title: Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery.
abstract: BACKGROUND
  We evaluated the clinical results of subfascial endoscopic perforating vein surgery (SEPS) in patients with severe chronic venous insufficiency (CVI) (clinical class 4-6) and assessed the hemodynamic changes associated with SEPS using air plethysmography (APG).
  
  
  METHODS
  Forty-five patients with severe CVI who had undergone SEPS were evaluated. Clinical score and venous hemodynamics, as measured by APG before operation and at 1 month and 1 year after operation, were compared using the Wilcoxon signed rank test. Patient satisfaction (on a visual analogue scale of 0 to 100%) was also assessed.
  
  
  RESULTS
  There were 29 men and 16 women; their mean age was 60 years (range, 37-83). Thirty-five patients (78%) had active venous ulcers; the ulcers' mean size was 7.8 +/- 11.9 cm2 and the mean duration of ulceration was 9 +/- 10 months. There were no hospital deaths. Postoperative complications were uncommon (one groin wound infection and one case of thrombophlebitis). At a mean follow-up of 15 +/- 9 months, 34 ulcers (97%) had healed. The cumulative ulcer healing was 82% at 3 months. There were five recurrent ulcers (15%). Significant improvement was seen in the clinical scores (10 +/- 3 before operation, 6 +/- 4 at 1 month, and 4 +/- 3 at 1 year after operation). The venous filling index was also significantly improved after operation; this improvement was maintained at 1-year follow-up (7.36 +/- 6.23 ml/sec before operation, 3.63 +/- 3.90 ml/sec at 1 month, and 3.14 +/- 2.06 ml/sec at 1 year). The degree of patient satisfaction was also remarkable, with 74 +/- 17% and 90 +/- 12% satisfaction at 1-month and 1-year follow-up, respectively.
  
  
  CONCLUSIONS
  SEPS is a safe and effective treatment for patients with severe CVI. It leads to hemodynamic improvement, with rapid ulcer healing, and it is associated with a high degree of patient satisfaction.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: A C W
authors.initials: AC
authors.lastname: Ting
authors.forename: S W K
authors.initials: SW
authors.lastname: Cheng
authors.forename: P
authors.initials: P
authors.lastname: Ho
authors.forename: L L H
authors.initials: LL
authors.lastname: Wu
authors.forename: G C Y
authors.initials: GC
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction; D010991:Plethysmography; D012008:Recurrence; D012501:Saphenous Vein / Q000503:physiopathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D013924:Thrombophlebitis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000209:etiology / Q000601:surgery; D014648:Varicose Veins / Q000209:etiology / Q000601:surgery; D014656:Vascular Surgical Procedures; D014689:Venous Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*