Varicose Vein Treatment by Suction-assisted Shaving Phlebectomy without the Use of Transillumination/Irrigation: A Simple, Quick and Effective Method

Traditional management of saphenous vein incompetency is using high ligation and stripping with multiple stab incision phlebectomies for the varicose tributaries. A number of minimally invasive options have been described, each with their own advantages and disadvantages. We describe a new technique using suction-assisted shaving phlebectomy without transillumination and irrigation in the management of varicose veins.

Transilluminated powered phlebectomy in the treatment of large area venous leg ulcers: A case-control study with 3 years follow-up

OBJECTIVE

To evaluate the efficacy, safety and long-term outcome of TIPP for the adjunct therapy of superficial venous reflux-related VLUs.

METHODS

A total of 93 consecutive patients (104 legs) with superficial venous insufficiency-related VLUs who underwent TIPP (53 legs) or conventional phlebectomy (51 legs) between January 2010 and December 2013 were retrospectively studied.

RESULTS

Compared to patients in the conventional phlebectomy group, TIPP patients had larger ulcer areas before surgery (P < 0.005). However, TIPP group required a significantly shorter operation time (P < 0.005), fewer incisions (P < 0.005) but less ulcer healing time (1.25 month vs 2.5 months, P < 0.05). No significant difference in in-hospital and follow-up complications was found between the two groups. For long-term outcome, TIPP group leaded a lower ulcer recurrence rate at 36 months (13.2% vs 29.4%, P < 0.05).

CONCLUSION

TIPP may be an adjunct surgical method contributes to healing of VLUs, especially for large ulcer areas.

Removal of Benign Superficial Masses Using the TriVex System: Preliminary Clinical Results

BACKGROUND AND OBJECTIVE

Transilluminated powered phlebectomy using the TriVex system is a new procedure for minimally invasive varicose vein surgery. We used the TriVex system for the removal of benign superficial subcutaneous soft tissue masses, and we also achieved satisfactory clinical effects. The objective of this study was to explore the feasibility, benefits, and technique-related complications of using the TriVex system for the removal of benign superficial masses as a novel and minimally invasive surgical technique.

METHOD

Between January 2010 and August 2016, 452 patients with benign superficial soft tissue masses underwent surgical removal of masses using the TriVex II system in our department. The surgical complications, postoperative cosmetic outcome, and personal satisfaction were reviewed at a mean follow-up of 24 months.

RESULTS

The TriVex procedure was successfully completed in all patients using only local tumescent anesthesia without any technical problem and serious complications. The mean operation duration was 8.5 minutes, and the average blood loss was 5 mL. Surgical complications were observed in 69 cases (15.3%) of subcutaneous ecchymosis, 34 cases (7.5%) of skin perforation, 14 cases (3.1%) of subcutaneous hematoma, 13 cases (2.9%) of wound infection, and 7 cases (1.5%) of induration of operation area. Eleven patients (2.4%) showed recurrence during the follow-up and were cured by reoperation by the TriVex system. Overall, the majority of patients (N = 436, 96.5%) were very satisfied or satisfied with the outcome.

CONCLUSION

The TriVex procedure for the removal of benign superficial masses is simple, safe, and effective with advantages of short operation time, small incisions, and good cosmetic outcome, which is predicted as a new minimally invasive surgery of superficial masses.

Phlebectomy Techniques for Varicose Veins

Ambulatory phlebectomy is a well-known and widely used procedure for residual symptomatic venous disease. Tumescent anesthesia complements the procedure, providing the ability to perform this intervention in a wide range of practice settings. The procedures are well tolerated by most patients, and complications are rare. They include venous thromboembolism, infection, and hematoma and are generally simple to manage. Alternative and emerging techniques of powered phlebectomy and cyanoacrylate glue are providing alternative forms for treatment and will advance the practice further.

Transilluminated Powered Phlebectomy in the Treatment of Varicose Veins

Recent trends toward less invasive technologies for treating varicose veins have led to expanding interest in transilluminated powered phlebectomy. Although initial experience with transilluminated powered phlebectomy was variable, with the newer-generation system and modification of technique that allow for slower oscillation speed, higher suction, and extensive tumescence irrigation and drainage, these previous problems have been mostly eliminated. The following report reviews current instrumentation, operative technique, and reported outcomes for transilluminated powered phlebectomy.

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

Einleitung: 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<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 (>4 Wochen 39,4 %), als nach der nicht-TP-OP (23,9 %, 43,3 %, >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.

