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Objective:To compare the clinical effects of different minimally invasive surgeries in the treatment of varicose veins of lower extremities,and to explore their application values.Methods:A total of 201 patients with varicose veins of lower extremities were selected and treated with different operation methods.52 cases were treated by endovenous laser therapy(EVLA group),46 cases were treated by transilluminated powered phlebectomy (TIPP group),49 cases were treated by EVLA combined subfascial endoscopic perforator surgery(SEPS)(EVLA+SEPS group)and 54 cases were treated by TIPP combined SEPS(TIPP+SEPS)group.The operation time, the intraoperative blood loss,the postoperative hospitalization cost,the hospitalization time,the incidence rates of postoperative complications(residual varicose veins,subcutaneous induration,superficial phlebitis,skin necrosis and saphenous nerve injury)of the patients in various groups were compared.Results:There were significant differences in the operation time,the intraoperative blood loss and the postoperative hospitalization time,the hospitalization cost of the patients between various groups(P<0.05).Compared with EVLA group,the incidence rats of residual varicose veins,superficial phlebitis,and lower extremity swelling and ecchymosis of the patients in TIPP group were significantly decreased(P<0.05);the incidence rates of subcutaneous induration,wound hematoma,saphenous nerve injury and skin numbness were increased,but there were no significant differences (P>0.05).Compared with EVLA group and TIPP group,the incidence rates of reidual varicose veins and superficial phlebitis in EVLA + SEPS group and TIPP + SEPS group were significantly decreased(P<0.05). The healing rates of the patients 3 months after operation in TIPP group,EVLA+ SEPS group and TIPP+ SEPS group were significantly increased compared with EVLA group(P<0.05).The recurrence rates 1 year after operation in TIPP group,EVLA + SEPS group and TIPP + SEPS group were lower than that in EVLA group (P<0.05).Conclusion:The curative effects of EVLA combined with SEPS and TIPP combined with SEPS in treatment of varicose veins in lower extremities are superior to EVLA and TIPP,with the advantages of safe and reliable methods,complete varicose vein resection,less postoperative complications,quick ulcer healing and low recurrence rate and so on.
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Objective: To compare the clinical effects of different minimally invasive surgeries in the treatment of varicose veins of lower extremities, and to explore their application values. Methods: A total of 201 patients with varicose veins of lower extremities were selected and treated with different operation methods. 52 cases were treated by endovenous laser therapy (EVLA group), 46 cases were treated by transilluminated powered phlebectomy (TIPP group), 49 cases were treated by EVLA combined subfascial endoscopic perforator surgery (SEPS) (EVLA + SEPS group) and 54 cases were treated by TIPP combined SEPS (TIPP + SEPS) group. The operation time, the intraoperative blood loss, the postoperative hospitalization cost, the hospitalization time, the incidence rates of postoperative complications (residual varicose veins, subcutaneous induration, superficial phlebitis, skin necrosis differences in the operation time, the intraoperative blood loss and the postoperative hospitalization time, the hospitalization cost of the patients between various groups (P0.05). Compared with EVLA group and TIPP group, the incidence rates of reidual varicose veins and superficial phlebitis in EVLA + SEPS group and TIPP + SEPS group were significantly decreased (P<0.05). The healing rates of the patients 3 months after operation in TIPP group, EVLA + SEPS group and TIPP + SEPS group were significantly increased compared with EVLA group (P<0.05). The recurrence rates 1 year after operation in TIPP group, EVLA + SEPS group and TIPP + SEPS group were lower than that in EVLA group (P<0.05). Conclusion: The curative effects of EVLA combined with SEPS and TIPP combined with SEPS in treatment of varicose veins in lower extremities are superior to EVLA and TIPP, with the advantages of safe and reliable methods, complete varicose vein resection, less postoperative complications, quick ulcer healing and low recurrence rate and so on.
