Outpatient Varicose Vein Surgery with Transilluminated Powered Phlebectomy

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Abstract
The present study was done to determine the feasibility, efficacy, and safety of varicose vein removal using a minimally invasive, powered, vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compare this to a retrospective group of hook phlebectomy operations. After preliminary development of the procedure, a prospective evaluation was done. There were 59 limbs in 56 patients (51 women, five men) treated with use of the vein extractor aided by transcutaneous illumination. Saphenous reflux was confirmed by preoperative duplex ultrasound using reflux technique and was treated by ligation of the saphenofemoral junction and stripping of the greater saphenous vein to the knee with external hooks. Surgery was performed under general anesthesia on an outpatient basis. Complications were documented. The number of incisions made was recorded and analyzed. Operative time was noted and patient satisfaction analog scores were recorded. Patients were asked to describe their pain and cosmetic results on an analog scale ranging from 1 to 10 with 1 representing no pain and 10 the worst imaginable and a similar scale for the best and worst cosmetic results. Data were analyzed by use of appropriate tests of significance and compared to historical controls of 114 hook phlebectomy operations done over a 12-month period. The 51 women ranged in age from 23 to 66 years (mean: 46). The men were 48, 48, 54, 59, and 72 years of age, respectively. There were 58 unilateral procedures (98%) and one bilateral operation. Operative time ranged from 23 to 58 minutes (mean: 41.0 minutes). The number of incisions per limb averaged 5.6. Cellulitis, small hematoma formation, and swelling or bruising beyond that expected occurred in four limbs (6.8%). Mean postoperative pain score at 48 hours was 3.0 with a median of 3.0. Mean postoperative pain score at 7 days was 2.0 with a median of 2.0. Postoperative pain scores at 6 weeks and 3 months were zero. Mean cosmetic score at 6 weeks was 2.5 with a median of 2.0. Mean cosmetic score at 3 months was 1.0 with a median of 1.0. These results compare very favorably to a historical control group of 114 similar patients who underwent stab avulsion hook phlebectomy to remove varicose vein clusters. Varicose vein extraction using transilluminated powered phlebectomy (TIPP) is safe, efficacious, and cosmetically satisfactory. The procedure decreases operating time and number of incisions required to remove varicose clusters.