Transilluminated Powered Phlebectomy

What is transilluminated powered phlebectomy (TIPP)?
Transilluminated powered phlebectomy is a minimally invasive procedure for the treatment of varicose veins. Varicose veins are dilated blood vessels in the legs which develop in about one third of individuals 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. All of these symptoms and the unsightly appearance of the varicose veins can be relieved with transilluminated powered phlebectomy.

How does transilluminated powered phlebectomy compare to other techniques?

Transilluminated powered phlebectomy was developed to replace hook phlebectomy. When compared to hook phlebectomy, transilluminated powered phlebectomy requires fewer incisions, less time, and less anesthesia, and yet transilluminated powered phlebectomy gives patients a better cosmetic result. Transilluminated powered phlebectomy can be done with local or a combination of local and light general anesthesia allowing the patient to ambulate soon after the procedure also reducing complications.

Is TIPP the best treatment option for me?
Only a physician who performs transilluminated powered phlebectomy can determine if a patient is a candidate for this procedure. A complete medical history, exam, and duplex venous doppler studies (sonogram of the leg veins) are needed prior to scheduling the procedure. While insurance frequently covers the cost of transilluminated powered phlebectomy, 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. Often in patients with extensive varicose veins, more than one treatment will be required.

How is transilluminated powered phlebectomy performed?

On the day of the procedure, the patient must walk for about twenty minutes prior to marking the veins to be removed with a surgical marker. Then with the patient supine in the procedure room the legs are scrubbed with an antiseptic solution and local anesthetic is injected along the veins to be removed. Many patients have transilluminated powered phlebectomy with only local anesthesia but sedation or a light general anesthesia can be added for the patient’s comfort.

Two small incisions are made for each group of veins to be removed. Through one incision a light source is inserted under the veins to allow better visualization. In the second incision the physician inserts the powered phlebectomy device which both removes the vein and suctions it away from the surrounding tissues. The local anesthetic keeps the area numb and compresses surrounding small blood vessels to prevent bleeding. The combination of the light source and the powered phlebectomy device make the work of removing the veins easier for the surgeon, shortening the procedure. Local anesthetic reduces the immediate post procedure recovery.

What can be expected during the first 24 hours after TIPP?

Following the procedure, the leg is wrapped with a compression bandage which is left in place for two days. The patient is able to walk within a couple of hours of 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 entire recovery period may take up to six weeks. Following the removal of the compression bandage, compression hose are worn for at least three weeks. The patient is also instructed to avoid heavy lifting during the recovery period. Cosmetically, with fewer and smaller incisions, patients who have a transilluminated powered phlebectomy are very happy with the appearance of their legs post procedure.

Is TIPP approved for used in the US?
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.

What are other benefits of TIPP?

The advantages of the transilluminated powered phlebectomy over the traditional hook phlebectomy performed through stab incisions are tremendous. Less time and anesthesia is required due to the powered phlebectomy device which removes the veins more effectively and visualization of the veins is better due to the light source under the veins which transilluminates them. Better cosmetic results are obtained due to the reduction in the number of incisions, the effectiveness of removing the entire vein, and the hydrostatic pressure from the local anesthetic decreases post operative bleeding. Patients with varicose veins should see a physician experienced in transilluminated powered phlebectomy to determine if they are candidates for this procedure.

Disclaimer: This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.

By Staff
Updated: October 14, 2009

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