Subfascial Endoscopic Perforator Vein Surgery in Patients with Chronic Venous Insufficiency

Abstract

Purpose: Subfascial endoscopic perforator surgery (SEPS) is a minimal invasive technique performed on patients with advanced chronic venous insufficiency (CVI). Although SEPS has been accepted as an improved treatment concept for the perforator vein insufficiency, the role of perforator surgery still remains unclear. The other issue with SEPS is that this procedure requires several special devices, such as a special endoscope and a roll-on tourniquet. We performed a “modified” SEPS procedure to eliminate incompetent perforator veins (IPV). This procedure is a two-port system SEPS using a 5 mm endoscope and a 6 mm port trocars (No leg tourniquet), requiring two small 7 mm skin incisions. This technique is simple and cost-effective since all the devices are reusable, and same as normal laparoscopic surgery. The aim of this study is to determine the effectiveness of the “modified” SEPS procedure on patients with CVI.
Methods: We analysed 68 limbs of 64 patients who underwent the“modified” SEPS from April 2009 to November 2011. Twenty-eight limbs were classified as C6 (active ulcer), 10 limbs as C5 (healed ulcer), 16 limbs as C4b (lipodermatosclerosis) and 14 limbs as C4a (Dermatitis). Nineteen patients previously had surgery (11 strippings, 3 high ligations, 2 Linton procedures, 1 venous reconstruction, 3 skin graftings). We performed saphenous venous surgery in addition to the “modified” SEPS on 50 limbs of 48 patients.
Results: Clinical improvement was seen in 63 limbs (94%) with no complications. Delayed ulcer healing was observed in 3 limbs. Although minor recurrent ulcers were recorded in 2 limbs, these were small, superficial, and easier to heal.
Conclusions: The “Modified” SEPS is a safe and highly effective procedure for patients with CVI due to IPVs. However a long-term study is needed to define benefits of the “modified” SEPS, we believe that this procedure is worth trying on patients with perforator vein insufficiency due to the simplicity, safety, and cost-effectiveness.