Development of the Subfascial Endoscopic Perforator Vein Surgery (SEPS) and Its Influence on the Final Postoperative Results

Abstract

The aim of this study is to present results of treatment of 97 patients (118 lower extrem ities) with chronic venous insufficiency (CVI) by use of the new technique of subfascial endoscopic perforator vein surgery (SEPS). Forty-seven extremities were assigned to class 4, 33 to class 5, and 38 to class 6 of CVI. Eighty extremities (group A), were operated on earlier (1989-1993) by use of standard open endoscopic approach under direct vision, which is described further, whereas 38 extremities (group B) were operated on later (1993-1994) with use of modified endoscopic technique. The latter involved indirect vision by means of video technique, application of vascular clips, subfascial insufflation of CO2, skin traction, and routine use of subfascial drainage. Clinical outcome of the early postoperative and three monthly follow-ups was judged on a published catego rization of operative results. There were 83.7% mild and moderate improvements in group A vs 89.4% in group B. The most significant late complication was dysesthesia in the distribution of the saphenous nerve. This was observed in 6.2% of patients in group A vs 2.6% in group B. We conclude that improvement of results of treatment was related to our growing experience and implementation of the modifications presented here.