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Objective To investigate the efficacy of transilluminated powered phlebectomy (TIPP) and endovanous laser treatment(EVLT) combined with high ligation on treating varicose great saphenous vein.Methods A total of 238 cases with varicose great saphenous vein were divided into TIPP group (119 cases)and EVLT group (119 cases).The incidence of postoperative recovery and complications of the two groups were compared.Results There was no significant difference between the two groups on the surgery duration and postoperative recovery incident(P ＞ 0.05);the saphenous nerve injury incidence and skin impairment incidence of the TIPP group were significantly less than that of EVLT group (P ＜ 0.05);the amount of bleeding,subcutaneous hematoma incidence,and amount of surgical incision of TIPP group were significantly more than that of the EVLT group(P ＜ 0.05).Conclusions TIPP and EVLT combined with high ligation are two effective minimally invasive surgical approaches on treating varicose great saphenous vein.EVLT is with less surgical incision and less bleeding,and is more applicable for mild case;TIPP is with less operative trauma,and is more applicable for severe case.
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Objective To analyze the clinical efficacy of endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity and summarize the experiencein order to achieve better results.Methods From January 2014 to June 2015,45 patients (52 limbs,including 17 males and 28 females,aged 36 to 68 years) diagnosed as great saphenous varicosity received endovenous laser treatment combined with transilluminated powered phlebectomy.Thirty-eight cases was unilateral great saphenous vafcose veins,7 cases was bilateral large saphenous varicose veins.The clinical efficacy was analyzed.Results All cases were performed successfully.The mean operation time was (68.4 ± 15.1) minutes,the average bleeding volume was (23.5 ± 10.7) ml,the number of mean operative incision quantity was (5.8 ± 1.9) and the average hospitalization time was (5.9 ± 1.6) days.All patients had no serious complications.During a mean follow-up time of 22 months (12 to 30 months),only one patient recurred.Conclusions Endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity is effective and safe.It also has the advantages of shorter operation time,less bleeding,shorter hospitalization time,small trauma and better cosmetic results.
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Objective To compare the efficacy of endovenous laser treatment combined with transilluminated powered phlebectomy and traditional surgical treatment for great saphenous varicosity. Methods From January 2014 to January 2015,77 patients diagnosed as great saphenous varicosity were enrolled. They were randomly divided into two groups, 37 patients received endovenous laser treatment combined with transilluminated powered phlebectomy and the other 40 patients underwent traditional surgical treatment. The related indicators were compared.Results The mean operation time,average bleeding volume,operative incisionquantity and average hospitalization time of EVLT+ TIPP group were (66.1±14.7) min,(24.4±10.5) ml,5.7±1.7,(5.6±1.4) d respectively,of control group were (84.3±18.5) min,(59.0±15.6) ml,8.0±1.8,(10.1±3.1) d respectively,there were significant differences between the two groups(t =-4.749,-11.460,-5.714;P0.05).During a mean follow?up time of (18±7) months(12 months to 24 months),1 patient recurrence in theEVLT+ TIPP group,2 cases recurrence in the traditional operation group.The recurrence rates of the two groupswere similar,the difference was not significant between them(P=1.000) .Conclusion Endovenous lasertreatment combined with transilluminated powered phlebectomy for great saphenous varicosity is effective andsafe.It also has the advanta and better cosmetic results.
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Objective To evaluate TriVex based transilluminated powered phlebectomy (TIPP)three-stage management for lower limb venous ulcers.Methods This retrospective study included 86 patients with 103 diseased limbs treated in our hospital from October 2005 to July 2013.All received TriVex TIPP three-stage management.Results After therapy there was no acute cellulitis,skin necrosis nor lower limb deep venous thrombosis.There were 2 cases of subcutaneous ecchymosis,1 case of subcutaneous hematoma,1 case of skin abnormal sensation and 1 case of subcutaneous induration.Ulcers healed within one month postoperation in all cases,while skin abnomalities were alleviated with no ulcer recurrence during the follow-up ranging from 4 to 48 months.Conclusions TriVex TIPP centered threestage management is a good option for lower limb venous ulcer,with shortened healing time,low recurrence rate.
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Varicose veins is the main clinical manifestations of the chronic venous insufficiency.TIPP transilluminated powered phlebectomy,a new minimally invasive surgery,received much attention while surgical techniques aimed at treating varicose vein were constantly updated.In this article,TIPP in the varicose vein surgery is reviewed from its history,operating techniques and advantages,and TIPP's future is being prospected.
