Subfascial endoscopic perforator surgery for venous ulcers.

Area of Science:

• Vascular Surgery
• Phlebology
• Minimally Invasive Procedures

Background:

• Severe chronic venous insufficiency (CVI) and persistent venous ulceration pose significant clinical challenges.
• Incompetent perforating veins in the calf are a common cause of advanced CVI and recalcitrant ulcers.
• Previous superficial venous ablative surgery may not fully address underlying perforator incompetence.

Purpose of the Study:

• To evaluate the safety and efficacy of subfascial endoscopic perforator surgery (SEPS) in patients with severe CVI and long-standing venous ulceration.
• To assess ulcer healing rates, recurrence, and clinical outcomes following SEPS.
• To determine the impact of SEPS on patient symptom and disability scores.

Main Methods:

• Retrospective analysis of 12 patients undergoing SEPS for severe CVI and venous ulceration.
• All patients had prior superficial venous ablative surgery and persistent ulcers (>10 years).
• Outcome measures included ulcer healing time, recurrence, clinical symptom scores, and disability scores.

Main Results:

• SEPS was associated with a single wound complication.
• Cumulative ulcer healing rates were 25% at 3 months, 42% at 6 months, and 92% at 1 year.
• Mean clinical and disability scores significantly improved (P<0.001) at a median follow-up of 15 months.

Conclusions:

• Subfascial endoscopic perforator surgery is a safe and effective treatment for severe CVI and venous ulceration due to incompetent calf perforators.
• SEPS offers a high rate of ulcer healing and substantial improvement in patient-reported outcomes.
• This approach is valuable for patients with persistent venous ulceration refractory to other treatments.