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Online ISSN 1827-1847
Cirielli C., Serino F., Santini A. *, Bandiera G.
From the 3rd Division of Vascular Surgery Department of Surgery and Vascular Pathologies
* Radiology Unit, IDI-IRCCS, Rome, Italy
Background. To determine the efficacy of Subfascial Endoscopic Perforator vein Surgery (SEPS) in assisting the healing of venous ulcers.
Methods. During the period of December 1998 to July 1999, 12 limbs in 11 patients were treated using SEPS under hospitalised care. Five limbs (42%) had open ulcers (clinical, etiologic, anatomic, pathophysiologic - CEAP grades C6), four limbs (33%) had healed ulcers (C5) and three limbs (25%) had severe lipodermosclerosis (C4). There were five male and six female patients (mean age 55, range 35-74). Preoperative examination with colour flow duplex ultrasound scan showed in three limbs (25%) incompetence of the medial calf perforating veins (IPVs) only, in three limbs (25%) incompetence of IPVs associated with superficial reflux and in 6 limbs (50%) incompetence of IPVs associated with deep reflux. SEPS was performed with laparoscopic instrumentation and CO2 insufflation. In addition to SEPS, stripping of the greater saphenous vein (GSV) in one case and lesser saphenous vein (LSV) ligation in another case (17%) were performed. Stab avulsion of painful varicose veins was also performed in 8 limbs (67%). The average number of perforators ligated during SEPS was 2.5 (range 1-4).
Results. After a mean follow-up period of 22 months (range 18 to 26) four out of five active ulcers healed within 12 weeks. The average healing time was 7 weeks (range 3-12 weeks), only one ulcer recurred 12 months after surgery and was treated conservatively.
Conclusions. SEPS is a safe and important adjunct in the treatment of chronic venous insufficiency (CVI). According to other groups’ and our experience, SEPS appears to accelerate the healing of venous ulcers without any increase in wound complication.
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