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Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency.
J Vasc Surg. 2006 Mar; 43(3):546-50.JV

Abstract

BACKGROUND

Subfascial endoscopic perforating vein surgery (SEPS) and superficial vein surgery (SVS) have been the recommended treatment for advanced chronic venous insufficiency (CVI), despite a high prevalence of deep vein reflux in these patients. The anatomic and hemodynamic results of these procedures, however, remain uncertain. It is hypothesized that concomitant SEPS and SVS would result in a reduction of deep vein reflux in patients with advanced primary CVI. We investigated the effect of concomitant SEPS and SVS on deep vein reflux as well as the associated hemodynamic and clinical changes after surgery in a cohort of patients with advanced primary CVI.

METHODS

We prospectively evaluated 53 consecutive SEPSs with concomitant SVS procedures in 47 patients with advanced primary CVI. There were 25 men and 22 women with a mean age of 58 years at operation. Thirty-four procedures (64%) were performed for limbs with active venous ulcers (class 6), and the other 19 procedures were performed for 15 class 5 limbs, one class 4a limb, and three class 4b limbs, respectively. Duplex scan and air plethysmography were performed before operation, at 1 month, and at 1 year after operation. The patients were followed up regularly with clinical assessment, and the ulcer healing and recurrence rates were documented.

RESULTS

The proportion of limbs with common femoral vein incompetence decreased from 68% to 28% at 1 month and to 32% at 1 year after operation. The proportion of limbs with deep vein incompetence at more than one site also decreased from 42% to 15% at 1 month and to 12% at 1 year after concomitant SEPS and SVS. Venous hemodynamics as measured by air plethysmography improved significantly after operation. The cumulative ulcer healing was 85% at 3 months and 97% at 6 months. With a mean follow-up of 31 +/- 16 months, all ulcers healed. Only three recurrent ulcers (6%) were detected during the follow-up period.

CONCLUSION

Concomitant SEPS and SVS are effective in reducing deep vein reflux and results in hemodynamic and clinical improvements in patients with advanced primary CVI. Deep vein reconstruction procedures may not be necessary in these patients.

Authors+Show Affiliations

Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China. acwting@graduate.hku.hkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16520170

Citation

Ting, Albert C W., et al. "Reduction in Deep Vein Reflux After Concomitant Subfascial Endoscopic Perforating Vein Surgery and Superficial Vein Ablation in Advanced Primary Chronic Venous Insufficiency." Journal of Vascular Surgery, vol. 43, no. 3, 2006, pp. 546-50.
Ting AC, Cheng SW, Ho P, et al. Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency. J Vasc Surg. 2006;43(3):546-50.
Ting, A. C., Cheng, S. W., Ho, P., Poon, J. T., Wu, L. L., & Cheung, G. C. (2006). Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency. Journal of Vascular Surgery, 43(3), 546-50.
Ting AC, et al. Reduction in Deep Vein Reflux After Concomitant Subfascial Endoscopic Perforating Vein Surgery and Superficial Vein Ablation in Advanced Primary Chronic Venous Insufficiency. J Vasc Surg. 2006;43(3):546-50. PubMed PMID: 16520170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency. AU - Ting,Albert C W, AU - Cheng,Stephen W K, AU - Ho,Pei, AU - Poon,Jensen T C, AU - Wu,Lisa L H, AU - Cheung,Grace C Y, PY - 2005/09/12/received PY - 2005/11/12/accepted PY - 2006/3/8/pubmed PY - 2006/4/8/medline PY - 2006/3/8/entrez SP - 546 EP - 50 JF - Journal of vascular surgery JO - J Vasc Surg VL - 43 IS - 3 N2 - BACKGROUND: Subfascial endoscopic perforating vein surgery (SEPS) and superficial vein surgery (SVS) have been the recommended treatment for advanced chronic venous insufficiency (CVI), despite a high prevalence of deep vein reflux in these patients. The anatomic and hemodynamic results of these procedures, however, remain uncertain. It is hypothesized that concomitant SEPS and SVS would result in a reduction of deep vein reflux in patients with advanced primary CVI. We investigated the effect of concomitant SEPS and SVS on deep vein reflux as well as the associated hemodynamic and clinical changes after surgery in a cohort of patients with advanced primary CVI. METHODS: We prospectively evaluated 53 consecutive SEPSs with concomitant SVS procedures in 47 patients with advanced primary CVI. There were 25 men and 22 women with a mean age of 58 years at operation. Thirty-four procedures (64%) were performed for limbs with active venous ulcers (class 6), and the other 19 procedures were performed for 15 class 5 limbs, one class 4a limb, and three class 4b limbs, respectively. Duplex scan and air plethysmography were performed before operation, at 1 month, and at 1 year after operation. The patients were followed up regularly with clinical assessment, and the ulcer healing and recurrence rates were documented. RESULTS: The proportion of limbs with common femoral vein incompetence decreased from 68% to 28% at 1 month and to 32% at 1 year after operation. The proportion of limbs with deep vein incompetence at more than one site also decreased from 42% to 15% at 1 month and to 12% at 1 year after concomitant SEPS and SVS. Venous hemodynamics as measured by air plethysmography improved significantly after operation. The cumulative ulcer healing was 85% at 3 months and 97% at 6 months. With a mean follow-up of 31 +/- 16 months, all ulcers healed. Only three recurrent ulcers (6%) were detected during the follow-up period. CONCLUSION: Concomitant SEPS and SVS are effective in reducing deep vein reflux and results in hemodynamic and clinical improvements in patients with advanced primary CVI. Deep vein reconstruction procedures may not be necessary in these patients. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/16520170/Reduction_in_deep_vein_reflux_after_concomitant_subfascial_endoscopic_perforating_vein_surgery_and_superficial_vein_ablation_in_advanced_primary_chronic_venous_insufficiency_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(05)01933-6 DB - PRIME DP - Unbound Medicine ER -