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Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better?
Vasc Endovascular Surg. 2007 Feb-Mar; 41(1):41-7.VE

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.

Authors+Show Affiliations

Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Marc.Passman@ccc.uab.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17277242

Citation

Passman, Marc A., et al. "Combined Endovenous Ablation and Transilluminated Powered Phlebectomy: Is Less Invasive Better?" Vascular and Endovascular Surgery, vol. 41, no. 1, 2007, pp. 41-7.
Passman MA, Dattilo JB, Guzman RJ, et al. Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? Vasc Endovascular Surg. 2007;41(1):41-7.
Passman, M. A., Dattilo, J. B., Guzman, R. J., & Naslund, T. C. (2007). Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? Vascular and Endovascular Surgery, 41(1), 41-7.
Passman MA, et al. Combined Endovenous Ablation and Transilluminated Powered Phlebectomy: Is Less Invasive Better. Vasc Endovascular Surg. 2007 Feb-Mar;41(1):41-7. PubMed PMID: 17277242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? AU - Passman,Marc A, AU - Dattilo,Jeffery B, AU - Guzman,Raul J, AU - Naslund,Thomas C, PY - 2007/2/6/pubmed PY - 2007/4/7/medline PY - 2007/2/6/entrez SP - 41 EP - 7 JF - Vascular and endovascular surgery JO - Vasc Endovascular Surg VL - 41 IS - 1 N2 - 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. SN - 1538-5744 UR - https://www.unboundmedicine.com/medline/citation/17277242/Combined_endovenous_ablation_and_transilluminated_powered_phlebectomy:_is_less_invasive_better DB - PRIME DP - Unbound Medicine ER -