How TRansLuminal Occlusion of Perforators (TRLOP) is performed
As with all endovenous surgery techniques, the target vein is identified with duplex ultrasound.
Under local anaesthetic, a needle or “cannula” is inserted into the incompetent perforating vein (IPV) to be treated. Once in position, the device that is going to be used to treat the incompetent perforating vein (IPV) is passed down this cannula and into the incompetent perforating vein (IPV). Once in position, the needle or cannula is removed leaving the device within the target vein.
Under ultrasound control, more local anaesthetic is placed around the vein to both stop any pain but also to stop any heat spreading from the treatment device and treated incompetent perforating vein (IPV) to other structures of the leg which might be inadvertently damaged.
- Ultrasound guiding the cannula and thermoablation device into the incompetent perforator
- During the TRLOP technique, a thermoablation device is passed down the cannula into the incompetent perforating vein (IPV)
Once the local anaesthetic has been injected around the incompetent perforating vein (IPV) and the device within it, the device can be turned on and the vein treated. In most cases and with most devices, treatment can be seen on ultrasound scanning, usually with the formation of bubbles of steam within the vein wall at the point of treatment.
- Incompetent perforator closed with heat (EVLA, RFA etc) using the TRLOP technique
Once the appropriate amount of energy has been passed into the incompetent perforating vein (IPV) to ensure closure, the device is withdrawn. A duplex ultrasound scan can then be performed looking for any flow of blood in the area. If any flow is noted, the areas checked again after another 5 min. If a blood flow is still noted, the transluminal occlusion of perforators (TRLOP) procedure is repeated.