Subfascial endoscopic division of perforating veins in chronic venous insufficiency: a single port technique

ABSTRACT

Subfascial endoscopic perforator surgery [SEPS] is a minimally invasive procedure alternative to conventional techniques for incompetent calf perforators to minimize the high incidence of postoperative wound complications. This study was undertaken to assess the results of subfascial endoscopic perforator surgery [SEPS] in twenty patients, 16 males and 4 females, with chronic venous insufficiency [C.V.I] from December 1997 to February 1999. Ten patients [50%] were presented by active ulcers, four patients [20%] had recently healed ulcers and six patients [30%] with lipodermatosclerosis. We used a single port technique for clipping and division of medial perforating veins. Concomitant removal of the superficial veins was performed in twelve patients. The number of incompetent perforating veins interrupted endoscopically per leg ranged from 2 to 5 [a mean of 3.2] and operative time ranged between 40 to 80 minutes [average 52 minutes]. Complete ulcer healing occurred in eight of ten initially ulcerated limbs at a mean of 6 weeks post operative, while ulcer size decreased by at least 50% in two patients. In patients with healed ulcer and lipodermatosclerosis the pain and heaviness in the leg resolved or decreased significantly. In conclusion, subfascial endoscopic perforator surgery [SEPS] seems to be a safe technique with favorable early results: