Development of the Subfascial Endoscopic Perforator Vein Surgery (SEPS) and Its Influence on the Final Postoperative Results

Abstract

The aim of this study is to present results of treatment of 97 patients (118 lower extrem ities) with chronic venous insufficiency (CVI) by use of the new technique of subfascial endoscopic perforator vein surgery (SEPS). Forty-seven extremities were assigned to class 4, 33 to class 5, and 38 to class 6 of CVI. Eighty extremities (group A), were operated on earlier (1989-1993) by use of standard open endoscopic approach under direct vision, which is described further, whereas 38 extremities (group B) were operated on later (1993-1994) with use of modified endoscopic technique. The latter involved indirect vision by means of video technique, application of vascular clips, subfascial insufflation of CO₂, skin traction, and routine use of subfascial drainage. Clinical outcome of the early postoperative and three monthly follow-ups was judged on a published catego rization of operative results. There were 83.7% mild and moderate improvements in group A vs 89.4% in group B. The most significant late complication was dysesthesia in the distribution of the saphenous nerve. This was observed in 6.2% of patients in group A vs 2.6% in group B. We conclude that improvement of results of treatment was related to our growing experience and implementation of the modifications presented here.

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References

Kostewicz W. , Ciostek P. , Noszczyk W. : A new method utilizing subfascial CO 2 insufflation and video technique in postthrombotic syndrome endoscopic surgery. Surg Endoscopy 8:53-55, 1994.

Wienert V. : Epidemiologie et socioeconomie des maladies veineuses en Allemagne . Phlebologie 46:225-232, 1993.

Le Pen, Levy E : Socioeconomie de la maladie veineuse: Les enseignements d'une enquete sur les consommateurs de medicaments phlebotoniques en France. Phlebologie 46:47-50, 1993.

Wittens Cha , Pierik RGJM, van Urk H: The surgical treatment of incompetent perforating veins. Eur J Endovasc Surg 9:19-23, 1995.

Hauer G. : The endoscopic subfascial division of perforating veins—preliminary information. VASA 14:59-61, 1985.

Fischer R. , Sattler G. , Vanderpuye R. : Die endoskopische Perforantensanierung (EPS). Heutiger Stand. VASA 22:3-8, 1993.

Gloviczki P. , Cambria RA , Rhee RY , Canton LG , McKusick MA : Surgical technique and preliminary results of endoscopic subfascial division of perforating veins . J Vasc Surg 23:517-523, 1996.

Hauer G. : Operative technique of the endoscopic subfascial division of perforating veins . Chirurg 58:172-177, 1987.

Pierik Egjm , Wittens Cha , van Urk H. : Subfascial endoscopic ligation in the treatment of incompetent perforating veins. Eur J Endovasc Surg 9:38-42, 1995.

10.

Fischer R. : Diagnosis and treatment of incompetent Cocket perforator veins by endoscopy: Present state. Phlebology 2:1086-1093, 1992 .

11.

Porter JM , Moneta GL : An International Consensus Committee on Chronic Venous Disease: Reporting standards in venous disease: An update. J Vasc Surg 21:635-645, 1995.

12.

Bergan JJ , Ballard JL , Sparks S. , et al: Chirurgie subfasciale des veins perforantes: (CSVP). Phlébologie 49:467-472, 1996.

13.

Bergan JJ , Murray J. , Greason K. : Subfascial endoscopic perforator vein surgery: A preliminary report . Ann Vasc Surg 10:211-219, 1996.

14.

Vanscheidt W. , Peschen M. , Kreitinger J. , et al: Para-tibial fasciotomy: A new approach for treatment of therapy-resistant venous leg ulcers . Phlebologie 23:45-48, 1994.

15.

von Langer C. , Vorpahl U. , Atamer C. , et al: Die endoskopische Laserfasciotomie . In: Neue Trends in Diagnostik und Therapie von Venenleiden , 1993.