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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2001 December;8(4):297-303

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English, Italian

Subfascial Endoscopic Perforator Surgery in chronic venous ulcerating pathology. Long-term results

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


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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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