December 22, 2008

Experience with Over 100 Consecutive Powered Phlebectomies: Too Many or Not Enough?

Jennifer A. Heller, MD FACS.
Johns Hopkins, Baltimore, MD, USA.

OBJECTIVES: Although introduced over a decade ago, powered phlebectomy (TriVex) has not gained widespread acceptance. The procedure has been predominantly classified as a difficult technique, requiring general anesthesia and a formal operating room. The objectives of this study were to evaluate the outcomes of TriVex, and to determine its performance practicality in an outpatient setting.
METHODS: The demographics, indications, and outcomes of TriVex were examined retrospectively. This study reviewed a single surgeon’s experience with this technique.
RESULTS: From November 2006-July 2008, TriVex was performed on 114 limbs in 93 patients. Mean age was 52 years. (74% female, 26% male). CEAP distribution consisted of: C2: 57%, C3: 22%, C4: 19%, C5: 2%. In addition, branch varicosities were graded on a separate scale 1-3. (Class 1: focal branch varicosity, Class 2: multiple branch varicosities, Class 3: history of phlebitis in affected segments, and/or involvement of >50% surface of affected extremity) All patients underwent venous physiologic reflux examination to determine indications for specific therapy. Concomitant endovenous radioablation was performed in 73%. Procedures were performed in an outpatient center with intravenous sedation in 80%; all of these cases were completed successfully. No intraoperative complications occurred. Patient follow-up occurred at 3 day, 2 week, and 4 week intervals. Postoperative complications included: temporary cutaneous paresthesias (5%), hematoma (3%) , phlebitis (4%), and retained vein branch segments (9%).
CONCLUSIONS: This report is the largest single surgeon experience with TriVex. This experience demonstrates successful performance of powered phlebectomy in an outpatient setting with excellent results.

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