title: Subfascial endoscopic perforator surgery using screw-type ports is a very useful component of a comprehensive treatment program for chronic venous insufficiency.
abstract: BACKGROUND
  Subfascial endoscopic perforator surgery (SEPS) with a two-port system utilizing screw-type ports, CO2 insufflation and an ultrasonic coagulation system, is a useful procedure that does not require burdensome apparatus and techniques. SEPS was accepted as a national advanced medical system by the Japanese Ministry of Health, Labor and Welfare in May 2009.
  
  
  METHODS
  Forty-one limbs of 35 patients with 10 active ulcers (C6) and 2 healed ulcers (C5) were treated by SEPS between February 2010 and December 2011. Thirty-three limbs had concomitant superficial vein surgery. SEPS alone was performed on 8 limbs, in 6 of which the superficial veins had already been ablated. In 2 limbs, incompetent perforating veins (IPVs) existed under the affected skin, around the scars of past surgery.
  
  
  RESULTS
  All stasis ulcers of the 10 C6 limbs healed between 1 week and 14 months after SEPS (mean 2.9 months), with no ulcer recurrence during the follow-up period (2 to 24 months). IPVs under the scars were easily and safely interrupted by SEPS.
  
  
  CONCLUSIONS
  SEPS is a very useful component of a comprehensive treatment program for chronic venous insufficiency, especially in patients with venous stasis ulcers and IPVs under the scars of past surgery.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kusagawa
authors.forename: Shin
authors.initials: S
authors.lastname: Shomura
authors.forename: Takuya
authors.initials: T
authors.lastname: Komada
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Katayama
authors.forename: Naoki
authors.initials: N
authors.lastname: Haruta
keywords: SEPS; national advanced medical system; screw-type ports; two-port system; ulcer healing
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