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Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery.
J Vasc Surg. 2004 Mar; 39(3):583-9.JV

Abstract

INTRODUCTION

In the United States more than 6 million persons have chronic venous insufficiency and more than 500,000 have venous ulcers. Patients in whom conservative therapies fail may improve after surgical treatment of superficial and perforating venous disease, but the degree of this benefit is uncertain.

PURPOSE

We performed a systematic review of health outcomes in patients with severe chronic venous insufficiency treated with surgical management that incorporated subfascial endoscopic perforator surgery (SEPS), to quantify the overall rates of surgical outcomes.

METHODS

Published studies in English reporting venous ulcer healing and recurrence outcomes after SEPS were obtained from a MEDLINE search. Data regarding patient characteristics and surgical outcomes were abstracted from each study, and the outcomes were combined by using a random effects model.

RESULTS

Our search identified 20 studies, 1 randomized trial and 19 case series, involving 1140 treated limbs. CEAP classification was secondary cause (E(S)) in 36%, deep venous involvement (A(D))in 56%, and obstructive (P(O)) in 12%. Overall, after surgical treatment including SEPS, with or without concomitant superficial venous ablation, ulcers in 88% of limbs healed. Ulcers recurred in 13%, at mean time of 21 months. Risk factors for nonhealing and recurrence included postoperative incompetent perforator veins, pathophysiologic obstruction, secondary cause, and ulcer diameter greater than 2 cm. Complications and their overall rates after surgical treatment including SEPS were wound infection (6%), hematoma (9%), neuralgia (7%), and deep venous thrombosis (1%).

CONCLUSION

Our results suggest that surgical management of venous ulcer including SEPS, with or without saphenous ablation, leads to an 88% chance of ulcer healing and a 13% chance of ulcer recurrence over the short term. Randomized controlled trials are needed to discern the contributions of compression therapy, superficial venous surgery, and SEPS in the treatment of venous ulcer disease.

Authors+Show Affiliations

Division of Clinical Decision Making, Department of Medicine, Tufts-New England Medical Center, Boston, MA 02111, USA. miafrati@tufts-nemc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

14981453

Citation

Tenbrook, John A., et al. "Systematic Review of Outcomes After Surgical Management of Venous Disease Incorporating Subfascial Endoscopic Perforator Surgery." Journal of Vascular Surgery, vol. 39, no. 3, 2004, pp. 583-9.
Tenbrook JA, Iafrati MD, O'donnell TF, et al. Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. J Vasc Surg. 2004;39(3):583-9.
Tenbrook, J. A., Iafrati, M. D., O'donnell, T. F., Wolf, M. P., Hoffman, S. N., Pauker, S. G., Lau, J., & Wong, J. B. (2004). Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. Journal of Vascular Surgery, 39(3), 583-9.
Tenbrook JA, et al. Systematic Review of Outcomes After Surgical Management of Venous Disease Incorporating Subfascial Endoscopic Perforator Surgery. J Vasc Surg. 2004;39(3):583-9. PubMed PMID: 14981453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. AU - Tenbrook,John A,Jr AU - Iafrati,Mark D, AU - O'donnell,Thomas F,Jr AU - Wolf,Michael P, AU - Hoffman,Stuart N, AU - Pauker,Stephen G, AU - Lau,Joseph, AU - Wong,John B, PY - 2004/2/26/pubmed PY - 2004/3/31/medline PY - 2004/2/26/entrez SP - 583 EP - 9 JF - Journal of vascular surgery JO - J Vasc Surg VL - 39 IS - 3 N2 - INTRODUCTION: In the United States more than 6 million persons have chronic venous insufficiency and more than 500,000 have venous ulcers. Patients in whom conservative therapies fail may improve after surgical treatment of superficial and perforating venous disease, but the degree of this benefit is uncertain. PURPOSE: We performed a systematic review of health outcomes in patients with severe chronic venous insufficiency treated with surgical management that incorporated subfascial endoscopic perforator surgery (SEPS), to quantify the overall rates of surgical outcomes. METHODS: Published studies in English reporting venous ulcer healing and recurrence outcomes after SEPS were obtained from a MEDLINE search. Data regarding patient characteristics and surgical outcomes were abstracted from each study, and the outcomes were combined by using a random effects model. RESULTS: Our search identified 20 studies, 1 randomized trial and 19 case series, involving 1140 treated limbs. CEAP classification was secondary cause (E(S)) in 36%, deep venous involvement (A(D))in 56%, and obstructive (P(O)) in 12%. Overall, after surgical treatment including SEPS, with or without concomitant superficial venous ablation, ulcers in 88% of limbs healed. Ulcers recurred in 13%, at mean time of 21 months. Risk factors for nonhealing and recurrence included postoperative incompetent perforator veins, pathophysiologic obstruction, secondary cause, and ulcer diameter greater than 2 cm. Complications and their overall rates after surgical treatment including SEPS were wound infection (6%), hematoma (9%), neuralgia (7%), and deep venous thrombosis (1%). CONCLUSION: Our results suggest that surgical management of venous ulcer including SEPS, with or without saphenous ablation, leads to an 88% chance of ulcer healing and a 13% chance of ulcer recurrence over the short term. Randomized controlled trials are needed to discern the contributions of compression therapy, superficial venous surgery, and SEPS in the treatment of venous ulcer disease. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/14981453/Systematic_review_of_outcomes_after_surgical_management_of_venous_disease_incorporating_subfascial_endoscopic_perforator_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741521403013442 DB - PRIME DP - Unbound Medicine ER -