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Related Experiment Videos

Redone endoscopic perforator surgery: feasibility and failure analysis.

R Kolvenbach1, H Ramadan, E Schwierz

  • 1Department of Vascular Surgery, Augusta Hospital, Düsseldorf, Germany.

Journal of Vascular Surgery
|October 8, 1999
PubMed
Summary

Repeat subfascial endoscopic perforator surgery (SEPS) is safe and effective for treating venous ulcers. Opening both superficial and deep compartments ensures better outcomes and prevents recurrence in patients with incompetent perforator veins.

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Area of Science:

  • Vascular Surgery
  • Minimally Invasive Procedures
  • Venous Disease Management

Background:

  • Subfascial endoscopic perforator surgery (SEPS) is a primary treatment for incompetent perforator veins and active venous ulcers.
  • Surgeons often consider SEPS a one-time procedure due to potential scarring and narrowing of the subfascial space.
  • This study investigates the feasibility, efficacy, and safety of performing a second SEPS procedure.

Purpose of the Study:

  • To demonstrate that a second subfascial endoscopic perforator surgery (SEPS) procedure can be performed safely and effectively.
  • To evaluate the outcomes of redo SEPS in patients with recurrent or persistent venous ulceration.
  • To identify factors contributing to treatment failures in initial SEPS procedures.

Main Methods:

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  • A consecutive series of 19 patients underwent a second SEPS procedure within a 30-month period.
  • Patients were classified using the CEAP (Clinical, Etiology, Anatomy, Pathophysiology) classification.
  • The redo SEPS utilized CO(2) insufflation, a dual-port technique, and subfascial balloon dissection.

    • Main Results:

    • The redo SEPS procedure was successful in most patients, with only two requiring conversion to open surgery.
    • No major complications occurred; however, a 21% incidence of minor issues like hematoma or cellulitis was observed.
    • Significant improvements were noted in clinical scores (P <.01), disability scores (P <.02), and clinical outcome scores (P <.001).
    • Cumulative ulcer healing was achieved in 85.8% of patients with active ulcers (class 6).
    • Incomplete subfascial dissection during the first procedure, septa, or intact deep fascia were identified as reasons for initial treatment failures.

    Conclusions:

    • Redone subfascial endoscopic procedures are safe and feasible.
    • To prevent recurrent symptoms, it is crucial to explore and open both the superficial and deep posterior compartments during SEPS.
    • Addressing all incompetent perforators and associated venous pathologies is essential for successful long-term outcomes.