SUBFASCIAL ENDOSCOPIC PERFORATOR LIGATION - AN ANALYSIS OF EARLY CLINICAL OUTCOMES AND COST

Purpose: Early results of subfascial endoscopic perforator surgery (SE PS) were examined. Data on ulcer healing, complications, and costs are presented. Methods: Data were prospectively collected for all patient s who underwent SEPS at our institution. A concurrent control group wa s not available because primary open perforator ligation is no longer performed at our hospital. Preoperative assessment included duplex sca nning (valve closure times and perforator mapping), plethysmography, a nd phlebography. Completeness of therapy was assessed with postoperati ve duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and f acilities management, are reported. Results: Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a sec ond procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 1 8 (11%), and Lipodermatosclerosis with edema (class 4) in two. Deep ve nous insufficiency was present in 14 of 18 (78%). The number of perfor ating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing oc curred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not impro ved. There were no new ulcers. Residual perforating veins were noted i n four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher t han those associated with limited-incision open perforator ligation ($ 2570 vs $1883). Conclusion: These preliminary data suggest that when u sed as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no r ecurrent ulceration in this series. Increased operating room costs ass ociated with longer operations and greater disposable expenses will li kely be overcome by shortened length of stay and diminished wound comp lications. These findings emphasize the importance of ligating all inc ompetent perforating veins, as ulcer healing was never achieved when r esidual perforating veins were found at follow-up.