Endoscopic subfascial sectioning of incompetent perforating veins in treatment of primary varicosis

Abstract

Subfascial elimination of incompetent perforating veins is the most effective therapeutic principle in the treatment of trophic skin disorders associated with varicosis. A recently developed endoscopic technique allows accurate sectioning of perforating veins with direct observation of the veins and minor trauma. From November 1986 to July 1991 endoscopic sectioning of perforating veins was performed in 72 patients (103 legs). The most frequently transected perforating veins were Cockett's veins (n = 219), 24 cm perforating veins (n = 83), and Boyd's perforating veins (n = 82). Postoperative delayed wound healing was observed in 3 (2.9%) legs with pronounced trophic skin disorders in the lower extremities. Two patients complained of dysesthesia in the area of distribution of the sural nerve. Further complications recorded were extended subcutaneous hematoma in 6 (5.8%) legs and postoperative dysesthesia in the area of distribution of the saphenous nerve in 10 (9.7%) legs. At follow-up examination (mean 27 months postoperatively) clinical investigation and Doppler sonography showed newly formed incompetent perforating veins in only 2 lower legs. Radiography at follow-up revealed one incompetent Dodd's perforating vein in 1 leg, which was the starting point of pronounced recurrent varicosis in the lower leg. After an average follow-up of greater than 2 years, we recorded the occurrence of new varices in 9 lower legs. Staging of chronic venous incompetence showed an upward trend ranging from change to a more favorable stage to complete cure. Findings were unchanged in only 10% of the patients. There was no case of postoperative aggravation.

Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure

“…Most pharmaceutical companies claim a favorable clinical experience, but objective data to prove effectiveness, often is lacking or nonconclusive [7]. Even in the absence of pharmacologic intervention, surgical correction of the underlying pathophysiologic venous dysfunction has proved to be most effective in ameliorating or reversing venous ulcer disease associated with CVI [10,13,19].…”

“…This technique proved to be a practical method for accessing the subfascial space [11]. There are currently many reports relating to the SEPS operation and the salutary longterm results achieved with this procedure [3,9,13].…”

Subfascial hemorrhage after endoscopic perforator vein ligation

“…However, wound-related complication rates averaged 17% and included delayed incisional healing, flap necrosis, and infection. In comparison, several series of endoscopic perforator vein interruption have documented an ulcer recurrence rate of less than 5% with surveillance of up to 3.9 years [3][4][5][6][7][8]. Reported wound complication rates have been significantly lower compared to the open procedure.…”

“…Reported wound complication rates have been significantly lower compared to the open procedure. Jugenheimer reported delayed wound healing in 2.9% of patients [7]. A more common complication was dysesthesia, which occurred in the distribution of the saphenous nerve in 9.7% of patients.…”

“…Unfortunately, wound-related complications frequently accompany the procedure. Since 1985, several series have documented early efficacy and a low complication rate of endoscopic perforator ligation [3][4][5][6][7][8]. We report the complication of postoperative subfascial hemorrhage after endoscopic subfascial perforator vein ligation and describe a novel minimally invasive method for its control using balloon tamponade.…”