title: Lateral subfascial endoscopic perforating vein surgery as treatment for lateral perforating vein incompetence and venous ulceration.
abstract: BACKGROUND
  The aim of this study was to evaluate the clinical results of lateral subfascial endoscopic perforating vein surgery (SEPS).
  
  
  METHODS
  Our study was conducted from February 2002 to January 2007. Sixty-three patients with lateral incompetent perforating veins (IPVs) and venous ulceration were allocated to two groups. Group 1 comprised 31 patients (33 limbs) who underwent only routine surgery (saphenofemoral or saphenopopliteal ligation, stripping, phlebectomies, endovascular laser treatment [EVLT], medial SEPS, and skin grafting). Group 2 comprised 32 patients (35 limbs) who underwent our routine surgery with the addition of lateral SEPS. Bidirectional ultrasonography was performed before the operation, and 6 weeks, 6 months, and 1 year after surgery. Clinical score and disability score were collected at the same time.
  
  
  RESULTS
  Twenty-nine (87.9%) of 33 limbs with active ulcers in group 1 healed, with recurrence in four (12.1%) limbs at follow-up at 25.9 +/- 10.0 months. All 35 limbs in group 2 healed, with recurrence in 0 (0.0%) limbs at follow-up at 25.4 +/- 10.1 months. Lateral SEPS could reduce the rate of recurrence of ulcers (Kaplan-Meier analysis). Patients in group 2 also showed improvement in clinical and disability scores, although they were not statistically significant differences (t test, p > 0.05). A significantly higher proportion of patients in group 1 had IPVs on the lateral aspect of the lower leg on ultrosonography imaging.
  
  
  CONCLUSIONS
  Lateral SEPS could contribute to ulcer healing and reduce ulcer recurrence. The addition of lateral SEPS to routine surgery did reduce the number of IPVs. Lateral SEPS may be safe and effective for lateral perforating vein incompetence and venous ulceration.
authors.affiliation: Department of Vascular Surgery, Shandong Provincial Hospital, Shandong University, 250021 Jinan, Shandong, China. doctorwmh@yahoo.com.cn
authors.forename: Mao-hua
authors.initials: MH
authors.lastname: Wang
authors.forename: Xing
authors.initials: X
authors.lastname: Jin
authors.forename: Shi-yi
authors.initials: SY
authors.lastname: Zhang
authors.forename: Xue-jun
authors.initials: XJ
authors.lastname: Wu
authors.forename: Zhen-Yue
authors.initials: ZY
authors.lastname: Zhong
authors.forename: Mo
authors.initials: M
authors.lastname: Wang
authors.forename: Dian-ning
authors.initials: DN
authors.lastname: Dong
authors.forename: Hai
authors.initials: H
authors.lastname: Yuan
mesh_terms: D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D014647:Varicose Ulcer / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*