TIPP was developed as an alternative to traditional phlebectomy, and has been found to be a safe and effective treatment for varicose veins. Varicose veins are dilated blood vessels in the legs which develop from prolonged standing, increased intra-abdominal pressure, and heredity. The valves in these blood vessels are broken leading to swelling of the feet and legs, leg cramps, and occasionally a breakdown of the skin known as venous stasis ulcers. Removal of varicose veins using TIPP alleviates these symptoms and the appearance of varicose veins.
What is transilluminated powered phlebectomy (TIPP)?
Transilluminated powered phlebectomy (TIPP) is a minimally invasive procedure for the removal of problem veins that uses a transcutaneous illuminator device to light up the veins, and a powered phlebectomy device to resection (cut and remove) problem veins. Illuminating problem veins helps your doctor identify and map out the veins which need to be removed. Once the veins are illuminated, small punctures (stab incisions) are made and the vein sections are removed with a powered phlebectomy device. Tumescent anesthesia (saline-infused anesthesia) is administered throughout the procedure to numb and firm up the area, making vein removal easier.
How does transilluminated powered phlebectomy compare to other phlebectomy techniques?
Phlebectomy is the removal of all or part of the vein. There are several types of phlebectomy procedures. The most common phlebectomy procedure is ambulatory phlebectomy (also known as microphlebectomy), which is a phlebectomy performed on the legs.
To perform ambulatory phlebectomy your doctor makes a series of small incisions or punctures in the vein, and removes portions of the vein using special phlebectomy hooks.
Transilluminated powered phlebectomy was developed as an alternative to ambulatory phlebectomy. TIPP is distinct from ambulatory phlebectomy in that the illuminator device maps out a network of veins and helps the doctor visualize the veins before beginning vein removal. This reduces the risk of missing problem veins, and gives TIPP a distinct advantage when a large number of veins have to be removed. As well, the powered phlebectomy tool makes removal of a large number of veins easier than using an individual phlebectomy hook.
According to one study, patients undergoing TIPP underwent fewer incisions than ambulatory phlebectomy patients, but patients reported experiencing more pain with TIPP, and more bruising was noted six weeks after the TIPP procedure, resulting in longer recovery times.
Talk to your doctor to determine which phlebectomy procedure is right for you.
How is transilluminated powered phlebectomy performed?
Before the procedure begins, the legs are scrubbed with an antiseptic solution, and the vein clusters are circled with a permanent surgical marker. Then you lay down, and your doctor injects local anesthesia along the veins to be removed. Many people have TIPP with only local anesthesia but sedation or a light general anesthesia can be added for your comfort.
Your doctor then makes two small incisions (stab incisions) for each group of veins to be removed. Through one incision your doctor inserts the light source under the veins to allow better visualization using an illuminator handpiece. Tumescent anesthesia is administered to the varicose vein sections to be removed. Tumescent anesthesia is a saline-infused anesthetic that numbs the area and constricts the blood vessels, making the numbed area swollen and rigid. This makes the veins to be removed standout distinctly, making removal of the veins easier.
In the second incision your doctor inserts the powered phlebectomy (endoscopic tissue dissector) device which both removes the vein and suctions it away from the surrounding tissues. The combination of the light source and the powered phlebectomy device make removing the veins easier for the surgeon, shortening the procedure. TIPP procedure can range from 20 minutes to 50 minutes for vein removal on one leg.
The use of local anesthetic instead of general or spinal anesthesia makes recovery a shorter process.
What can be expected during the first 24 hours after TIPP?
Following the procedure, your doctor will repeatedly compress your leg with a bandage to remove blood and tumescence. Steri-strips are often used to close the stab punctures. Multiple layers of compression with absorbent bandages are applied along the length of the vein removal site, and an elastic stretch bandage (like an ace bandage) is wrapped from the foot up to the groin to secure the bandages, encourage healing, and stimulate circulation. Wrap bandages are usually worn for 2 days. You will be able to walk within a couple of hours of TIPP. Follow-up with your doctor is recommended between 6-10 days following the procedure.
Potential post-operative complications can include bleeding, infection, discoloration of the skin, numbness, or tingling due to the proximity of nerves to the veins. The complication rate is less with a transilluminated powered phlebectomy when compared to traditional phlebectomy procedures due to the shorter time required, earlier ambulation, and due to fewer and smaller incisions.
What is the long-term recovery process like?
The patient is also instructed to avoid heavy lifting during the 2 week recovery period. Following the removal of the compression bandage, compression hose are worn for approximately 4 weeks. Patients can usually return to work within several days of the TIPP procedure. Patients are generally happy with the cosmetic result of TIPP, as stab incisions usually heal looking like small freckles.
Is TIPP approved for used in the U.S.?
Transilluminated powered phlebectomy is approved for use in the United States. It can be performed as an ambulatory procedure at an outpatient surgery setting. Candidates for the procedure are those individuals who have been screened with duplex Doppler sonograms of the legs and found to have dilation of the great saphenous or the femoral vein as a cause for the varicose veins in their legs.
Is TIPP the best treatment option for me?
A physician experience in performing transilluminated powered phlebectomy can best determine if you are a good candidate for TIPP. A complete medical history, exam, and duplex venous Doppler studies (sonogram of the leg veins) are needed prior to scheduling the procedure.
Will my insurance cover TIPP?
While insurance frequently covers the cost of transilluminated powered phlebectomy when deemed “medically necessary,” many plans require conservative measures such as exercise, weight loss, and compression hose first. Cost is determined by the extent of the varicose veins to be treated. More than one treatment may be required depending on the extent and severity of your varicose veins.
Reviewed February 3, 2017