Treatment Outcomes and Lessons Learned From Transilluminated Powered Phlebectomy for Varicose Veins in 1034 Patients.
BACKGROUND
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.
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA University Vascular Associates, Los Angeles, CA, USA plin@bcm.edu.
Peter H
PH
Lin
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Jesus M
JM
Matos
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Aaron
A
Chen
University Vascular Associates, Los Angeles, CA, USA.
Walter
W
Kim
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Mun J
MJ
Poi
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Jenny S
JS
Jiang
Department of Cardiothoracic and Vascular Surgery, Houston Methodist Hospital, Houston, TX, USA.
Carlos F
CF
Bechara
D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods*; D000772:Anesthesia, Local; D016208:Databases, Factual; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D015911:Sclerotherapy; D013781:Texas; D007507:Therapeutic Irrigation / Q000009:adverse effects; D013997:Time Factors; D014172:Transillumination / Q000009:adverse effects; D016896:Treatment Outcome; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*
stab phlebectomy; transilluminated powered phlebectomy; varicose vein