title: Early results from a randomized trial of saphenous surgery with or without subfascial endoscopic perforator surgery in patients with a venous ulcer.
abstract: BACKGROUND
  The aim was to clarify the role of incompetent perforators (IPs) in venous leg ulcers. This short-term report focused on safety, patient satisfaction and the fate of IPs after subfascial endoscopic perforator surgery (SEPS), or saphenous surgery alone.
  
  
  METHODS
  Patients aged 30-78 years with an open or recently healed venous ulcer, and with an incompetent saphenous vein and IPs, were allocated randomly to saphenous surgery alone, or in combination with SEPS. A control duplex scan was performed 6-9 months after surgery, and clinical follow-up was scheduled after 1 week, 3 and 12 months. A standard questionnaire was completed at each clinical visit.
  
  
  RESULTS
  Seventy-five patients were enrolled; 37 had SEPS and 38 had saphenous surgery alone. SEPS prolonged the operation by a median of 15 min (P = 0.003). Duplex imaging revealed significantly more remaining IPs in the no-SEPS group (P < 0.001). Compared with the preoperative scan, significantly more legs were free from IPs in the SEPS group compared with the no-SEPS group (21 of 36 versus 7 of 37 respectively; P < 0.001). There were no other major outcome differences between the groups.
  
  
  CONCLUSIONS
  There was no short-term clinical benefit from adding SEPS to saphenous surgery in patients with varicose ulcers and IPs, although SEPS reduced the number of perforators remaining after 1 year.
authors.affiliation: Vascular Surgery Unit, Skaraborg Hospital/Kärnsjukhuset, Skövde, Sweden. olle.nelzen@vgregion.se
authors.forename: O
authors.initials: O
authors.lastname: Nelzén
authors.forename: I
authors.initials: I
authors.lastname: Fransson
mesh_terms: D000328:Adult; D000368:Aged; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D012422:Rupture, Spontaneous; D012501:Saphenous Vein / Q000601:surgery*; D016037:Single-Blind Method; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000601:surgery*; D014689:Venous Insufficiency / Q000601:surgery; D014945:Wound Healing