title: Current state of the treatment of perforating veins.
abstract: Perforating veins may play a role in the development of chronic venous insufficiency and ulceration. There is renewed interest in minimally invasive treatments vs historic surgical options. Current indications for treatment, technical success, and evidence for clinical efficacy are summarized. Existing recommendations include perforator closure in Clinical, Etiology, Anatomy, and Pathophysiology class 5 or class 6 disease through percutaneous thermal ablation, subfascial endoscopic perforator surgery, open surgery, or sclerotherapy. Closure rates for percutaneous thermal ablation are reported as 60% to 80% initially. More recanalization and de novo perforator formation have been reported than after thermal saphenous closure. Ultrasound-guided foam sclerotherapy has shown promise in perforator closure and wound healing, but with variable success rates. Regardless of method used, successful closure of perforators appears predictive of wound healing with minimal morbidity. However, the power and design of all studies supporting this are far from robust, and more work is needed.
authors.affiliation: Division of Vascular Surgery, UPMC Hospitals, Pittsburgh, Pa. Electronic address: dilled@upmc.edu.
authors.forename: Ellen D
authors.initials: ED
authors.lastname: Dillavou
authors.affiliation: Division of Vascular Surgery, University of California, Los Angeles, Calif.
authors.forename: Michael
authors.initials: M
authors.lastname: Harlander-Locke
authors.affiliation: Division of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY.
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.affiliation: Division of Vascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY.
authors.forename: Steven
authors.initials: S
authors.lastname: Elias
authors.affiliation: Division of Vascular Surgery, Albany Medical College/Albany Medical Center Hospital, Albany, NY.
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Ozsvath
mesh_terms: D004724:Endoscopy; D006801:Humans; D035002:Lower Extremity; D015911:Sclerotherapy; D016896:Treatment Outcome; D014648:Varicose Veins; D014680:Veins / Q000473:pathology*; D014689:Venous Insufficiency / Q000209:etiology* / Q000628:therapy; D014945:Wound Healing