Development of open-scope subfascial perforating vein surgery: Lessons learned from the first 67 cases

Although perforating vein surgery in treatment and prevention of venous ulc ers remains controversial, minimization of the procedure has allowed its re evaluation. We have chosen to develop the technique using a single port and an open scope using a variety of mostly nondisposable instrumentation. Sin ce our first subfascial endoscopic perforator vein surgical (SEPS) procedur e in July 1993, we have operated on 67 limbs in 62 patients (27 women, 35 m en) ranging in age from 24 to 85 years. Using CEAP criteria, there were 16 limbs in class 4, 13 in class 5, and 38 in class 6. Preoperative investigat ions included duplex ultrasound in 35 cases, ascending phlebography in 29 c ases, and selective use of physiologic testing with air plethysmography (AP G) in 12 patients. A variety of initial explorations using different-diamet er scopes has given way to single-port methodology for medial leg explorati on. A mean of 3.08 perforators per patient was interrupted using electrocoa gulation or metal clips and scissor division, This technique, as developed, allows same-day or short-stay (<24 hr) surgery, A vigorous program of thro mboembolism prophylaxis was used in selected cases. From these 67 csaes we conclude that endoscopic perforating vein interruption provides a useful to ol for the surgeon interested in treating severe chronic venous insufficien cy. The open-scope, single-port technique accomplishes intervention objecti ves in a simplified manner. Although recurrent chronic venous insufficiency (CVI) is not eliminated, its postoperative treatment is markedly eased.