title: Transillumination mapping prior to ambulatory phlebectomy.
abstract: BACKGROUND
  Ambulatory phlebectomy (AP) for removal of varicose and reticular veins has become a very popular and widely used in-office outpatient technique over the past decade. One of the major obstacles of this or any other surgical vein removal technique is the technical difficulty presented to the surgeon by the disappearance of the veins to be removed when the patient is positioned horizontally on an operative table. Preoperative marking is therefore essential.
  
  
  OBJECTIVE
  To investigate whether use of transillumination would facilitate and enhance marking of varicose veins prior to AP, we performed a study in which both traditional marking with the patient standing and transillumination marking with the patient horizontal were performed sequentially.
  
  
  METHODS
  One hundred patients were sequentially examined prior to AP. The veins to be removed were mapped by the traditional way utilizing visual inspection and palpation in a standing position. They were then mapped in the supine or prone position utilizing a transillumination device specifically designed to enhance visualization of veins prior to venipuncture.
  
  
  RESULTS
  In 100 out of 100 patients the markings performed using transillumination mapping most closely correlated with actual vein position during surgery. In addition, transillumination allowed for gauging of vein depth.
  
  
  CONCLUSIONS
  Transillumination mapping significantly enhances the technique of ambulatory phlebectomy by more accurately visualizing the course of a varicose vein prior to extraction. Furthermore, sites for incisions or punctures are more accurately guided. As a result of this experience, it is now our routine practice to perform preoperative mapping for AP by transillumination in the horizontal position.
authors.affiliation: Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Weiss
authors.forename: M P
authors.initials: MP
authors.lastname: Goldman
mesh_terms: D000556:Ambulatory Surgical Procedures; D006801:Humans; D014172:Transillumination; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000473:pathology; D014680:Veins / Q000473:pathology / Q000601:surgery*