Conclusions of a Consensus Conference on Subfascial Endoscopy of Perforating Veins in the Medial Lower Leg

Abstract

On June 1, 1996, a workshop of the Association for Fasciotomy and Endoscopy (AFE) in Venous Surgery with predominantly German-speaking participants took place in Natters/Innsbruck/Austria. At present, a considerable number of endoscopes are used for subfascial endoscopic perforator vein surgery (SEPS). Five of those in most common use were discussed at the consensus meeting. These included the Hauer instrument (ETB Berlin), the Sattler and Lang instruments (Storz, Tuttlingen), the Langer instruments (Wolf Knittlingen), and laparoscopic instruments as used in Australia and the United States (Ethicon). All of these use TV endoscopic monitoring. Only the Fischer instrument (Storz, Tuttlingen) is designed for direct vision without video monitoring.

Indications for SEPS range from isolated incompetent perforating veins with or without greater saphenous system varicosities to third-degree chronic venous insufficiency (CVI), which includes venous ulceration and lipodermatosclerosis. The latter is the most important indication. The advantage of SEPS is that diagnosis of perforator incompetence and surgical obliteration of the perforators can be done simultaneously through one or more small remote incisions away from the trophic skin changes. The SEPS technique is now beginning to be used worldwide. The AFE conference was a valuable and informative meeting that provided a venue for discussion of indications, technique, and complications.