Slow-flow during carotid intervention with EPDs is a frequent event that is associated with an excess risk of periprocedural stroke. The association of the phenomenon with clinically symptomatic carotid lesions and use of larger stent diameters suggests that embolization of vulnerable plaque elements may play a pathogenic role.

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Conclusion:Transilluminated power phlebectomy (TIPP) compared with multiple stab incision phlebectomy (MSIP) results in fewer surgical incisions but has reduced early postoperative quality of life, with more extensive bruising and more prolongation of postoperative pain.Summary: This was a randomized clinical trial at a university teaching hospital in Australia. Patients who were to undergo surgery for varicose veins were randomized to receive either TIPP or MSIP for treatment of the varicosities. For both groups, analysis consisted of operative times, number of incisions, and postoperative outcome. A quality-of-life analysis was conducted at 1 and 6 weeks after surgery using disease-specific (Aberdeen varicose vein questionnaire) and generic (Short Form 36 and EuroQual 5D) measures as well as the domain-specific Burford Pain Scale. The MSIP arm of the trial had 33 patients, and the TIPP arm had 29 patients. All patients had complicated or symptomatic varicose veins. In the MSIP group, 29 of the 33 patients were CEAP class II, and 27 of 29 patients in the TIPP group were CEAP class II.Mean duration of surgery was 48 minutes (range, 41 to 63 minutes) in the MSIP patients and 50 minutes (range, 40 to 60 minutes) in the TIPP group (P ϭ .717). A significantly lower number of phlebectomy incisions were used in the TIPP group (mean, 5; range, 3 to 7), than the MISP group (mean, 20; range, 11 to 25) (P Ͻ .001). At 1 and 6 weeks, skin bruising was significantly higher in the TIPP group (P Ͻ .01), and the Burford Pain Scale at 6 weeks was also significantly higher in the TIPP group (P ϭ .019). At 1 week after surgery, both groups had significant deterioration on the qualityof-life outcomes domains of physical function, role play, and social function of the SF36. The magnitude of deterioration was greater after TIPP. At 6 weeks, patients who had TIPP had no significant change in any SF36 quality-of-life domain compared with pretreatment values. Patients treated with MSIP at 6 weeks showed significant improvements in role play and in physical and bodily pain.Comment: In this randomized trial of transilluminated power phlebectomy vs standard multiple stab incisions for varicose vein treatment, the only advantage of the transilluminated power phlebectomy was a decreased number of incisions. Surprisingly, there was no difference in operative time. If patient recovery is the issue, it therefore appears that standard multiple incisions provide a better outcome. If the patient is interested in fewer incisions for cosmetic concerns, transilluminated power phlebectomy will provide this but at the expense of a more prolonged recovery from the initial procedure.

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