Division of incompetent perforator veins and subfascial interposition of a polypropylene foil in post-thrombotic syndrome. Preliminary results.
OBJECTIVE
The safety, feasibility and early efficacy of subfascial endoscopic perforator surgery was gradually accepted for patients who had severe chronic venous insufficiency but, in the literature, the recurrence rate of ulceration is about 10-40%, especially in patients with previous deep vein thrombosis (DVT).


METHODS
From October 1998 to February 2002, 205 patients with 280 inferior leg ulcers were followed; 115 had venous ulcers but only 20 patients had chronic ulcers with previous DVT; 4 patients were excluded and only 16 patients (9 female, 7 male, mean age 61 years) with 18 chronic ulcers were included. These patients underwent sub-aponeurotic interruption of perforating veins with blind technique in association with subfascial interposition of a hand-made polypropylene foil. Eight of these patients had persistent non-healing ulcers at the time of surgery and 10 had chronic recurrent ulceration healed at the time of the surgical procedure. All patients were assessed clinically and with duplex scanning.


RESULTS
The follow-up was done clinically and with eco-Doppler from 6 to 38 months with a mean follow up period of 23.2 months. The healing rate was 100%. The 2-year life table incidence of ulcer recurrence was 0%. Hospital stay ranged from 1-2 days, early operative complications included extensive ecchymosis in 1 patient, oedema in 3 patients.


CONCLUSIONS
The division of perforating veins, with the subfascial support of a polypropylene foil give promising results in the treatment of venous ulcers in post-thrombotic syndrome with low morbidity and short hospital stay.
Vettorello
G
G
Department of General Surgery, General Hospital, Tolmezzo, Udine, Italy. gfvettorello@yahoo.it
D017546:Angioscopy / Q000009:adverse effects / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D004210:Dissection / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004438:Ecchymosis / Q000209:etiology; D015150:Echocardiography, Doppler; D004487:Edema / Q000209:etiology; D005205:Fascia; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D015993:Life Tables; D008026:Ligation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011126:Polypropylenes; D011186:Postphlebitic Syndrome / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D014945:Wound Healing
D011126:Polypropylenes