Subfascial endoscopic perforating vein surgery as treatment for lateral perforating vein incompetence and venous ulceration.
BACKGROUND
Endoscopic ligation of perforating veins (subfascial endoscopic perforating vein surgery [SEPS]) is valuable in treatment of venous ulcer on the medial aspect of the lower leg. Venous ulcerations on the lateral aspect of the lower leg are less common, but are of equal clinical importance.


METHODS
Over 4 years we performed SEPS on the lateral aspect of the lower leg in 13 patients. Preoperative and postoperative duplex scanning of the perforating veins was performed in all patients.


RESULTS
Mean follow-up was 53 months (range, 33-81 months). Complete healing of venous ulcer was achieved in six patients within 6 months. Ulceration persisted in six patients, and ulcer recurred in three patients after 17, 29, and 60 months, respectively. Postoperative duplex scans showed persistent insufficient perforating veins in about 25% of patients.


CONCLUSIONS
There is a considerable difference between the results of SEPS on the medial side of the lower leg and the same procedure on the lateral side. SEPS on the lateral side of the lower leg, as performed in this small series, does not contribute to ulcer healing or recurrence. A considerable number of perforating veins are missed at surgery, resulting in persistent insufficient perforating veins postoperatively. The poor results of this study emphasize the need for adequate anatomic information to improve the surgical outcome.
de Rijcke
P A R
PA
Department of Vascular Surgery, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands. pderijcke@yahoo.com
Hop
W C J
WC
Wittens
C H A
CH
D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014647:Varicose Ulcer / Q000601:surgery*; D014648:Varicose Veins / Q000601:surgery; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery*