Endoscopic Subfascial Ligation of Perforating Veins

Chronic venous insufficiency and current treatment options

“…Uzun süre ayakta sabit durmak da bu hipertansiyonu daha da artırır [12]. Perforan venlerde de yetmezlik olması çok daha ciddi ambulatuar venöz hipertansiyon sebebidir [10].…”

“…Baldır kas pompası ve tek yönlü akıma izin veren kapaklar sayesinde her ayak bileği hareketi veya adım atma ile kan akımı distaldan kraniale doğru yer çekimine zıt yönde ve yüzeyden derine doğru seyreder [9]. KVY'yi oluşturan temel patoloji venöz basınçta artış, yani venöz hipertansiyondur [10]. Yüzeyel venler çaplarına göre spider ven (<1 mm), telenjektazi (1-4mm), pake (>4 mm) ve safenöz varisler olarak adlandırılabilir [11].…”

Is color Doppler ultrasound-assisted perforating vein ligation with a mini-incision still a viable alternative?

“…Chronic venous insufficiency (CVI) and the leg ulcers associated with it are common causes of morbidity. [1] During a physical examination, the lesser saphenous vein (LSV) and the perforating veins (PVs) of the leg should at least be evaluated along with the greater saphenous vein (GSV) because those veins might be entirely responsible for the lower extremity venous ulcers. [2] For this reason, color Doppler ultrasound (CDUS) plays a crucial role in investigating the venous pathology before a diagnosis can be firmly established.…”

“…The PVs of the leg (Cockett's perforators) connect the posterior tibial vein with the posterior arch vein (Leonardo's vein) and are not connected to the GSV. [1] Hence, symptoms due to venous insufficiency do not adequately recover if only the GSV is treated because this does not address the existing PV reflux. Currently, medical treatment, subfascial endoscopic ligation of PVs, percutaneous ablation of the perforators, and CDUS-enhanced ligation with mini incisions are the preferred methods of treatment for this condition.…”