Other Treatment Options

Standard Vein Stripping
When Dr. Powell first started treating vein disease in the 1980’s, vein stripping was the procedure used. An incision was made in the groin and above the ankle, a wire was threaded through the larger veins, a large plastic knob was attached to one end of the wire, and it was pulled back through the leg tearing out the diseased vein. Then large incisions were made over the marked varicose tributaries, the varicose veins were pulled out, and the incisions were sutured closed leaving multiple large scars. Patient remained in the hospital for as much as a week before going home and had to wear compression stockings for six weeks following the procedure.

PIN (P-Perforate IN- Invaginate) Stripping
Vein surgeons in Europe started treating venous insufficiency with a procedure called Inversion Stripping or PIN (P-Perforate IN-Invaginate) stripping where they would make small incisions in the groin, above the knee, and above the ankle, run a wire or stripping device through the larger veins, suture the vein in such a way that when the wire was pulled back through the leg, it invaginated the vein inside itself. Small 1-2 millimeter stab wounds were made over marked varicose tributaries and small hooks were used to pull the varicose veins out of the small incisions (Ambulatory Phlebectomy). The incisions were so small they did not need to be sutured closed and they left very tiny scars that were hardly noticeable. Dr. Powell learned these techniques and started using them at Camp Pendleton Naval Hospital in the 1990’s.

Tumescent Local Anesthesia
A local anesthesia technique where saline, Lidocaine, Epinephrine, and Bicarbonate was injected into the tissues numbing the area of the surgery, constricting vessels resulting in less bleeding, and lessening stinging from the medicines changed the entire approach to vein surgery. Tumescent anesthesia allowed vein procedures to be performed safely in the office and made it possible for patients to go home right after the procedure. In fact, most patients can go back to work the same day as the surgery as a result of tumescent anesthesia, graduated compression stockings, and radiofrequency/laser techniques.

SEPS - Subfascial Endoscopic Perforator Surgery
SEPS is an endoscopic procedure where a viewing camera is placed through an incision on the upper, inner, lower leg to view the perforator veins connecting the superficial veins to the deep veins above the ankle. Clips are used to occlude the perforator veins and they are cut with scissors. This procedure is very useful when the skin is permanently damaged from leakage of blood from the diseased perforator veins above the ankle. The incision is made through healthy skin at the knee so that it heals well. Once the back-flowing perforator veins are destroyed, non-healing ulcers will heal in most cases. Dr. Powell has been trained to do the SEPS procedure; however, he is not presently doing it.