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Subfascial endoscopic perforator ligation: an analysis of early clinical outcomes and cost.
J Vasc Surg. 1997 Jun; 25(6):995-1000; discussion 1000-1.JV

Abstract

PURPOSE

Early results of subfascial endoscopic perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented.

METHODS

Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open perforator ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported.

RESULTS

Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open perforator ligation ($2570 vs $1883).

CONCLUSION

These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up.

Authors+Show Affiliations

Division of Vascular Surgery, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9201159

Citation

Iafrati, M D., et al. "Subfascial Endoscopic Perforator Ligation: an Analysis of Early Clinical Outcomes and Cost." Journal of Vascular Surgery, vol. 25, no. 6, 1997, pp. 995-1000; discussion 1000-1.
Iafrati MD, Welch HJ, O'Donnell TF. Subfascial endoscopic perforator ligation: an analysis of early clinical outcomes and cost. J Vasc Surg. 1997;25(6):995-1000; discussion 1000-1.
Iafrati, M. D., Welch, H. J., & O'Donnell, T. F. (1997). Subfascial endoscopic perforator ligation: an analysis of early clinical outcomes and cost. Journal of Vascular Surgery, 25(6), 995-1000; discussion 1000-1.
Iafrati MD, Welch HJ, O'Donnell TF. Subfascial Endoscopic Perforator Ligation: an Analysis of Early Clinical Outcomes and Cost. J Vasc Surg. 1997;25(6):995-1000; discussion 1000-1. PubMed PMID: 9201159.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subfascial endoscopic perforator ligation: an analysis of early clinical outcomes and cost. AU - Iafrati,M D, AU - Welch,H J, AU - O'Donnell,T F,Jr PY - 1997/6/1/pubmed PY - 2001/3/28/medline PY - 1997/6/1/entrez SP - 995-1000; discussion 1000-1 JF - Journal of vascular surgery JO - J Vasc Surg VL - 25 IS - 6 N2 - PURPOSE: Early results of subfascial endoscopic perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented. METHODS: Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open perforator ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported. RESULTS: Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open perforator ligation ($2570 vs $1883). CONCLUSION: These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up. SN - 0741-5214 UR - https://www.unboundmedicine.com/medline/citation/9201159/Subfascial_endoscopic_perforator_ligation:_an_analysis_of_early_clinical_outcomes_and_cost_ DB - PRIME DP - Unbound Medicine ER -