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Multifocal Pull‐Through Endovascular Cannulation Technique of Ambulatory Phlebectomy

BACKGROUND New treatment indications and improved technique modifications have made ambulatory phlebectomy increasingly popular in the management of intermediate and large truncal varicosities. OBJECTIVE To describe a new technique of ambulatory phlebectomy that combines a multifocal incisional and endovascular cannulation approach. This study compares this newly described technique to the previously described “pulling maneuver.” METHODS A double-blinded study consisting of 50 patients who were treated by the conventional pulling maneuver and 50 patients treated by the multifocal pull-through endovascular cannulation technique was conducted. This newly described technique was compared to the previously described “pulling maneuver” in terms of length of vessel avulsed per puncture site, intraoperative time, and complication profile. An average of 20 cm of diseased venous segment was avulsed in each patient subgroup. Results were analyzed utilizing the paired t test (P <.05). RESULTS A 36% increase in vessel avulsion length per puncture site was achieved in the endovascular pull-through cannulation subgroup compared to the classic pulling maneuver population. The number of puncture sites in the 20 cm segment of veins in the classic pulling maneuver population was 4.50 versus 3.04 in the multifocal pull-through subgroup. The mean operative time was 20% less in the pull-through cannulation population versus the classic pulling technique. Side effect profiles were similar in the two patient subgroups. CONCLUSION The multifocal pull-through cannulation technique allows extraction of large segments of diseases varicose veins with fewer puncture sites in a more efficient fashion than previously described techniques.