Therapeutic Effect Analysis and Operation Comprehend of Transilluminated Powered Phlebectomy for Patients with Varicose Vein of Lower Extremities . _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Yuanzhi , LUO Jun , LIU Kun , JIE Yuegao

Department of Vascular Surgery, The First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

Keywords：

Transilluminated powered phlebectomy; Great saphenous vein; Varicose vein; Vascular surgical procedures; Cosmetically satisfactory

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Objective To explore the effect, operational essential, and clinical meaning of transilluminated powered phlebectomy for patients with varicose vein of the lower extremity. Methods In the study, 255 patients with 363 lower extremities of varicose vein in our hospital between May 2006 and November 2009 were treated by transilluminated powered phlebectomy. According to revised clinical etiology anatomic and pathophysiological classification system (CEAP), there were 104 limbs in C2, 53 limbs in C3, 155 limbs in C4, 34 limbs in C5, and 17 limbs in C6. The patients were followed up to observe postoperative complications. Results All varicose vein labeled before operation were resected. Surgical time was (100±20) min in unilateral lower extremity and (147±19) min in bilateral lower extremities. Total 221 patients (302 lower extremities) were followed up in 4 to 46 months, median follow up time was 24.5 months. Total 167 cases (247 lower extremities) had accepted the operation more than 1 year, 154 cases (229 lower extremities) in which were followed up. In the 229 lower extremities above, recurrences occurred in 11 extremities, small amounts of residual small varices were observed in 2 extremities, the recurrence rate was 5.68% （13/229）. Twenty-one limbs with ulcer were healing in 3 to 6 weeks after operation. Postoperative complications: there was paresthesias or pain of ankle area in 16 limbs, which was improved in 3 to 6 months after physical therapy; there was ecchymosis of skin of leg in 112 limbs, which disappeared in 3 to 5 weeks after operation; there was light edema in 37 limbs, which disappeared in 1 to 2 weeks after operation; there was local hematoma in 2 limbs, incision light infection in 5 limbs, skin and subcutaneous tissue necrosis above medial malleolus in one limb, and back of knee popliteal skin lesion in 2 limbs, which were all cured by the symptomatic treatment.
Conclusions Surgical treatment of varicose veins is actually the combination of various surgical procedures. Varicose vein extraction using transilluminated powered phlebectomy is safe, efficacious, and cosmetically satisfactory.

Citation： ZHU Yuanzhi,LUO Jun,LIU Kun,JIE Yuegao. Therapeutic Effect Analysis and Operation Comprehend of Transilluminated Powered Phlebectomy for Patients with Varicose Vein of Lower Extremities . . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(11): 1171-1174. doi: Copy

