Retrospective long-term evaluation of the quality of life and the results of a modified transilluminated powered phlebectomy (TPP) technique

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.