Hooks, clamps, and suction. Application of new techniques to enhance varicose vein surgery

Surgical principles that guided varicose vein surgery for nearly 75 years have been time honored and taught to generations of surgeons. Each of these principles has been challenged successfully, and, as a result, varicose vein surgery has changed markedly. The fundamental principle of totally removing varicose clusters from the circulation remains firmly established. However, methods of accomplishing this have changed and continue to change. Hook phlebectomy and clamp phlebectomy have replaced open dissection and tributary ligation. The place of tumescent anesthesia, transilluminated-powered phlebectomy, and sclerotherapy remain unsettled. However, there now are a number of alternatives in planning patient care.

Transilluminated Powered Mini-Phlebectomy: Early Clinical Experience

.We report our preliminary experience with a new surgical endoscopic technique, the Transilluminated Powered Phlebectomy (TriVex™ System, Smith+Nephew) to remove varicose veins. TriVex™ System combined an irrigated illuminator device and a powered vein resector. There were 15 patients with a mean age of 50 years, nine were women and six were men. We evaluated prospectively the safety, efficacy and clinical benefits of this new surgical device.

Outpatient Varicose Vein Surgery with Transilluminated Powered Phlebectomy

The present study was done to determine the feasibility, efficacy, and safety of varicose vein removal using a minimally invasive, powered, vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compare this to a retrospective group of hook phlebectomy operations. After preliminary development of the procedure, a prospective evaluation was done. There were 59 limbs in 56 patients (51 women, five men) treated with use of the vein extractor aided by transcutaneous illumination. Saphenous reflux was confirmed by preoperative duplex ultrasound using reflux technique and was treated by ligation of the saphenofemoral junction and stripping of the greater saphenous vein to the knee with external hooks. Surgery was performed under general anesthesia on an outpatient basis. Complications were documented. The number of incisions made was recorded and analyzed. Operative time was noted and patient satisfaction analog scores were recorded. Patients were asked to describe their pain and cosmetic results on an analog scale ranging from 1 to 10 with 1 representing no pain and 10 the worst imaginable and a similar scale for the best and worst cosmetic results. Data were analyzed by use of appropriate tests of significance and compared to historical controls of 114 hook phlebectomy operations done over a 12-month period. The 51 women ranged in age from 23 to 66 years (mean: 46). The men were 48, 48, 54, 59, and 72 years of age, respectively. There were 58 unilateral procedures (98%) and one bilateral operation. Operative time ranged from 23 to 58 minutes (mean: 41.0 minutes). The number of incisions per limb averaged 5.6. Cellulitis, small hematoma formation, and swelling or bruising beyond that expected occurred in four limbs (6.8%). Mean postoperative pain score at 48 hours was 3.0 with a median of 3.0. Mean postoperative pain score at 7 days was 2.0 with a median of 2.0. Postoperative pain scores at 6 weeks and 3 months were zero. Mean cosmetic score at 6 weeks was 2.5 with a median of 2.0. Mean cosmetic score at 3 months was 1.0 with a median of 1.0. These results compare very favorably to a historical control group of 114 similar patients who underwent stab avulsion hook phlebectomy to remove varicose vein clusters. Varicose vein extraction using transilluminated powered phlebectomy (TIPP) is safe, efficacious, and cosmetically satisfactory. The procedure decreases operating time and number of incisions required to remove varicose clusters.