SAFETY, FEASIBILITY, AND EARLY EFFICACY OF SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY - A PRELIMINARY-REPORT FROM THE NORTH-AMERICAN REGISTRY

Purpose: The North American Subfascial Endoscopic Perforator Surgery ( NASEPS) Registry was established to evaluate the safety, feasibility, and efficacy of minimally invasive endoscopic Linton operations for tr eatment of chronic venous insufficiency. Methods: Retrospective analys is was performed on the clinical data of 151 patients who underwent at tempt at 158 SEPS in 17 medical centers in the United States and Canad a between Tune 1993 and February 1996. Results: SEPS was completed on 155 limbs of 148 patients, 81 male and 67 female (mean age, 56 years; range, 27 to 87 Fears). Three procedures were aborted. Seven patients had bilateral procedures (data from one limb were analyzed). One hundr ed four limbs (70%) had active ulcers, and 22 (15%) had healed ulcers. A single endoscopic port without insufflation was used in 66 procedur es (45%) and laparoscopic instrumentation, with two or three ports, in 82 (55%), with CO2 insufflation in 78 (53%). A tourniquet was used on 112 patients (76%). Concomitant venous procedures were performed in 1 06 patients (72%; saphenous stripping in 71, high ligation in 17, vari cosity avulsion in 85). No early deaths or thromboembolism occurred. C omplications included wound infections (9), superficial thrombophlebit is (5), cellulitis (4), and saphenous neuralgia (10), Seven patients w ith wound infection had open ulcers; nine of 10 with neuralgia had con comitant procedures. A roll-on tourniquet caused skin necrosis in one patient. The clinical score improved from 9.4 to 2.9 after surgery (p <0.0001). Mean follow-up was 5.4 months; 31 patients had greater than or equal to 6 months follow-up. Ulcers healed in 88% (75 of 85); recur rence or new ulcer was reported in 3% (4 of 120). Conclusions: The SES S modified Linton operation appears safe, with no postoperative deaths or early thromboembolism. Wound infection after SEPS remains importan t. Early results indicate rapid ulcer healing. Prospective evaluation of long-term results is warranted.