Endoscopic subfascial surgery for incompetent perforator veins in patients with active venous ulceration

Abstract

The results suggest that the SEPS procedure incorporated into the overall treatment plan for patients with CVI produces active healing with a minimum of postoperative complications. The study demonstrates the safety and efficiency of this procedure; it also underscores the important role incompetent perforator veins have in the formation of venous ulcers.

Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery

“…After excluding duplicate reports, 18 articles had data on healing outcomes after SEPS. [6][7][8][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Two studies found in references of included studies were added, 28,29 for a total of 20 included studies. Of these, 19 were case series and 1 was a randomized trial that compared open perforator ligation with SEPS.…”

“…34 Variation in surgical technique and individual surgeon experience may account, at least in part, for variation in rates of postoperative incom- petent perforator vessels. Also, use of skin grafts varied among studies (some routinely applied skin grafts in all patients with large ulcers 25 ), and this could have contributed to variability in outcomes. In the one study that reported healing according to presence or absence of skin grafting the healing rate was higher in patients with skin grafts, but the difference was not statistically significant.…”

“…Total mean follow-up among 16 studies reporting these data was 29 months. [6][7][8][13][14][15][18][19][20][22][23][24][25][26][27][28] Risk factors for nonhealing. To explore risk factors for nonhealing, we first identified factors examined in individual studies.…”

Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure

“…We then pass a blunt obturator just beneath the deep fascia. We prefer a single port for subfascial endoscopic perforator vein surgery [2]. A Fogarty balloon dissector (General Surgical Innovations, Palo-Alto, CA, USA) then is inserted into the posterior superficial compartment.…”

Evidence‐based (S3) guidelines for diagnostics and treatment of venous leg ulcers

“…Various published series showed that surgery of incompetent perforators yielded good results in the treatment of venous leg ulcers …”