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Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure.
Surg Endosc. 2005 Jan; 19(1):126-9.SE

Abstract

BACKGROUND

Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS).

METHODS

From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration).

RESULTS

The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period.

CONCLUSIONS

This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency.

Authors+Show Affiliations

Department of Surgery, Division of Vascular Surgery, Mount Sinai School of Medicine / Cabrini Program, 222 East 19th Street, Suite 2 J, New York, NY 10003, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15531974

Citation

Baron, H C., et al. "Treatment of Severe Chronic Venous Insufficiency Using the Subfascial Endoscopic Perforator Vein Procedure." Surgical Endoscopy, vol. 19, no. 1, 2005, pp. 126-9.
Baron HC, Wayne MG, Santiago C, et al. Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure. Surg Endosc. 2005;19(1):126-9.
Baron, H. C., Wayne, M. G., Santiago, C., Lown, I., Castellano, M., Cioroiu, M., & Grossi, R. (2005). Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure. Surgical Endoscopy, 19(1), 126-9.
Baron HC, et al. Treatment of Severe Chronic Venous Insufficiency Using the Subfascial Endoscopic Perforator Vein Procedure. Surg Endosc. 2005;19(1):126-9. PubMed PMID: 15531974.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure. AU - Baron,H C, AU - Wayne,M G, AU - Santiago,C, AU - Lown,I, AU - Castellano,M, AU - Cioroiu,M, AU - Grossi,R, Y1 - 2004/11/11/ PY - 2004/02/17/received PY - 2004/07/27/accepted PY - 2004/11/9/pubmed PY - 2006/4/28/medline PY - 2004/11/9/entrez SP - 126 EP - 9 JF - Surgical endoscopy JO - Surg Endosc VL - 19 IS - 1 N2 - BACKGROUND: Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS). METHODS: From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration). RESULTS: The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period. CONCLUSIONS: This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/15531974/Treatment_of_severe_chronic_venous_insufficiency_using_the_subfascial_endoscopic_perforator_vein_procedure_ L2 - https://doi.org/10.1007/s00464-004-8124-6 DB - PRIME DP - Unbound Medicine ER -