Subfascial endoscopic ligation of perforator veins (SEPS) in the treatment of venous ulcers.

BACKGROUND: Subfascial endoscopic ligation of perforator veins (SEPS) is presently considered the procedure of choice for the treatment of venous ulcers. This study was undertaken in order to determine the efficacy and effectiveness of SEPS in the treatment of venous ulcers as reported in the literature. DATA: 428 active ulcers, treated by SEPS are included in this study. SOURCE: Current world literature. CONCLUSIONS: 428 active ulcers were treated by SEPS. 17 patients had a history of a healed ulcer. 101 patients had moderately severe to severe lipodermatosclerosis. 79% of the active ulcers healed on average in 2.3 months, with a range of 21 days to 5.4 months. 2.8% recurrent ulcers were identified. 6.5% of the active ulcers did not heal. 5 active ulcers apparently got worse postoperatively. SEPS is both an efficacious and effective procedure in the treatment of venous ulcers.

Pathophysiology of venous ulcers: surgical implications, review, and update.

BACKGROUND: Ambulatory venous hypertension has long been accepted as the principal and sole factor underlying the development of venous ulcers of the leg. This concept is now being seriously challenged as other factors emerge as important in the pathophysiology of venous ulcers. OBJECTIVE: This study was undertaken in order to review and update the current thinking concerning the pathophysiology of venous ulcers of the leg. METHOD: A review of the current medical literature. RESULTS: The prevailing current thinking about the pathophysiology of venous ulcers of the leg reveals that ambulatory venous pressure is the initiating factor. Over time this causes endothelial damage by the activation of leukocytes with subsequent release of proteolytic enzymes along with free oxygen radicals, leading to tissue damage which over time may cause ulceration. CONCLUSIONS: The production of venous ulcers of the leg is more complex than what was first thought. Although it is most likely that inflammatory factors are involved in its production, the cascade of inflammatory events postulated to occur need further investigation and clarification.

Pitfalls in ambulatory phlebectomy.

BACKGROUND: Pitfalls, precautions, and technical maneuvers concerning ambulatory phlebectomy are presented in order to facilitate the execution of this procedure. OBJECTIVE: The objective of this article is to underline certain pitfalls and precautions in the performance of ambulatory phlebectomy in order to minimized morbidity and procure satisfactory results. METHODS: The author has principally used his experience in more than 4,000 ambulatory phlebectomies as the basis for this study. RESULTS: The pitfalls and precautions concerning patient selection, operative technique, wound care, and the postoperative compressive dressing are discussed. CONCLUSION: It is concluded that ambulatory phlebectomy can be performed with minimal complications and will provide a pleasing experience for both the patient and surgeon if certain pitfalls are avoided and precautions are heeded.

A study of the competency of the saphenopopliteal junction by duplex ultrasonography.

BACKGROUND: Objective determination of saphenopopliteal junction incompetency has eluded surgeons for many years. With the advent of duplex ultrasonography incompetency of the saphenopopliteal junction can be determined with an acceptable degree of clinical certitude. OBJECTIVE: This study was undertaken in order to determine the accuracy of duplex ultrasonography in studying the competency of the saphenopopliteal junction. METHODS: A total of 50 patients were included in the study, and the saphenopopliteal junction was studied bilaterally in each patient. The Biosound Phase II Duplex Ultrasound System with a 7.5-mHz B-mode imaging was used. RESULTS: The degree of accuracy of ascertaining the competency of the saphenopopliteal junction was approximately 96%. CONCLUSION: This test is reliable, and provides helpful information to the clinician.

Ambulatory phlebectomy of the foot. Review of 75 patients.

BACKGROUND: Review of 75 patients on whom ambulatory phlebectomy of the foot was performed as part of their varicose vein treatment. OBJECTIVE: To demonstrate that ambulatory phlebectomy is an effective modality of treatment for varicosities of the foot. METHODS: Ambulatory phlebectomies were performed on an outpatient basis under local anesthesia. RESULTS: The overall satisfactory result of ambulatory phlebectomy of the foot employed in the 75 patients in this study revealed the procedure to be very effective with few complications resulting and with a high degree of patient satisfaction. CONCLUSIONS: Ambulatory phlebectomy of the foot has proven to be a most satisfactory procedure for the treatment of varicose veins of the foot.

Complications of ambulatory phlebectomy. Review of 1000 consecutive cases.

BACKGROUND: Complications of ambulatory phlebectomy performed in an office setting. OBJECTIVE: Complications of phlebectomy. METHODS: Review of 1000 consecutive cases performed in an office setting. CONCLUSIONS: Ambulatory Phlebectomy is a satisfying procedure for the treatment of most patients presenting with varicose veins. Its clinical as well as cosmetic results are very gratifying. As pleasing as ambulatory phlebectomy has proven to be, complications do result and must be dealt with. The two most frequent complications were: blister formation and localized thrombophlebitis, and the most serious were two cases of skin necrosis.

Maneuver to facilitate ambulatory phlebectomy.

BACKGROUND: In the course of phlebectomy varicose veins often brake under traction. When this happens, a great number of stab incisions are needed and veins must be extracted piecemeal. OBJECTIVE: To describe a traction maneuver that facilitates vein extraction. METHODS: Holding the exteriorized vein with the tip of the mosquito forceps pointed toward the skin, and pushing (rather than pulling) the vein out. RESULTS: This maneuver allows extraction of longer vein segments without breaking the vein. CONCLUSIONS: Easier removal and longer segments of veins can be extracted using this maneuver, thereby decreasing the number of "micro-incisions" needed.

Ambulatory phlebectomy. A rare complication of local anesthetic: case report and literature review.

BACKGROUND: Full-thickness skin necrosis can occur after infiltration of 1.0% lidocaine with 1/100,000 epinephrine for ambulatory phlebectomy. OBJECTIVE: To demonstrate an exaggerated local response to epinephrine resulting in full-thickness skin necrosis and ultimately a permanent scar. METHODS: A postoperative complication was clinically observed. CONCLUSION: Permanent scar formation after ambulatory phlebectomy was found in a patient with a previous probable exaggerated local response to epinephrine. Uneventful phlebectomy resulted in the same patient when epinephrine was deleted from the local anesthetic, suggesting a local inability to eliminate epinephrine or an exaggerated local alpha-one response.

Alkaline reflux gastritis. A study in forty postoperative duodenal ulcer patients.

A study to determine the incidence of alkaline reflux gastritis in forty postoperative duodenal ulcer patients has been presented. Since the majority of patients had evidence of gastritis, the precise role that gastritis plays in the production of symptoms is discussed but needs further clarification. It is suggested that the presence of gastritis may only represent an incidental or associated finding in many patients presenting with symptoms presumably characteristics of alkaline reflux gastritis.