[Endoscopic perforating vein surgery. Review of the literature and personal experience]

The endoscopic treatment of perforating veins incompetence of the legs has been recently introduced as an effective surgical therapy in serious cases of chronic venous insufficiency. According to CEAP classification, the primary indication is set on the class 5 or 6 patients, affected by active ulcers or relapsing ulcerative lesions. During the last two years, 53 operations of SEPS have been performed at the Vascular Surgery Unit of G. Salvini Hospital in Garbagnate Milanese. Here we present A perspective study of 24 cases with a 6 to 18 months follow-up is presented. In 8 patients (33%) an active ulcer was present, while in 16 cases history of relapsing ulcers was described. After the first month, all the lesions were healed and a subjective clinical improvement of the hypodermosclerosis was observed. At 12 months follow-up new ulcerations appeared only in four patients. On the basis the experiences of many authors and the results obtained in this study, following conclusions are made: the best results are achieved in case of sole perforating veins incompetence; the insufficiency of superficial venous circulation must be treated simultaneously or better previously, considering later the operation on the perforators veins; the sclerotherapy is introduced to cure the ectasic superficial veins in order to avoid a sponge effect with a precocious reappearance of the ulcers.