Abstract
Objective: To evaluate incompetent perforating vein (IPV) treatment in chronic vein disease patients. Materials and Methods: Fifty-four limbs with IPV in chronic vein disease patients (CEAP classes C4a–C6) were treated by subfascial endoscopic perforator surgery (SEPS) or direct IPV dissection. Each patient underwent duplex ultrasonography, and IPVs with diameters >3 mm were marked. SEPS was performed on 48 limbs and direct IPV dissection via healthy skin incision on 6 limbs. A dual port system and CO2 insufflation enabled IPV dissection using an ultrasonic surgical system. SEPS plus great saphenous vein stripping were performed in 30 cases, SEPS plus small saphenous vein stripping in 2 cases, SEPS plus varicotomy in 4 cases, SEPS plus great and small saphenous vein stripping in 1 case, and SEPS alone in 6 cases. Results: Patients with CEAP classes C4a–C5 had fewer serious complications. No advancement in CEAP classification class was observed in any group after treatment. Ulcers in 13 out of 15 cases healed. Minor infection developed at the port incision site in 3 cases. The outcomes and wound healing after direct IPV dissection were excellent. Conclusion: SEPS is the preferred treatment of severe dermatitis and ulcers with IPVs. Direct IPV dissection is useful when incision can be made on healthy skin.