Treatment of primary varicose veins has changed with the introduction of new techniques

New technologies have produced a revolution in primary varicose vein treatments. Duplex ultrasound is now used for preoperative diagnosis, postoperative surveillance, and during many procedures. Ultrasound has also altered our understanding of the pathophysiology of chronic venous disease. Laser and radiofrequency saphenous ablations are common. Classic techniques, such as sclerotherapy, high ligation, stripping, and phlebectomy, have been improved. Magnetic resonance venography, computed tomographic venography, and intravascular ultrasound have improved diagnostic capabilities. New strategies like ambulatory selective varices ablation under local anesthesia (ASVAL) and conservative hemodynamic treatment for chronic venous insufficiency (CHIVA) raise important questions about how to manage these patients.

Transilluminated powered phlebectomy in an office setting: procedural considerations and clinical outcomes

PURPOSE

To report a series of non-sedated patients treated with transilluminated powered phlebectomy (TIPP) under tumescent anesthesia in an office setting.

METHODS

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.

RESULTS

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.

CONCLUSION

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: a clinical report

Twenty-one patients with varicose vein incompetence of the legs have been treated with the TriVex system (Smith & Nephew, Andover, MA, USA). The technique is designed for treatment of local varicosities to provide a good cosmetic result (remaining varicosities and pigmentation) and less morbidity (pain and loss of work days). These parameters showed good results with few remaining varicosities and pigmentations. Reasonable number of days out of work and moderate pain. Eighteen of the 21 patients had an overall good outcome with no complaints.

Light-Assisted Stab Phlebectomy: Early Postoperative Experience

Light-assisted stab phlebectomy (LASP) is a technique that we have developed for treatment of lower extremity varicose veins. It combines powered and stab phlebectomy with minimally invasive surgical instruments to optimize intraoperative visualization of varicose veins and to remove branch veins with minimal bruising, hematoma, or pain. The early experience with this technique has not been reported. We conducted a retrospective review of all patients who underwent LASP to characterize the associated perioperative experience and to identify postoperative factors that indicated a successful outcome. From 2004 to 2006, LASP was performed on 268 limbs to remove lower extremity branch veins. The majority of patients were women (75%), and the mean age was 52 years. A group of 184 patients underwent LASP in combination with another procedure, and 49 patients underwent LASP alone. Nearly all patients had conscious sedation for anesthesia (99%); operating room time averaged 44 minutes, and blood loss averaged 88 cc. Immediate postoperative complications were infrequent, occurring in 10 per cent of patients, and included unresected or missed veins, hematoma, and cellulitis. LASP provides improved visualization of branch veins and allows varicose veins to be removed with a short operating room time and minor postoperative complications.

Transilluminated Powered Phlebectomy: Not Enough Advantages? Review of the Literature

BACKGROUND

Recently, new procedures for the treatment of varicose veins have been developed. The purpose of this review is to analyse the data available concerning the transilluminated powered phlebectomy (TIPP).

DESIGN

Review of the English literature.

RESULTS

The number of studies is limited. Currently, no trial has proven any significant advantage of TIPP technique when compared with conventional surgery, except for the number of surgical incisions. TIPP procedure seems to be shorter than conventional surgery, particularly for the extensive or recurrent varicose veins.

CONCLUSIONS

Several questions regarding TIPP technique remain. Further randomised trials are needed to determine the benefit of this procedure.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

TIPP had the advantage of fewer surgical incisions, but was associated with more extensive bruising, prolonged pain and reduced early postoperative QoL.

New approaches for the treatment of varicose veins

New, minimally invasive techniques for the treatment of varicose veins including radiofrequency ablation (RFA), endovenous laser therapy (EVLT), and transilluminated power phlebectomy (TIPP) represent effective and possibly superior alternatives to traditional saphenous vein stripping and stab avulsion of varicose veins. Further experience with these procedures will help to determine which ones will become the method of choice for treating this complex disease process. Some of these new techniques may not prove to be effective in the hands of all treating specialists. However,it is very likely that some of these techniques, such as foam sclerotherapy and RFA, will replace the procedures that we currently use today.

Prospective randomized controlled trial: conventional versus powered phlebectomy

OBJECTIVES

Transilluminated powered phlebectomy (TriVex) is a new surgical technique that uses tumescent dissection, transillumination, and powered phlebectomy. The purpose of this study was to compare TriVex with conventional varicose vein surgery in terms of pain, cosmesis, recurrence, complications, and operating time.

