Early clinical outcomes after subfascial endoscopic perforator surgery (SEPS) and saphenous vein surgery in chronic venous insufficiency

Background: Subfascial endoscopic perforator surgery (SEPS) has recently be come popular as a minimally invasive way to treat chronic venous insufficie ncy (CVI) of the lower extremities. We report the early clinical outcomes o f SEPS and saphenous vein surgery in a prospective series of Chinese patien ts who presented with severe CVI. Methods: All patients referred to our hospital for the management of severe CVI (class IV disease or above) after January 1998 underwent SEPS using an ultrasonic scalpel in conjuction with saphenous vein surgery. All patients were followed up prospectively to assess ulcer healing, ulcer recurrence, and symptoms after SEPS, Clinical outcome was evaluated by the scoring syst em suggested by the Consensus Committee of the American Venous Forum on Chr onic Venous Disease. Results: Over a 24-month period, we performed 36 SEPS on 31 patients. Ninet een lower extremities (53%) had active or healing ulcers. Sapheno-femoral l igation was also performed in 33 limbs (92%). Four limbs (11%) developed su perficial wound infection, and two (6%) had saphenous nerve dysesthesia. Th e mean clinical score and disability score decreased from 8.42 to 3.42 and 1.45 to 0.31 respectively, after a median follow-up of 14 months (range, 6- 22) (p < 0.005). Eleven ulcers (58%) healed within 6 weeks after surgery. A t 1-year follow-up, ulcer recurrence was found in two legs (11%). Conclusion: SEPS is safe and feasible, Early clinical results have shown a promising outcome in patients with severe chronic venous insufficiency.