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Related Experiment Videos

Optimal therapy for advanced chronic venous insufficiency.

Roy L Tawes1, Miguel L Barron, Abilio A Coello

  • 1Department of Surgery, University of California at San Francisco, San Francisco, CA, USA. rtawes@cox.net

Journal of Vascular Surgery
|March 6, 2003
PubMed
Summary

Subfascial endoscopic perforating vein surgery (SEPS) effectively treats advanced chronic venous insufficiency (CVI) by reducing venous hypertension. This surgical approach demonstrates safety, efficacy, and durability in improving CVI symptoms and healing ulcers.

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Area of Science:

  • Vascular Surgery
  • Phlebology
  • Minimally Invasive Procedures

Background:

  • Chronic venous insufficiency (CVI) management remains debated, lacking definitive level I evidence for optimal surgical treatment.
  • Venous hypertension, caused by hydrodynamic and hydrostatic reflux, is a primary driver of advanced CVI.
  • Subfascial endoscopic perforating vein surgery (SEPS) offers a pragmatic approach to address these underlying venous abnormalities.

Purpose of the Study:

  • To evaluate the efficacy, safety, and durability of SEPS combined with fasciotomy and superficial system ligation/stripping for advanced CVI.
  • To assess the impact of SEPS on ambulatory venous pressure (AVP) in a randomized subset of patients with C4 CVI.

Main Methods:

  • A retrospective multicenter review of 832 patients with advanced CVI (CEAP C4-C6) undergoing SEPS.

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  • Prospective randomization of 92 patients with C4 CVI to assess AVP changes pre- and post-operatively.
  • Duplex ultrasound (US) was used to identify and document venous reflux in all patients.

    • Main Results:

    • SEPS interrupted a mean of 7 incompetent perforating veins per patient.
    • Ulcer healing or significant improvement was observed in 92% of patients within 4-14 weeks.
    • Ambulatory venous pressure (AVP) was significantly reduced in the SEPS group compared to controls (P <.01).
    • Complication rates were low (<3%), with no operative deaths. Durability was demonstrated over a mean follow-up of 3.5 years.

    Conclusions:

    • The evaluated SEPS protocol is safe, effective, and durable for treating advanced CVI based on extensive clinical experience.
    • Objective reduction in AVP in randomized patients supports SEPS as a valuable intervention for reflux surgery in CVI.
    • This operative technique is recommended as optimal therapy for CVI in the absence of definitive level I evidence.