Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery

Abstract

Background: We evaluated the clinical results of subfascial endoscopic perforating vein surgery (SEPS) in patients with severe chronic venous insufficiency (CVI) (clinical class 4-6) and assessed the hemodynamic changes associated with SEPS using air plethysmography (APG). Methods: Forty-five patients with severe CVI who had undergone SEPS were evaluated. Clinical score and venous hemodynamics, as measured by APG before operation and at 1 month and 1 year after operation, were compared using the Wilcoxon signed rank test. Patient satisfaction (on a visual analogue scale of 0 to 100%) was also assessed. Results: There were 29 men and 16 women; their mean age was 60 years (range, 37-83). Thirty-five patients (78%) had active venous ulcers; the ulcers' mean size was 7.8 ± 11.9 cm 2 and the mean duration of ulceration was 9 ± 10 months. There were no hospital deaths. Post-operative complications were uncommon (one groin wound infection and one case of thrombophlebitis). At a mean follow-up of 15 ± 9 months, 34 ulcers (97%) had healed. The cumulative ulcer healing was 82% at 3 months. There were five recurrent ulcers (15%). Significant improvement was seen in the clinical scores (10 ± 3 before operation, 6 ± 4 at 1 month, and 4 ± 3 at 1 year after operation). The venous filling index was also significantly improved after operation; this improvement was maintained at 1-year follow-up (7.36 ± 6.23 ml/sec before operation, 3.63 ± 3. 90 ml/sec at 1 month, and 3.14 ± 2.06 ml/sec at 1 year). The degree of patient satisfaction was also remarkable, with 74 ± 17% and 90 ± 12% satisfaction at 1-month and 1-year follow-up, respectively. Conclusions: SEPS is a safe and effective treatment for patients with severe CVI. It leads to hemodynamic improvement, with rapid ulcer healing, and it is associated with a high degree of patient satisfaction.