METHODS

One hundred eighty-eight limbs in 141 patients (33 men, 108 women; mean age, 42.5 years) with varicose veins were randomised to conventional (n = 100) or TriVex (n = 88). Exclusion criteria were venous ulceration or deep venous disease. Varicosities were graded with CEAP and clinical assessment (grades 1-3), and were similar in both groups. Randomization was single blinded. Long or short saphenous vein ligation or stripping was performed as indicated with duplex scanning. Operative time was from skin incision to leg bandaging. Phlebectomy was performed with conventional stab avulsions or TriVex. Patients completed assessment forms preoperatively and postoperatively (2, 6, 26, 52 weeks), and this was supplemented with physician clinical evaluation. Pain was assessed with visual analog score.

RESULTS

There was a significant difference in the number of incisions for phlebectomy in the two groups (conventional, n = 29; TriVex, n = 5; P <.0001). TriVex was faster in the grade 3 (extensive) group, but this did not reach statistical significance. There was no difference in mean postoperative pain score over 8 days in the two groups (P =.4624). At 2 weeks there was no significant difference between the groups with regard to bruising (P =.77), cellulitis (P =.33), and numbness (P =.33). At 6 weeks there was no significant difference between the groups with regard to nerve injury (P =.97), residual veins (P =.79), cosmetic score (P =.837), and overall satisfaction (P =.878). At 6 and 12 months, there was no significant difference in cosmesis (P =.955, P =.088, respectively) or recurrence (P =.27, P =.11, respectively).

CONCLUSIONS

TriVex is a safe and effective method for excision of varicosities and compares well, after a learning curve, with conventional surgery in regard to complications and recurrence. It has the advantage of a trend toward reduced operating time in extensive varicosities, and significantly fewer incisions, although there was no perceived difference in cosmesis during follow-up.

Transilluminated powered phlebectomy: advantages and disadvantages of a new technique

BACKGROUND

Transilluminated powered phlebectomy is a new procedure for minimal invasive varicose vein surgery.

OBJECTIVE

To evaluate this technique for its benefit and the technique-related risks and complications.

METHODS

Thirty patients were prospectively operated with this new technique by the same surgeon (11 of them bilaterally [41 legs in all]). According to the sonography, sapheno-femoral-junction ligation and stripping of the long saphenous vein were done if necessary. The phlebectomy of the side branches was done with the new system (Trivex System/Smith and Nephew). The postoperative follow-up was at 10 days and 6 weeks.

RESULTS

There was no intraoperative complication. The mean operation time per leg was 40 minutes. Twenty-five patients had an uneventful postoperative course. Twenty two have been very satisfied with the cosmetically result. Two patients required reoperation because of postoperative hematoma. One patient developed a seroma, which could be managed via puncture. One patient developed persistent brown scar. The overall morbidity was 12.2%.

CONCLUSION

Using transilluminated powered phlebectomy, multiple and large incisions could be reduced. A perfect cosmetic outcome might be reached if the surgeon is aware of technique-related complications. To evaluate the real value of this technique, further randomized trials are necessary.

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

OBJECTIVES

to compare Transilluminated Powered Phlebectomy (TIPP) (TriVex 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.

Treating varicose veins with transilluminated powered phlebectomy

In the past, patients endured hours of surgery, many incisions, and multiple scars to manually remove painful, unsightly, swollen varicose veins. Patients now have a new treatment option. Endoscopic resection and ablation of superficial varicosities is possible using a powered vein resector, irrigated illuminator, and tumescent anesthesia. This article describes this new technique, called transilluminated powered phlebectomy, and explains how the procedure reduces the number of incisions and provides direct visualization of the veins as they are resected.

Powered phlebectomy (TriVex) in treatment of varicose veins

This study assesses the operation of transilluminated powered phlebectomy for removal of varicose veins. It was a prospective, noncomparative, multicenter, pilot study designed to evaluate the safety and efficacy of the powered varicose vein extractor for ablation of primary varicose veins. A total of 114 patients (117 limbs) were recruited from four centers in Europe and four centers in the United States. Safety of the varicose vein extractor was evaluated by recording nature and severity of all adverse events and complications. Efficacy was assessed by the patient, an independent study nurse, and the surgeon. Operations were performed under general, spinal, or epidural anesthesia and tumescent anesthesia was added with infusions of dilute lidocaine with epinephrine. Transillumination was achieved with a specially designed cannula, and the vein extraction was done using a vein resector with a rotating tubular inner cannula encased in a stationary outer sheath dissector. Demographic information regarding the 28 men and 89 women included in the study are detailed. Eighty-four percent of the limbs were CEAP class 2 with only 16% being in classes 3 and 4. Accompanying greater saphenous vein stripping was done in 67% of the limbs in the United States and 88% in those in Europe. Proximal ligation only was used in one limb in the United States and eight in Europe. The study showed that transilluminated powered phlebectomy used in varicose vein removal is swift and efficacious with a conservation of operating time and the results being satisfactory to the patient and clinician alike.