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


OBJECTIVE
To introduce and evaluate the use of TIPP under TA in the treatment of tributary varicose veins.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
de Zeeuw
R
R
Phlebology, Sint Franciscus Gasthuis, Kleiweg 500 Rotterdam Zuid-Holland, The Netherlands. r.dezeeuw@sfg.nl
Wittens
C
C
Loots
M
M
Neumann
M
M
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D010865:Pilot Projects; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D014172:Transillumination; D016896:Treatment Outcome; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*