Development of open-scope subfascial perforating vein surgery: lessons learned from the first 67 cases

Although perforating vein surgery in treatment and prevention of venous ulcers remains controversial, minimization of the procedure has allowed its reevaluation. We have chosen to develop the technique using a single port and an open scope using a variety of mostly nondisposable instrumentation. Since our first subfascial endoscopic perforator vein surgical (SEPS) procedure in July 1993, we have operated on 67 limbs in 62 patients (27 women, 35 men) ranging in age from 24 to 85 years. Using CEAP criteria, there were 16 limbs in class 4, 13 in class 5, and 38 in class 6. Preoperative investigations included duplex ultrasound in 35 cases, ascending phlebography in 29 cases, and selective use of physiologic testing with air plethysmography (APG) in 12 patients. A variety of initial explorations using different-diameter scopes has given way to single-port methodology for medial leg exploration. A mean of 3.08 perforators per patient was interrupted using electrocoagulation or metal clips and scissor division. This technique, as developed, allows same-day or short-stay (<24 hr) surgery. A vigorous program of thromboembolism prophylaxis was used in selected cases. From these 67 csaes we conclude that endoscopic perforating vein interruption provides a useful tool for the surgeon interested in treating severe chronic venous insufficiency. The open-scope, single-port technique accomplishes intervention objectives in a simplified manner. Although recurrent chronic venous insufficiency (CVI) is not eliminated, its postoperative treatment is markedly eased.