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PURPOSE: There are several new surgical techniques for varicose vein surgery. Transilluminated Powered Phlebectomy (TIPP) and Endovenous Laser Therapy (EVLT) are accepted as useful surgical procedures for varicose veins. However, these techniques have some associated problems such as complications, remnant varicosities and are relatively expensive. We compared some of the new techniques with conventional methods and introduce new technique called Transillumination assisted EVLT (T-EVLT). METHOD: We reviewed cases with primary varicose veins involving the lower extremity in 217 patients managed by TIPP, EVLT and T-EVLT in the department of Surgery, Presbyterian Medical Center, from January 2003 to January 2007. RESULT: The distribution of age was the fifth decade (38.4%), fourth (23.8%) and third (15.2%), in order frequency. The male to female ratio was 1:1.43. The TIPP procedure had the lowest frequency of remnant varicosities (6.0%) but the second highest complication rate (17.9%). The EVLT procedure had a relatively low complication rate (9.5%) and good cosmetic results but the longest operation time and the highest frequency of remnant varicosities (21.6%). The T-EVLT procedure had the shortest operation time and the lowest frequency of remnant varicosities (19.5%) compared to the EVLT. CONCLUSION: Each of the operation methods had risks and benefits. The EVLT procedure had good cosmetic results and was easy to learn. However, had a relatively long operation time and many remnant varicosities. These problems may be overcome by the T-EVLT.
Subject(s)
Female , Humans , Male , Laser Therapy , Lower Extremity , Protestantism , Risk Assessment , Transillumination , Varicose VeinsABSTRACT
PURPOSE: Transilluminated powered phlebectomy (TIPP) has emerged as a very attractive surgical procedure for varicose vein because of it's many advantages. However, it also has some problems such as hematoma, and skin perforation, and needs general or spinal anesthesia and hospitalization. To overcome these shortcomings, we performed TIPP under only local anesthesia using the tumescent method. METHOD: Eleven (12 limbs) patients were operated and we prospectively estimated the operative complication, pain, duration of hospital stay, side effects and amounts of lidocaine. Lidocaine was infiltrated for groin dissection, and tumescent anesthesia was used on the calf area for TIPP. Great saphenous veins were stripped in 9 limbs, and closed suction drains were inserted in the calf area in 11 limbs. We calculated the amounts of lidocaine, according to the unit area of TIPP, body weight, and body surface area. RESULT: The mean age of the 11 patients was 55.4+/-10.7 years, and 3 patients (27.3%) had risk factors for general anesthesia. Mean operation time was 54.9+/-9.2 minutes, the number of incisions including groin was 4.7+/-0.6, and the area of TIPP was 272.6+/-85.3 cm2. The total lidocaine used was 495.4+/-167.5 mg (1.45 mg/cm2, 8.3 mg/kg, 302.1 mg/BSA m2). Except 2 patients (16.6%) who complained of mild pain and 2 of hematoma (16.6%), there were no side effects of lidocaine or operative complication. Mean hospital stay was 5.8+/-1.4 hours. CONCLUSION: TIPP under local anesthesia might be a relative safe method, and it could reduce the risks and complications of general or spinal anesthesia, hospital stay, and hesitancy to operation.
Subject(s)
Humans , Anesthesia , Anesthesia, General , Anesthesia, Local , Anesthesia, Spinal , Body Surface Area , Body Weight , Extremities , Groin , Hematoma , Hospitalization , Length of Stay , Lidocaine , Prospective Studies , Risk Factors , Saphenous Vein , Skin , Suction , Varicose VeinsABSTRACT
PURPOSE: To determine the efficacy and safety of endoscopic resection and ablation of superficial varicose vein using a powered vein resector and irrigated illuminator. METHODS: Forty-three limbs in 29 patients were involved in our hospital study. The clinical records between August 2002 and February 2004 were reviewed. All patients were treated with a minimally invasive, powered vein resecting device, using cutaneous transillumination and tumescent fluid under general or spinal anesthesia. RESULTS: The 29 varicose vein patients were composed, (19 men (65.5%) and 10 women (34.5%), with a mean age of 56.9 years. The most common symptom or sign of varicose vein was an unsightly vein (15 patients, 51.7%). Fifteen unilateral (5: right, 10: left) and 14 bilateral operation for varicose veins were performed. The mean operative time, number of skin incisions and length of hospital stay were 34.2 minutes, (ranging from 26 to 58, 3.2 sites, (ranging form 2 to 6) and 3.3 days, (ranging from 2 to 6). Postoperative complications occurred in 12 limbs (27.9%), including skin perforation (1 limb, 2.3%), wound abscess (1 limb, 2.3%), cellulitis (1 limb, 2.3%), lower limb pain (4 limbs, 9.3%), edema (2 limbs, 4.7%), hematoma (1 limb, 2.3%), remaining varicose vein (1 limb, 2.3%) and paresthesia (1 limb, 2.3%). CONCLUSION: This study showed that the TIPP (TriVexTM) technique for varicose vein removal was swift and efficacious. When performed by trained surgeons the complication rates of the technique were comparable with those of conventional surgery, with the advantages of a trend toward reduced operating times in extensive varicose vein, and significantly fewer incisions.