1.	Callam MJ. Epidemiology of varicose veins [J]. Br J Surg，1994; 81(2): 167-173.
2.	王深明. 下肢深静脉瓣膜功能不全的外科治疗 [J]. 中国普外基础与临床杂志, 2006; 13（6）： 629-631.
3.	陈孝平. 外科学 [M]. 北京：人民卫生出版社， 2005: 789-791.
4.	Eklf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement [J]. J Vasc Surg, 2004; 40(6): 1248-1252.
5.	Dwerryhouse S, Davies B, Harradine K, et al. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial [J]. J Vasc Surg, 1999; 29(4): 589-592.
6.	Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein [J]. J Vasc Surg, 2004; 40(4): 634-639.
7.	Fischer R, Chandler JG, Stenger D, et al. Patient characteristics and physician-determined variables affecting saphenofemoral reflux recurrence after ligation and stripping of the great saphenous vein [J]. J Vasc Surg, 2006; 43(1): 81-87.
8.	王深明. 静脉疾病的临床诊断和治疗策略 [J]. 中国实用外科杂志, 2006; 26(10): 736-738.
9.	刘维藩，谭小宇，曾连山，等. 保留五大分支大隐静脉次高位结扎术(附288例分析) [J]. 中国实用外科杂志， 1998; 18(8): 508-509.
10.	黄英，蒋米尔，张培华. 下肢浅静脉曲张的微创治疗 [J]. 外科理论与实践， 2004; 9（1）: 76-77， 83.
11.	Elias SM, Frasier KL. Minimally invasive vein surgery [J]. Mt Sinai J Med, 2004; 71(1): 42-46.
12.	Shamiyeh A, Schrenk P, Huber E, et al. Transilluminated powered phlebectomy: advantages and disadvantages of a new technique [J]. Dermatol Surg, 2003; 29(6): 616-619.
13.	de Zeeuw R, Wittens C, Loots M, et al. Transilluminated powered phlebectomy accomplished by local tumescent anaesthesia in the treatment of tributary varicose veins: preliminary clinical results [J]. Phlebology, 2007; 22(2): 90-94.
14.	Aremu MA, Mahendran B, Butcher W, et al．Prospective randomized controlled trial: conventional versus powered phlebectomy [J]. J Vasc Surg, 2004; 39(1): 88-94.
15.	Scavée V. Transilluminated powered phlebectomy: not en-ough advantages? Review of the literature [J]. Eur J Vasc Endovasc Surg, 2006; 31(3): 316-319.
16.	Scavée V, Lesceu O, Theys S, et al． Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results [J]. Eur J Vasc Endovasc Surg, 2003; 25(5): 473-475.
17.	Nazarenko GI, Kungurtsev VV, Sidorenko VI, et al． Transillumination-assisted phlebectomy with the help of the TriVex system in comprehensive management of varicose disease of lower-limb veins [J]. Angiol Sosud Khir, 2008; 14(2): 96-100.
18.	Chetter IC, Mylankal KJ, Hughes H, et al．Randomized clinical trial comparing multiple stab incision phlebectomy and transilluminated powered phlebectomy for varicose veins [J]. Br J Surg, 2006; 93(2): 169-174.
19.	Hanrahan LM, Araki CT, Rodriguez AA, et al． Distribution of valvular incompetence in patients with venous stasis ulceration [J]． J Vasc Surg, 1991; 13(6): 805-812.
20.	Labropoulos N, Leon M, Geroulakos G, et al． Venous hemodynamic abnormalities in patients with leg ulceration [J]．Am J Surg, 1995; 169(6): 572-574.
21.	Padberg FT Jr. Endoscopic subfascial perforating vein ligation: its complementary role in the surgical management of chronic venous insufficiency [J]． Ann Vasc Surg, 1999; 13(3): 343-354.
22.	时德, 赵渝. 下肢慢性静脉功能不全治疗的再认识 [J]. 中国普外基础与临床杂志， 2009; 16（6）： 421-424.
23.	李昭辉, 景在平, 陈泉, 等. 腔镜深筋膜下交通支结扎＋溃疡周围环缝术治疗慢性下肢静脉性溃疡23例 [J]. 中国普外基础与临床杂志, 2008; 15（6）： 416-417.
24.	Passman MA, Dattilo JB, Guzman RJ, et al．Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? [J]. Vasc Endovascular Surg, 2007; 41(1): 41-47.
25.	Luebke T, Brunkwall J. Meta-analysis of transilluminated powered phlebectomy for superficial varicosities [J]. J Cardiovasc Surg (Torino), 2008; 49(6): 757-764.

