Picture: Crochet hook 
Crochet hooks might soon be
used in a new way; © pschemp

More than 250 patients at University of California, Los Angeles (UCLA) have undergone Light-Assisted Stab Phlebectomy (LASP). The technique combines two current varicose vein-removal methods — powered phlebectomy and stab phlebectomy — which excise veins through a small incision in the skin. The method also employs transilllumination, in which a light source is placed beneath the skin to help highlight the veins during the procedure.

In addition new, minimally invasive surgical instruments to remove the veins were developed. "This new, sutureless technique allows complete and rapid varicose branch vein removal with few missed varicose veins, little bruising and an excellent cosmetic result," said Dr. Peter Lawrence, author of the study and a professor at the David Geffen School of Medicine at UCLA.

During the LASP procedure, in which the patient is sedated but remains conscious, Lawrence makes a tiny incision near the varicose veins and threads a slender tube with a light source at its tip underneath the vein cluster. A mixture of saline, lidocaine and epinephrine is infused into the area, providing a further anaesthetic and "plumping up" the veins so that they are easily visible.

Lawrence then makes a very small incision immediately adjacent to a varicose vein. Taking a size seven crochet hook that has been filed down and modified for the procedure, he passes it through the incision, hooks a vein and pulls it through the opening. Then he grasps the vein at its base with a tiny mosquito clamp. Using a gentle circular motion, he dislodges the vein from the skin. Further incisions are made to remove remaining veins.

The empty vein channels are flushed with solution to help collapse them and prevent bruising and hematomas from any residual blood remaining in the channels. No sutures are used; this allows for continued drainage if needed. A compression dressing is applied to the affected area, and within an hour, the patient goes home with instructions to elevate the leg for 48 hours.

Between 2004 and 2006, 268 patients received LASP treatment at UCLA — 49 of them underwent LASP alone, and 184 had it combined with another varicose vein-removal procedure. Researchers followed up with patients roughly a year after their procedures and found few early postoperative complications, such as infection, hematoma formation or severe pain requiring additional pain prescriptions.
MEDICA.de; Source: University of California, Los Angeles