SURGICAL TECHNIQUE AND PRELIMINARY-RESULTS OF ENDOSCOPIC SUBFASCIAL DIVISION OF PERFORATING VEINS

Purpose: Direct surgical ligation of incompetent perforating veins has been reported to effectively treat severe chronic venous insufficienc y. It is associated, however, with significant wound complications. We evaluate our early experience with endoscopic subfascial division of the perforating veins. Methods: From August 5, 1993, to December 31, 1 994, 11 legs in nine patients (five male and four female) were treated with endoscopic subfascial division of perforating veins. Nine of the 11 legs had active or recently healed venous ulcers. Mean duration of the ulcerations was 5.6 years. Standard laparoscopic equipment with t wo 10-mm ports was used to perform clipping and division of medial per forating veins through two small incisions made just below the knee, a voiding the area of ulcer and lipodermatosclerosis. Carbon dioxide was insufflated at a pressure of 30 mm Hg into the subfascial space to fa cilitate dissection, and a pneumatic thigh tourniquet was used to obta in a bloodless operating field. Concomitant removal of superficial vei ns was performed in eight limbs. Mean follow-up was 9.7 months (range, 2 to 13 months). Results: A mean of 4.4 perforating veins (range, 2 t o 7) were divided; tourniquet time averaged 58 minutes (range, 30 to 7 2). Wound infection of a groin incision and superficial thrombophlebit is were early complications; each occurred in one patient. In seven le gs the ulcer healed or did not recur and symptoms resolved. In three l egs the ulceration improved, and in one it was unchanged. Conclusions: Endoscopic subfascial division of perforating veins seems to be a saf e technique, with favorable early results obtained in a small number o f patients. This preliminary experience supports further clinical tria ls to evaluate this technique.