Summary
Introduction: Transilluminated powered phlebectomy (TPP) using the TriVex method has become an
established method of treating varicosis of the lateral saphenous branches. Investigations
with follow-up times of up to 2 years have shown that TPP requires fewer incisions,
is associated with shorter surgery time and shows better cosmetic results than traditional
hook phlebectomy. To date, no long-term follow-up studies/results for a period of
longer than 2 years are available in the scientific literature, nor has any systematic
evaluation of the health-related quality of life after TPP phlebectomy been performed
using the SQOR-V score.
Material and methods: Between February 2001 and May 2009, 627 patients with varicoses underwent TPP surgery
in the Zollikerberg Clinic, using a modified surgical procedure. A total of 141 of
these patients had previously undergone varicose vein surgery using various non-TPP
surgical methods. These 141 patients were contacted as part of a retrospective evaluation.
SQOR-V and an additional, newly developed internal TPP questionnaire were used. 69
patients gave their informed consent to the data collection, completed the questionnaires
and were included in the analysis. The results of TPP and non-TPP surgery were compared
exploratively. The postoperative course (6 weeks) was analysed, including photographic
documentation obtained pre- and post-surgery. The patients were invited to the clinic
for follow-up photographic documentation and clinical assessment. 18 patients accepted
this invitation.
Results: The maximum follow-up period was 8 years and 2 months, the minimum period was 2 months
(mean: 4.58 y, median: 4.25 y). A moderate to excellent improvement in the cosmetic
impression was observed in 70 % of patients after TPP surgery. 87 % of patients had
little or no reduction in activities after TPP surgery. 60 % of patients reported
minimal or no oedema after TPP surgery. Peripheral thrombosis was observed in two
patients after TPP surgery but no deep vein thrombosis was reported. By contrast,
6 patients who had undergone non-TPP surgery suffered deep venous thrombosis of the
leg. Following their experience with both types of varicose vein surgery, the patients
reported significantly less pain after TPP (p=0.001). The patients were more satisfied,
to a statistically significant degree, with the results of TPP surgery (82 %) than
with non-TPP surgery (7 %) (p<0.001). After non-TPP surgery, more patients had recurrent
varicose veins and venous ulcers than after TPP surgery (recurrence: non-TPP 100 %
vs. TPP 42 %; ulcer: non-TPP 3 % vs. TPP 1.4 %). Haematomas were more frequent after
TPP surgery (severe 35.3 %, moderate 38.2 %) and persisted for longer (>4 weeks 39.4
%) than after non-TPP surgery (23.9 %, 43.3 %, >4 weeks 32.4 %). Pigmentations were
observed more frequently after TPP surgery (31 %) than after non-TPP surgery (18 %).
Discussion: There was greater satisfaction, to a statistically significant degree, with the cosmetic
results and lower pain levels after TPP surgery compared with non-TPP surgery. Of
clinical significance are the reduced number of recurrent varicose veins and the lower
rate of complications after TPP surgery. The haematomas and pigmentations were unfavourable
effects but were surprisingly well tolerated. Randomised clinical studies are required,
in order to confirm these promising results.
Keywords
Transilluminated Powered Phlebectomy (TPP) - varicosis - minimally invasive - TriVex
