Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: A preliminary report from the North American registry

Abstract

The SEPS modified Linton operation appears safe, with no postoperative deaths or early thromboembolism. Wound infection after SEPS remains important. Early results indicate rapid ulcer healing. Prospective evaluation of long-term results is warranted.

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

“…9) However, concomitant surgeries deemed necessary at the time of perforator interruption masked the effects of perforator vein intervention alone, as opposed to solitary ablation of superficial reflux. However, in a report from North America, 2) during an average follow-up period of 5.4 months, ulcer healing was achieved in 21 of 27 C6 limbs (78%) in which the only manipulation was perforator interruption.…”

“…Incompetence of perforator veins that connect the superficial to the deep venous system has been implicated in the pathogenesis of venous ulcerations. 2) It was reported that the deteriorating CEAP grade of CVI is associated with an increase in the number and diameter of medial calf perforating veins, particularly those permitting bidirectional flow. 15) The objective of SEPS is to interrupt incompetent medial calf perforating veins, so as to reduce ambulatory venous hypertension in critical areas above the ankle where venous ulcers most frequently develop.…”

“…Accessing the subfascial space and interrupting perforator veins through small skin incisions made in skin unaffected by the changes of severe CVI and remote from ulcerations is an attractive concept. 2) Due to the avoidance of incisions in an area of already-compromised skin, wound complications can be dramatically reduced by SEPS as compared with transcutaneous surgery.…”

“…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. These previous studies presented favorable results with SEPS.…”

Venous leg ulceration pathophysiology and evidence based treatment

“…However, the evidence regarding management of perforator abnormality was complicated by combining its treatment with that of superficial venous reflux. 80,81 Similar to saphenous vein intervention, the quality of evidence for the surgical management of perforator vein abnormality in VLU healing and prevention of recurrence was mostly limited to level C. However, endovenous methods, including radio frequency and laser ablation as well as foam sclerotherapy of perforator veins, have gained acceptance due to the minimally invasive nature of these interventions. In one large series of endovenous ablation procedures on 110 VLUs in 88 limbs (74 saphenous and 66 perforator veins), there was a significant reduction in ulcer size and expedited healing in those who failed standard of care, including compression therapy.…”