Combined endovenous ablation and transilluminated powered phlebectomy

Is less invasive better?

Marc A. Passman, Jeffery B. Dattilo, Raul J. Guzman, Thomas C. Naslund

    Research output: Contribution to journalArticle

    14 Citations (Scopus)

    Abstract

    This study was undertaken to evaluate the evolution of operative vein approaches from combined "open" saphenous stripping-stab avulsion phlebectomy to combined "minimally invasive" endovenous ablation-transilluminated powered phlebectomy with a focus on comparing clinical outcomes. All patients undergoing a combined operative approach for concomitant saphenous vein insufficiency and associated varicose tributary veins between January 1, 1998 and December 31, 2005 were identified. Patients were stratified by operative approach into 3 groups: combined saphenous vein stripping-stab avulsion phlebectomy (STRIP-PHLEB); combined saphenous vein stripping- transilluminated phlebectomy (STRIP-TPP); and combined endovenous ablation-transilluminated phlebectomy (EVAB-TPP). Clinical volume, indications, technical details, and complications were retrospectively reviewed. Over the 8-year period, there were 72 limbs in 59 patients treated with STRIP-PHLEB, 92 limbs in 81 patients with STRIP-TPP, and 99 limbs in 76 patients with EVAB-TPP, with a time-dependent transition in operative techniques noted. There was no difference in distribution of CEAP clinical classification between groups, overall with most limbs in the C2-C4 categories (93.1%) and fewer in the C5-C6 categories (6.9%). There was no difference in overall complication rates between STRIP-PHLEB and EVAB-TPP, although the distribution of complications did shift with a trend toward more wound problems noted in procedures involving saphenous stripping (STRIP-PHLEB 5.6%, STRIP-TPP 6.5%, EVAB-TPP 2.0%; P = NS), and more hematomas in procedures involving transilluminated powered phlebectomy (STRIP-PHLEB 5.6%, STRIP-TPP 16.3%, EVAB-TPP 6.9%; P <.05; see Table 2). Complications associated with the endovenous ablation portion were low including technical inability to cannulate 1.6%, saphenous re-cannulation 2.4%, hematoma 2.4%, severe phlebitis 3.1%, venous thromboembolism 0.8%, and no wound or thermal injury problems. With the shift of combined operative vein approaches for concomitant saphenous vein insufficiency and varicose tributary veins towards "minimally invasive" techniques the overall complication rate has remained unchanged. While combined endovenous ablation-transilluminated phlebectomy offers some advantage of "less" invasiveness, this perceived benefit should be balanced against unchanged overall risk over traditional operative approaches.

    Original languageEnglish (US)
    Pages (from-to)41-47
    Number of pages7
    JournalVascular and Endovascular Surgery
    Volume41
    Issue number1
    DOIs
    StatePublished - Feb 1 2007

    Fingerprint

    Saphenous Vein
    Extremities
    Varicose Veins
    Hematoma
    Veins
    Wounds and Injuries
    Hospital Distribution Systems
    Phlebitis
    Venous Thromboembolism
    Catheterization
    Hot Temperature

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Combined endovenous ablation and transilluminated powered phlebectomy : Is less invasive better? / Passman, Marc A.; Dattilo, Jeffery B.; Guzman, Raul J.; Naslund, Thomas C.

    In: Vascular and Endovascular Surgery, Vol. 41, No. 1, 01.02.2007, p. 41-47.

    Research output: Contribution to journalArticle

    Passman, Marc A. ; Dattilo, Jeffery B. ; Guzman, Raul J. ; Naslund, Thomas C. / Combined endovenous ablation and transilluminated powered phlebectomy : Is less invasive better?. In: Vascular and Endovascular Surgery. 2007 ; Vol. 41, No. 1. pp. 41-47.
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