Endoscopic subfascial discission of perforating veins

Abstract

The insufficiency of perforating veins is thought to be crucial in the pathogenesis of varicose and postphlebitic ulcers as well as postoperative varicose vein recurrence. Their eradication is a valid and effective therapeutic concept. No presently available technique has yielded satisfactory results, hence our efforts to develop a new method: the endoscopic subfascial discission of perforating veins (ESDP). It involves performing a small incision in an area remote from the point of trophic disturbance and allows the operator to accurately and atraumatically perform a subfascial discission of the perforating veins where they join the deep veins under direct endoscopic control. Our initial experience with the technique showed promising results: 78%-93% good and very good results depending on the clinical parameters applied. These are the results of a follow-up period of up to 14 months. During that time, none of our patients developed a complication or recurrence. Our technique has many advantages over traditional techniques of perforator vein eradication: (1) more accurate localization; (2) improved wound healing, (3) dependable occlusion; (4) immediate postoperative mobilization of the patient. We feel that ESDP represents a major advance in the development of better methods of subfascial perforator vein eradication. Greater experience and a longer follow-up period will, however, be required to confirm this initial observation.

Subfascial Endoscopic Perforator Surgery Using Screw-Type Ports Is a Very Useful Component of a Comprehensive Treatment Program for Chronic Venous Insufficiency

“…Recently, severing incompetent perforating veins (IPV) by a direct approach in an area with already compromised skin is less commonly performed because of excessive invasiveness of the procedure itself. Since its first description by Hauer in the 1980s, 1) SEPS has been accepted as an improved treatment modality in the surgical treatment of perforating vein insufficiency, particularly in cases with advanced skin changes. SEPS is performed in some facilities in North America [2][3][4][5] and Europe [6][7][8][9][10] as a component of the comprehensive treatment program for venous insufficiency.…”

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

“…Recently, with the introduction of subfascial endoscopic perforating vein surgery (SEPS) by Hauer in Germany, the interest in perforator surgery has been revived [9]. Using this minimally invasive approach, surgeons in North America and Europe have reported promising results for ulcer healing [8,13].…”

Ultrasound-Guided Injection of Polidocanol Microfoam in the Management of Venous Leg Ulcers

“…Subfascial endoscopic perforator surgery has become the surgical technique of choice for perforator ablation. 7 Nevertheless, the efficacy of perforator ablation remains highly controversial, regardless of the technique used. Furthermore, this approach cannot be adopted in all cases.…”