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

Abstract

).With advancements in technology and improvements in established procedures, multiple techniques for the treatment of superficial venous disease are now available. Current techniques employed include compression therapy; endovenous laser or radiofrequency ablation of saphenous and perforator veins; phlebectomy; sclerotherapy; subfascial endoscopic perforator surgery; and transilluminated powered phlebectomy (TIPP). 1 TIPP is a minimally invasive method of varicose vein removal that is an alternative to traditional ambulatory phlebectomy procedures. This technique incorporates three technologies: (1) tumescent anesthesia, which assists in defining the operative plane via hydrodissection; (2) transillumination, which facilitates direct visualization of varicosities; and (3) a powered endoscopic tissue dissector, which rapidly and efficiently resects and removes varicosities. 2,3 Direct visualization of varicosities has the potential to reduce the risk of missed veins and incomplete vein resection, while minimizing the number of incisions required. In theory, such advantages may reduce operative time and improve cosmesis. 4,5 The use of tumescent anesthesia assists in reducing postoperative pain and patient morbidity, while expediting recovery. 6 Previous clinical studies 3,4,7-12 and a recent meta-analysis 13 support the use of TIPP for the removal of varicose veins, especially when extensive. Perioperative and follow-up outcomes based on one surgeon's 9-year experience performing TIPP in the era of endovenous laser ablation therapy are analyzed. Insight and technique modifications gleaned over time are also provided. MethodThis study involved a retrospective review of data and received institutional review board approval.