Varicose Vein Treatment by Suction-assisted Shaving Phlebectomy without the Use of Transillumination/Irrigation: A Simple, Quick and Effective Method

Traditional management of saphenous vein incompetency is using high ligation and stripping with multiple stab incision phlebectomies for the varicose tributaries. A number of minimally invasive options have been described, each with their own advantages and disadvantages. We describe a new technique using suction-assisted shaving phlebectomy without transillumination and irrigation in the management of varicose veins. METHODS: All patients that underwent combined conventional high ligation and stripping for saphenous vein insufficiency and suction-assisted shaving phlebectomy for varicose tributaries between 2011 and 2016 was included. They were evaluated with respect to surgical time, number of incisions, complications, and outcomes. RESULTS: A total of 232 patients with mean age of 49 years old were included. The mean operation time for combined saphenous stripping and suction-assisted shaving phlebectomy was 29.5 minutes and for suction-assisted shaving phlebectomy was 7.4 minutes. The number of incisions excluding the groin incision was 3 incisions in 38 limbs, 2 incisions in 186 limbs, and 1 incision in 33 limbs. Postoperative complications included 2 (0.8%) skin perforation, 1 cellulitis (0.4%), 2 hematoma (0.8%), 3 saphenous neuropathy (1.2%), 4 skin pigmentation (1.6%), 4 skin depression or irregularities (1.6%), and 3 hypertrophic scarring (1.2%). CONCLUSIONS: Suction-assisted shaving phlebectomy has the advantage of decreased operating time, fewer surgical incisions, ad decreased scar formation. There is no need to purchase expensive medical equipment. It is a simple and effective procedure with comparable complication rates. This technique aims to replace traditional ambulatory phlebectomy and transilluminated powered phlebectomy.