Abstract
Incompetent perforating veins (IPVs) participate in the onset of venous stasis skin lesion by chronic venous insufficiency and are important as a cause of recurrent varices after surgery. IPVs are divided into the one which connects it with main saphenous vein and the one which doesn’t. Between February 2010 and June 2013, 632 legs of 446 patients underwent venous echo for the diagnosis of IPVs. In their way, pressure loading to detect the reflux other than usual pressure loading test such as a milking method of the lower leg or a Valsalva maneuver in standing position, was also devised and tried. For the former 31 IPVs, direct ligation and resection above the fascia was performed on the connection with saphenous vein where the stripping was also conducted. For the latter IPVs, 110 IPVs of 98 limbs without stasis skin lesion underwent direct ligation and resection above the fascia. And 91 limbs of 78 patients underwent subfascial endoscopic perforator surgery (SEPS) for the IPVs under the stasis skin lesion in the superficial posterior compartment. The other 2 IPVs were treated by echoguided foam sclerotherapy. No serious complications were observed. Especially in 23 limbs with stasis ulcer, SEPS was conducted and all ulcers healed and ulcer recurrence was seen only in 1 limb (4.3%). Our treatment strategy for IPV based on the exact diagnosis by venous echo is thought to be proper.