Subject(s)
Female , Humans , Male , Abscess , Anesthesia, Spinal , Cellulitis , Edema , Extremities , Hematoma , Length of Stay , Lower Extremity , Operative Time , Paresthesia , Postoperative Complications , Skin , Transillumination , Varicose Veins , Veins , Wounds and InjuriesABSTRACT
PURPOSE: This study was designed to compare Transilluminated Powered Phlebectomy (TIPP) with conventional surgical treatment (high ligation of the greater saphenous vein and above knee stripping with varicosectomy). METHODS: 428 cases of varicose veins, managed surgically at our hospital, were reviewed. A retrospective review of clinical records, between November 2000 an March 2003, was performed. The patients were divided into one of two groups: TIPP or a conventional operation. All the patients had at least a C2 CEAP disease. RESULTS: The demographics, hospital stays and operating times for the two groups were similar. However, a TIPP was associated with significantly fewer incisions (4.4+/-1.5 vs 8.2+/-3.9; P<0.001) and recurrence (n=14, 6% vs n=24, 12%; P=0.003). The incidence of a postoperative hematoma developing was more common with TIPP (n=20, 9% vs n=1, 0.5%; P=0.023). The problem of a hematoma formation in TIPP was solved by the insertion of a small closed suction drain. Skin perforation and wrinkling, and dermatosclerosis, were only complicated in the TIPP. The mean pain scores (out of 10) for the TIPP and conventional operation groups, at 2 and 7 days and 4 weeks, were 4.8, 1.4 and zero, and 4.8, 2.8 and zero, respectively. The cosmetic satisfaction score was higher in the TIPP group (8.7 vs 5.7; P<0.001). CONCLUSION: With respect to pain, cosmetic satisfaction and residual varicose, the outcomes in the TIPP group were significantly better than those in the conventional operation group.
Subject(s)
Humans , Demography , Hematoma , Incidence , Knee , Length of Stay , Ligation , Lower Extremity , Recurrence , Retrospective Studies , Saphenous Vein , Scleroderma, Localized , Skin , Suction , Varicose VeinsABSTRACT
PURPOSE: Transilluminated powered phlebectomy (TIPP) offers a minimally invasive operation alternative to stab avulsion for varicose veins. The purpose of this study is to compare the safety and efficacy of TIPP with conventional phlebectomy (CP) for removal of varicose veins. METHOD: A retrospective review was performed on the clinical records from March 2001 to March 2002. We divided the patients into 2 groups. The first group consisted of 87 patients (107 limbs) who had undergone TIPP. The second group of 27 patients (29 limbs) had undergone CP by the stab avulsion. We compared operation time, number of skin incisions, duration of hospital stay, patient's satisfaction scores, and complications. RESULT: Mean operation time was significantly shorter in the TIPP group than in the CP group (47.3 min vs. 64.0 min). The number of skin incision was also significantly less in the TIPP group (3.4 vs. 4.9). Length of hospital stay was significantly shorter in the TIPP group (2.5 days vs. 4.0 days). However, postoperative patient's satisfaction score was similar in both groups. 81 patients (93%) in the TIPP group developed ecchymosis postoperatively, resolved spontaneously within approximately 8 weeks. CONCLUSION: TIPP can make the better cosmetic result, shorter duration of hospitalization and operation time. These results suggest that TIPP is a feasible surgical treatment modality for varicose veins of the lower extremity. However, we should minimize postoperative ecchymosis and improve the surgical technique.