Minimally invasive vein surgery: its role in the treatment of venous stasis ulceration

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

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

A review of the current management and treatment options for superficial venous insufficiency

The recognition of lower extremity venous disease as a significant cause of morbidity and lower quality of life, afflicting up to 25 % of Western populations, has led to rapid and drastic improvements in treatment options as well as an increasing awareness of the disease. Superficial venous disease, a frequent medical problem encountered in clinical practices, is now a common reason for referral to providers offering a spectrum of interventions. Venous guidelines have been set forth by the American Venous Forum and Society for Vascular Surgery covering simple spider veins to chronic venous ulcerations. (Gloviczki et al. J Vas Surg 53:2S-48S, 2011) This review provides an overview of the modern management of varicose veins and venous insufficiency.

Venous disease in women: epidemiology, manifestations, and treatment

Until the past decade, venous disease was commonly underdiagnosed and undertreated due to lack of interest on the part of providers and to reluctance to undergo procedures on the part of patients. Modern venous interventions, improved diagnostic modalities, and increased awareness through education, training, and screening programs have all raised enthusiasm for venous disease in recent years. This has been crucial to gain control over a disease that affects a significant proportion of the population, with women being affected more than men. This article will discuss epidemiologic studies that highlight some of the gender-related issues and review the risk factors for venous disease. We will also discuss the physiologic venous changes that occur with pregnancy and highlight functional venous disease in women. Finally, we will review the indications for and treatment of superficial venous disease.

Venous ulcers: new options in treatment: minimally invasive vein surgery

Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the underlying venous pathology either due to venous valvular dysfunction or venous obstruction leading to venous hypertension. Recently, significant advances in endogenous methods have evolved. The development of a new concept, minimally invasive vein surgery (MIVS), has improved upon traditional, open, invasive treatments of venous disease. MIVS techniques are performed percutaneously, with minimal anesthesia, no incisions and rarely require hospital admission. This article summarizes the concept of MIVS, describes each method of MIVS and its complementary role in the management of venous leg ulcers patients.

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.

Treatment of Venous Ulcers

Underlying the pathogenesis of venous ulceration is venous hypertension. Therefore, the use of multilayered compression therapy is the gold standard in the treatment of a venous ulcer. As treatment progresses, an important determinant of response is wound assessment, which should be performed on initial visit and subsequently thereafter. Among the methods to assess improvement are digital photography and planimetry, which are objective methods to measure response to treatment and rate of wound healing. Lack of improvement over a 2- to 4-week period is predictive of eventual lack of response to therapy and suggests the need for adjunctive methods to achieve success, such as oral pentoxifylline, tissue-engineered skin, or skin grafting.