Revista do Colégio Brasileiro de Cirurgiões
Print version ISSN 0100-6991
AGUIAR, Eduardo Toledo de; LEDERMAN, Alex; FARJALLAT, Marina A. and RUDNER, Mônica A.. Subfascial endoscopic perforator venous surgery: initial experience. Rev. Col. Bras. Cir. [online]. 2003, vol.30, n.3, pp. 170-176. ISSN 0100-6991. http://dx.doi.org/10.1590/S0100-69912003000300003.
BACKGROUND: Prevalence of varicose ulcers in Brazil has been estimated as high as 3.6%. Perforator vein insufficiency is the main source for the development of these ulcers. The recently proposed SEPS technique is regarded as minimally invasive approach followed by low complication rates and short in-hospital stay. Our objective is to study the results of subfascial endoscopic perforator surgery associated or not to superficial venous system surgery. METHODS: Prospective, non-controlled ,clinical study. Inclusion criteria were patent deep venous system, patient with primary or secondary venous insufficiency (congenital not included) and an ankle/arm index higher than 0.8; exclusion criteria were: deep vein thrombosis, trauma or orthopedic surgery and deep venous system surgery occurring during post-operative follow-up. All patients had a duplex-scan perfomed before operation. RESULTS: Forty-three lower limbs were operated on since june/97; there were 27 patients with mean age 56.6 years; great saphenous vein, lesser saphenous vein and tributaries stripping were associated in 29 limbs; three limb were classified as C3, 15 as C4, 11 as C5 and 14 as C6. Venous insufficiency was secondary to deep venous thrombosis in 2 limbs. There were no immediate deaths; three to five perforators per limb were ligated; all ulcers healed during a period from two to 15 weeks; there were three infections (6.9%); 19 patients left hospital on 1st, six on 2nd and two on 3rd post-operative day. There was one ulcer recurrence (4.0%) after 10 months (perforator vein left in place). CONCLUSION: the procedure is safe, the hospitalization time is short, ulcer healing occurs mostly within two weeks and recurrence rate depends on a follow-up period at least of five years.
Keywords : Venous insufficiency; Video-assisted surgery; Minimally invasive surgical procedures; Varicose veins; Saphenous vein.