Transilluminated Powered Phlebectomy (TIPP) is a minimally invasive technique of permanently removing varicose veins of the legs. It can be used anytime a traditional stab (ambulatory) phlebectomy is appropriate.
During TIPP your doctor will use a small light that’s inserted under the skin to determine the exact location of the unwanted veins. Once located, these veins are carefully removed using specialized surgical instruments. Only local anesthesia is necessary. Most TIPP procedures are performed on an outpatient basis.
Transilluminated Powered Phlebectomy vein removal method is particularly useful for patients with very large varicose veins. It’s also the preferred technique for treating more complicated cases such as veins located near bleeding ulcers or active infections.
How is a transilluminated powered phlebectomy (TIPP) different than a “regular” ambulatory phlebectomy?
The term “phlebectomy” refers to the minimally invasive surgical removal of a varicose vein. There are currently two variations of the procedure in wide use today. These are:
- The ambulatory phlebectomy – This procedure is also sometimes referred to as a microphlebectomy. Before the procedure a local anesthetic, usually lidocaine, is used to prepare the area. Once the area is thoroughly numb the surgeon makes several tiny access incisions along the length of the vein. These are typically less than 5 mm across, making stitches unnecessary. The surgeon then removes the vein in small segments using specialized instruments.
- The Transilluminated Powered Phlebectomy (TIPP) – In this procedures the area around the vein is prepared with lidocaine exactly as with an ambulatory phlebectomy. A very small light source is then inserted beneath the skin to reveal the exact position of the vein. The technical term for this is “transillumination.” Your doctor will then mark the length of the now clearly visible vein using a surgical marker. A single access incision is made and a long, flexible catheter with a bladed tip is inserted into the vein. As this instrument is slowly withdrawn the vein is sliced into small pieces which are then vacuumed up the length of the catheter and out of the body.
Both procedures accomplish the complete physical removal of the varicose vein. Both procedures are usually performed in-office, using only local anesthetics. Many surgeons prefer lidocaine, yet drugs such as bupivacaine are equally effective. Regardless of which agent is being used, this numbing medication is injected into the area surrounding the vein. This provides complete pain control for the duration of the procedure.
The only practical difference is that some surgeons prefer TIPP when removing veins located near ulcers or areas of infection.
How does a Transilluminated Powered Phlebectomy (TIPP) compare with a traditional phlebectomy?
The main advantage of the TIPP procedure is that it facilitates the entire length of the vein to be seen clearly. This allows the surgeon to exercise extreme precision, ensuring that nearby healthy veins are not damaged. Another advantage is that TIIP requires fewer incisions than a “normal” ambulatory phlebectomy. TIPP also takes less time.
The only significant disadvantage of TIPP is the overall cost. The equipment and supplies involved are more expensive which significantly raises the price of the procedure. This makes the ambulatory phlebectomy the obvious choice for many patients paying out-of-pocket.
Recovery Time Needed After a TIPP Procedure?
Since the access incisions used to perform TIPP are so small there’s no need for sutures. Instead, thin adhesive strips are placed across the incision. Known as Steri-Strips, these specialty dressings are applied under light tension in order to pull the edges of the wound together. The effect is very much like that of a butterfly bandage.
The area will then be covered with an absorbent sterile dressing. This serves to keep the wounds clean while drawing any fluid which might ooze from the incisions away from the skin. Multiple layers of cotton are then wrapped around the leg to form additional layers of absorbency. Finally, the limb is wrapped using Coban, a stretchy dressing which applies light compression. This not only holds the dressing in place but holds a constant, gentle pressure on the healing incisions.
Compression After a TIPP Procedure
It’s important to keep this wrapped dressing on for 48 hours. When bathing, remember to keep the area dry. This will help ensure that you’re your incisions heal properly.
Immediately following your procedure, you’ll be given a pair of prescription compression stockings. In the coming weeks you’ll wear them according to the following guidelines:
- Don’t remove the stockings for the first 2 days. Note that this coincides with the period that your multi-layer dressing should remain in place.
- Wear your stockings at all times during the first week after your procedure. You’re allowed to remove them to bathe but be sure to put them back on when you’re done.
- Wear your stockings during waking hours for the second week following your procedure. Unless you plan on bathing immediately upon waking it’s best to put them on before getting out of bed.
It’s highly recommended that you observe a 25-pound lifting limit during this first two weeks. This limits the amount of strain put on the healing veins and incisions. After this period, at the discretion of your doctor, you can resume your normal activities. If your job is particularly strenuous you may be advised to wait a bit longer. The same is true if you participate in high impact exercise such as strength training.
After your TIPP procedure you can expect some minor discomfort and mild bruising. More serious complications such as infection are possible; yet, extremely rare. By following the above instructions it’s highly likely that you’ll get great results without complications.
Will my insurance cover my Transilluminated Powered Phlebectomy (TIPP) procedure? How much will it cost if I have to pay out of pocket?
The answer is yes, if the procedure is deemed “medically necessary.”
Medically Necessary means that:
- You’re experiencing physical symptoms. Visible, ropey surface veins are usually accompanied by swelling, achiness, heaviness, and fatigue (among other symptoms).
- Evidence that the problem is bad enough to treat. Doppler ultrasound images are taken of the vein in question and measurements are determined. If the vein is over a certain width, usually 5 mm, then your insurance is likely to cover the cost.
The TIPP procedure process is similar to getting any other procedure covered. First, call your insurance company and ask if the particular procedure is covered. Then your doctor will gather information to determine if it’s bad enough to treat. If the answer to both questions is yes, then the procedure is medically necessary. Once it is determined the procedure has been approved by your insurance, your doctor can proceed with treatment.
Unfortunately, this isn’t always the case. If medical necessity can’t be established, the procedure won’t be covered by insurance. At this point the patient can elect to pay out of pocket, or wait until the problem is bad enough to be determined “medically necessary”.