Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery

Ting, Acw; Cheng, Stephen W.K.; Ho, Pei; Wu, Lisa L. H.; Cheung, Gordon C. K.

doi:10.1007/s00464-002-8764-3

“…This study shows a high prevalence of SVR in Thai patients (more than 80%). Many other Asian studies had similar observations, such as those from Hong Kong (93%) (6) and Japan (90%). (7) The history of deep vein thrombosis (DVT) among our patients with CVI was unusual, at 6.7%.…”

Section: Discussionsupporting

confidence: 61%

Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs

Kanchanabat

¹

,

Stapanavatr

²

2018

smedj

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Calf vein reflux plays an important role in CVI and in patients with recurrent ulceration after previous superficial venous surgery. Although GSVR was present in most patients with CVI in the legs, SSVR may present in one-third of patients, especially those with lateral ulceration. The high prevalence of DVR in the absence of DVT and the presence of a pulsatile venous signal in some patients highlight the incomplete understanding of CVI aetiology.

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“…Advanced CVI was associated with multiple system reflux disease 43 . In the present study, 95% of the limbs operated had valvular incompetence in more than one venous system, and 51% of them had incompetence in all three systems: deep, superficial and perforating vein systems 41 . As concomitant superficial vein procedures were performed in the majority of the patients, favourable results cannot be ascribed exclusively to perforator interruption.…”

Section: Subfascial Endoscopic Perforating Vein Surgerymentioning

confidence: 41%

“…In our recent prospective study on the safety and efficacy of SEPS in the management of advanced CVI, 45 patients who had undergone SEPS were evaluated 41 . Thirty‐five patients (78%) had active venous ulcers with a mean size of 7.8 cm 2 .…”

Section: Subfascial Endoscopic Perforating Vein Surgerymentioning

confidence: 99%

Surgical treatment for advanced chronic venous insufficiency in Hong Kong

Ting

¹

,

Cheng

²

,

Ho

³

et al. 2004

Annals of the College of Surgeons of Hong Kong

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Advanced chronic venous insufficiency (CVI) is an important health problem. In Hong Kong, with its predominantly Chinese population, most patients have primary CVI because deep vein thrombosis is less common. Nevertheless, 80% of the limbs with advanced CVI had reflux in both the superficial and deep vein systems. This showed that advanced CVI in this population is a multisystem pathological condition affecting both the superficial and deep vein systems. In the present study, it was hypothesized that the abnormal hydrostatic forces in the superficial and perforating vein systems are the significant pathologic forces leading to advanced CVI, although deep vein incompetence is common. This deep vein incompetence can be contributed to significantly by venous overload as a result of superficial reflux (reflux circuit of venous overload). This is well supported by the abolition of deep venous reflux as well as significant haemodynamic improvement as measured by air plethysmography after superficial vein surgery in limbs with mixed superficial and deep venous incompetence. Recently, subfascial endoscopic perforating vein surgery (SEPS) was introduced as a minimally invasive technique to interrupt incompetent calf perforators. Preliminary local experience showed that SEPS with concomitant superficial vein surgery was associated with a 97% ulcer healing at a mean follow up of 15 months. Significant haemodynamic improvement was also shown by air plethysmography. However, recurrent ulcers were noted in 15% of the limbs. Thus, SEPS with superficial vein surgery where appropriate can be the optimal operative treatment strategy for advanced CVI in the local population, although ulcer recurrence remains a concern.

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“…In our recent prospective study on the safety and efficacy of SEPS in the management of advanced CVI, 45 patients who had undergone SEPS were evaluated. 41 Thirty-five patients (78%) had active venous ulcers with a mean size of 7.8 cm 2 . Concomitant superficial vein procedures were performed in addition to SEPS in 39 patients (87%).…”

Section: Subfascial Endoscopic Perforating Vein Surgerymentioning

confidence: 99%

“…43 In the present study, 95% of the limbs operated had valvular incompetence in more than one venous system, and 51% of them had incompetence in all three systems: deep, superficial and perforating vein systems. 41 As concomitant superficial vein procedures were performed in the majority of the patients, favourable results cannot be ascribed exclusively to perforator interruption. Nevertheless, the poor results of non-operative management to prevent ulcer recurrence would justify surgical attempts at perforator ligation in addition to ablation of superficial reflux.…”

Section: Subfascial Endoscopic Perforating Vein Surgerymentioning

confidence: 99%

Surgical treatment for advanced chronic venous insufficiency in Hong Kong

Chi-wai¹

0

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Advanced chronic venous insufficiency (CVI) is an important health problem. In Hong Kong, with its predominantly Chinese population, most patients have primary CVI because deep vein thrombosis is less common. Nevertheless, 80% of the limbs with advanced CVI had reflux in both the superficial and deep vein systems. This showed that advanced CVI in this population is a multisystem pathological condition affecting both the superficial and deep vein systems. In the present study, it was hypothesized that the abnormal hydrostatic forces in the superficial and perforating vein systems are the significant pathologic forces leading to advanced CVI, although deep vein incompetence is common. This deep vein incompetence can be contributed to significantly by venous overload as a result of superficial reflux (reflux circuit of venous overload). This is well supported by the abolition of deep venous reflux as well as significant haemodynamic improvement as measured by air plethysmography after superficial vein surgery in limbs with mixed superficial and deep venous incompetence. Recently, subfascial endoscopic perforating vein surgery (SEPS) was introduced as a minimally invasive technique to interrupt incompetent calf perforators. Preliminary local experience showed that SEPS with concomitant superficial vein surgery was associated with a 97% ulcer healing at a mean follow up of 15 months. Significant haemodynamic improvement was also shown by air plethysmography. However, recurrent ulcers were noted in 15% of the limbs. Thus, SEPS with superficial vein surgery where appropriate can be the optimal operative treatment strategy for advanced CVI in the local population, although ulcer recurrence remains a concern.

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Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery

Abstract: SEPS is a safe and effective treatment for patients with severe CVI. It leads to hemodynamic improvement, with rapid ulcer healing, and it is associated with a high degree of patient satisfaction.

Cited by 18 publications

References 19 publications

Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs

Venous ultrasonography findings and clinical correlations in 104 Thai patients with chronic venous insufficiency of the legs

Surgical treatment for advanced chronic venous insufficiency in Hong Kong

Surgical treatment for advanced chronic venous insufficiency in Hong Kong

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