Varicose veins: evaluating modern treatments, with emphasis on powered phlebectomy for branch varicosities

Varicose veins are an early manifestation of chronic venous insufficiency. Although the risk factors associated with varicose veins are well described, the basic pathophysiology leading to venous valvular incompetence, and thus, varicosities are less well known. However, cosmetics aside, the leg fatigue and heaviness that is associated with chronic venous insufficiency in the presence of varicose veins can be disabling. The treatment of superficial vein reflux has evolved in the past 10 years making open surgical ligation and stripping of the great saphenous vein largely a historic procedure. Endovenous ablation using catheter-based techniques achieve vein closure with minimal surgical risk. In the same sense, removal of varicosities associated with superficial reflux has also evolved. Traditionally, varicose veins were removed with multiple stab incisions and hook phlebectomy. The introduction of transilluminated-powered phlebectomy has allowed for removal of large clusters of varicose veins using fewer stab incisions and less procedural time. Herein, we discuss the development of transilluminated powered phlebectomy over the past decade and described in detail our technique for using transilluminated powered phlebectomy as well as our initial outcomes.