1. Callam MJ. Epidemiology of varicose veins [J]. Br J Surg，1994; 81(2): 167-173.
2. 王深明. 下肢深静脉瓣膜功能不全的外科治疗 [J]. 中国普外基础与临床杂志, 2006; 13（6）： 629-631.
3. 陈孝平. 外科学 [M]. 北京：人民卫生出版社， 2005: 789-791.
4. Eklf B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement [J]. J Vasc Surg, 2004; 40(6): 1248-1252.
5. Dwerryhouse S, Davies B, Harradine K, et al. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial [J]. J Vasc Surg, 1999; 29(4): 589-592.
6. Winterborn RJ, Foy C, Earnshaw JJ. Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein [J]. J Vasc Surg, 2004; 40(4): 634-639.
7. Fischer R, Chandler JG, Stenger D, et al. Patient characteristics and physician-determined variables affecting saphenofemoral reflux recurrence after ligation and stripping of the great saphenous vein [J]. J Vasc Surg, 2006; 43(1): 81-87.
8. 王深明. 静脉疾病的临床诊断和治疗策略 [J]. 中国实用外科杂志, 2006; 26(10): 736-738.
9. 刘维藩，谭小宇，曾连山，等. 保留五大分支大隐静脉次高位结扎术(附288例分析) [J]. 中国实用外科杂志， 1998; 18(8): 508-509.
10. 黄英，蒋米尔，张培华. 下肢浅静脉曲张的微创治疗 [J]. 外科理论与实践， 2004; 9（1）: 76-77， 83.
11. Elias SM, Frasier KL. Minimally invasive vein surgery [J]. Mt Sinai J Med, 2004; 71(1): 42-46.
12. Shamiyeh A, Schrenk P, Huber E, et al. Transilluminated powered phlebectomy: advantages and disadvantages of a new technique [J]. Dermatol Surg, 2003; 29(6): 616-619.
13. de Zeeuw R, Wittens C, Loots M, et al. Transilluminated powered phlebectomy accomplished by local tumescent anaesthesia in the treatment of tributary varicose veins: preliminary clinical results [J]. Phlebology, 2007; 22(2): 90-94.
14. Aremu MA, Mahendran B, Butcher W, et al．Prospective randomized controlled trial: conventional versus powered phlebectomy [J]. J Vasc Surg, 2004; 39(1): 88-94.
15. Scavée V. Transilluminated powered phlebectomy: not en-ough advantages? Review of the literature [J]. Eur J Vasc Endovasc Surg, 2006; 31(3): 316-319.
16. Scavée V, Lesceu O, Theys S, et al． Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results [J]. Eur J Vasc Endovasc Surg, 2003; 25(5): 473-475.
17. Nazarenko GI, Kungurtsev VV, Sidorenko VI, et al． Transillumination-assisted phlebectomy with the help of the TriVex system in comprehensive management of varicose disease of lower-limb veins [J]. Angiol Sosud Khir, 2008; 14(2): 96-100.
18. Chetter IC, Mylankal KJ, Hughes H, et al．Randomized clinical trial comparing multiple stab incision phlebectomy and transilluminated powered phlebectomy for varicose veins [J]. Br J Surg, 2006; 93(2): 169-174.
19. Hanrahan LM, Araki CT, Rodriguez AA, et al． Distribution of valvular incompetence in patients with venous stasis ulceration [J]． J Vasc Surg, 1991; 13(6): 805-812.
20. Labropoulos N, Leon M, Geroulakos G, et al． Venous hemodynamic abnormalities in patients with leg ulceration [J]．Am J Surg, 1995; 169(6): 572-574.
21. Padberg FT Jr. Endoscopic subfascial perforating vein ligation: its complementary role in the surgical management of chronic venous insufficiency [J]． Ann Vasc Surg, 1999; 13(3): 343-354.
22. 时德, 赵渝. 下肢慢性静脉功能不全治疗的再认识 [J]. 中国普外基础与临床杂志， 2009; 16（6）： 421-424.
23. 李昭辉, 景在平, 陈泉, 等. 腔镜深筋膜下交通支结扎＋溃疡周围环缝术治疗慢性下肢静脉性溃疡23例 [J]. 中国普外基础与临床杂志, 2008; 15（6）： 416-417.
24. Passman MA, Dattilo JB, Guzman RJ, et al．Combined endovenous ablation and transilluminated powered phlebectomy: is less invasive better? [J]. Vasc Endovascular Surg, 2007; 41(1): 41-47.
25. Luebke T, Brunkwall J. Meta-analysis of transilluminated powered phlebectomy for superficial varicosities [J]. J Cardiovasc Surg (Torino), 2008; 49(6): 757-764.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Therapeutic Effect Analysis and Operation Comprehend of Transilluminated Powered Phlebectomy for Patients with Varicose Vein of Lower Extremities . 

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