Subfascial endoscopic perforator vein surgery: a preliminary report

Area of Science:

• Vascular Surgery
• Minimally Invasive Procedures
• Venous Disease Management

Background:

• Open Linton subfascial perforator vein interruption effectively treats recurrent venous ulceration but causes significant morbidity and prolonged hospital stays.
• Minimally invasive techniques are sought to replicate the benefits of open surgery with reduced patient burden.

Purpose of the Study:

• To evaluate the efficacy and safety of subfascial endoscopic perforator vein surgery (SEPS) as a less invasive alternative to open Linton procedures.
• To assess the impact of SEPS on ulcer healing rates and patient recovery, focusing on reduced morbidity and hospitalization.

Main Methods:

• 31 consecutive SEPS procedures were performed on 30 patients with severe chronic venous insufficiency and ulcers.
• Operations utilized laparoscopic instrumentation, with modifications like no gas insufflation and outpatient management in some cases.
• Perforating veins were identified and interrupted via electrocoagulation or clipping and sectioning.

Main Results:

• Ulcer healing was observed in 13 of 15 limbs with open ulcers, with most healing within 8 weeks post-surgery.
• The procedure resulted in a mean hospitalization of 2.72 days for the 18 patients requiring admission.
• Complications were minimal, including atelectasis (1), cellulitis (3), wound hematomas (2), and wound seroma (1).

Conclusions:

• SEPS can achieve the objectives of perforator vein interruption with significantly reduced morbidity compared to open Linton operations.
• The endoscopic approach allows for effective treatment of chronic venous insufficiency and associated ulcers with minimal use of inpatient facilities.
• SEPS represents a promising, minimally invasive option for managing severe chronic venous insufficiency, warranting long-term follow-up.