Use of Powered Phlebectomy (Trivex^®) for the Treatment of Chronic Venous Stasis Ulcers: A Novel Technique

OBJECTIVES: The Trivex^® powered phlebectomy device is indicated for the treatment of varicose veins. The purpose of this study was to determine the effectiveness of this device as a new treatment for chronic venous stasis ulcers.
METHODS: Eight patients had chronic venous stasis ulcers due to underlying enlarged veins secondary to venous insufficiency. All had failed standard local venous ulcer wound care therapy. They were treated by removal of these veins using powered phlebectomy. A few small (1 cm) incisions were made to insert the powered phlebectomy device in healthier skin remote from the ulcer bed. Using tumescent anesthesia and transillumination, the device was inserted underneath the entire ulcer bed and the underlying veins were removed. Standard wound care was administered postoperatively until the ulcer healed.
RESULTS: There were 6 men and 2 women ranging in age from 38 to 78 years (mean: 63.5 years). The length of time the ulcer had been present ranged from 1 to 20 years (mean 9.2 ± 7.9 years). Ulcer size ranged from 2 to 6 cm in maximum diameter. Postoperative follow-up was complete in all 8 patients and ranged from 5 to 40 months (mean: 20 ± 12 months). All ulcers completely healed within 6 to 43 weeks (mean: 14 ± 12 weeks). One patient died 5 months postoperatively of liver failure but her ulcer remained healed. At follow-up, the other seven patients had no ulcer recurrences and remained healed. One wound complication occurred due to hematoma formation.
CONCLUSIONS: Powered phlebectomy is effective in treating chronic venous ulcers. Ulcer healing may occur as a result of removing both incompetent perforator and superficial varicose veins. This technique allows complete vein removal through a small number of incisions placed in healthy skin. Despite living with their ulcers for many years, all eight patients in this study completely healed without recurrence. This unique minimally invasive technique offers superb early and midterm results for the treatment of this disabling condition.