Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: Lessons learned from the North American Subfascial Endoscopic Perforator Surgery registry

Purpose: The safety, feasibility, and early efficacy of subfascial endoscop ic perforator surgery (SEPS) for the treatment of chronic venous insufficie ncy were established in a preliminary report The long-term clinical outcome and the late complications after SEPS are as yet undetermined Methods: The North American Subfascial Endoscopic Perforator Surgery regist ry collected information on 148 SEPS procedures that were performed in 17 c enters in the United States and Canada between August 1, 1993, and February 15, 1996. The data analysis in this study focused on mid-term outcome in 1 46 patients. Results:One hundred forty-six patients (79 men and 67 women; mean age, 56 y ears; range, 27 to 87 years) underwent SEPS. One hundred and one patients ( 69%) had active ulcers (class 6), and 21 (14%) had healed ulcers (dass 5). One hundred and three patients (71%) underwent concomitant venous procedure s (stripping, 70; high ligation, 17; varicosity avulsion alone, 16). There were no deaths or pulmonary embolisms. One deep venous thrombosis occurred at 2 months. The follow-up periods averaged 24 months (range, 1 to 53 month s). Cumulative ulcer healing at 1 year was 88% (median time to healing, 54 days). Concomitant ablation of superficial reflux and lack of deep venous o bstruction predicted ulcer healing (P < .05). Clinical score improved from 8.93 to 3.98 at the last follow-up (P < .0001). Cumulative ulcer recurrence at 1 year was 16% and at 2 years was 28% (standard error, < 10%). Post-thr ombotic limbs had a higher 2-year cumulative recurrence rate (46%) than did those limbs with primary valvular incompetence (20%; P <.05). Twenty-eight of the 122 patients (23%) who had class 5 or class 6 ulcers before surgery had an active ulcer at the last follow-up examination. Conclusions: The interruption of perforators with ablation of superficial r eflux is effective in decreasing the symptoms of chronic venous insufficien cy and rapidly healing ulcers. Recurrence or new ulcer development however, is still significant, particularly in post-thrombotic limbs. The reevaluat ion of the indications for SEPS is warranted because operations in patients without previous deep vein thrombosis are successful but operations in tho se patients with deep vein thrombosis are less successful. Operations on pa tients with deep vein occlusion have poor outcomes.