https://doi.org/10.4081/vl.2022.10690

Evaluation of stab avulsion versus subfascial endoscopic perforator surgery in the management of chronic venous insufficiency resulting from incompetent leg perforators in primary varicose veins

Vol. 11 (2022)
Submitted: 19 June 2022
Accepted: 25 September 2022
Published: 22 December 2022
subfascial endoscopic perforator surgery (SEPS), stab avulsion of incompetent perforators chronic venous insufficiency great/long saphenous vein, short saphenous vein, sapheno-femoral junction (SFJ), sapheno-popliteal junction (SPJ), perforator vein incompetence (PVI)
Abstract Views: 854
PDF: 206
HTML: 74
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Sudhir Kumar Jain
Department of Surgery, Maulana Azad Medical College, New Delhi; ESIC Medical College, Faridabad, India.
Vaishali Shirale (Saxena)
vaishali.shirale@gmail.com
https://orcid.org/0000-0002-7311-4338
Department of Surgery, ESI Hospital and PGIMSR, New Delhi, India.
Maneesh Kumar Jain
AIIMS, New Delhi, India.
Ritu K. Saxena
Queens College, New York, United States.

Chronic venous insufficiency (CVI) resulting from incompetent perforators due to varicose veins is a common surgical condition present in at least 10% of the general population. This study was planned to evaluate stab avulsion vs subfascial endoscopic perforator surgery in the management of incompetent perforators resulting in CVI. Forty patients of CVI resulting from primary varicose veins, falling into class 4 to 6 as per the clinical part of CEAP classification, along with Duplex assessment with proven incompetent perforators of lower extremity, irrespective of the status of saphenousfemoral or saphenous-popliteal junction status, were included in the study. All the patients were randomized into two groups, A and B, by a computer-generated draw. Group A patients underwent stab avulsion, and group B patients underwent SEPS for incompetent perforators. The following parameters were evaluated: (i) pain score using a visual analog scale at 1 hour, 12 hours and 24 hours after surgery, (ii) ulcer healing 1 month and 3 months after surgery, (iii) reversal of skin changes after 1 month and 3 months of surgery during follow-up, and (iv) wound-related complications. Early relief of symptoms in terms of ulcer healing, reversal of skin changes, and decreased incidence of wound complications was found to be better in the subfascial endoscopic perforators surgery (SEPS) group.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Leach BC, Gold MP. Venous digest. Dermatol. Surg. 2003;29:612–5. DOI: https://doi.org/10.1046/j.1524-4725.2003.29148.x
Jain SK, Gupta A, Kaza RCM. Use of ultrasonic scalpel in subfascial endoscopic perforator vein surgery: A novel approach. J. Lap. Endo. Adv. Surg. Tech. 2008;18:249-53. DOI: https://doi.org/10.1089/lap.2006.0246
Hauer G, Bergan JJ, Werner A, et al. Development of endoscopic dissection of perforating veins and fasciotomy for treatment of chronic venous insufficiency. Ann. Vasc. Surg. 1999;13:357–64. DOI: https://doi.org/10.1007/s100169900269
Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. J. Vasc. Surg. 2003;37:545-51. DOI: https://doi.org/10.1067/mva.2003.131
Gloviczki P, Bergan JJ, Menawat SS, et al. Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: A preliminary report from the North American Registry. J. Vasc. Surg. 1997;25:94-105. DOI: https://doi.org/10.1016/S0741-5214(97)70325-2
Labropoulos N, Leon M. Venous hemodynamic abnormality in patients with leg ulceration. Am. J. Surg. 1995;169:572-4. DOI: https://doi.org/10.1016/S0002-9610(99)80223-2
Vashist MG, Malik V, Singhal N. Role of subfascial endoscopic perforator surgery (SEPS) in management of perforator incompetence in varicose veins: A prospective randomized study. Ind. J. Surg. 2014;76:117-23. DOI: https://doi.org/10.1007/s12262-012-0675-5
Nelzen O. Prospective study of safety, patient satisfaction and leg ulcer healing following saphenous and subfascial endoscopic perforator surgery. Br. J. Surg. 2001;87:86-91. DOI: https://doi.org/10.1046/j.1365-2168.2000.01305.x
Sybrandy JE, van Gent WB, Pierik EG, Wittens CH. Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: longterm follow-up. J. Vasc. Surg. 2001;33:1028–32. DOI: https://doi.org/10.1067/mva.2001.114812
TenBrook JA Jr., Iafrati MD, O’Donnell TF, et al. Systemic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. J. Vasc. Surg. 2004;39:583-9. DOI: https://doi.org/10.1016/j.jvs.2003.09.017
Stuart WP, Adam DJ, Bradbury AW, Ruckley CW. Subfascial endoscopic perforator surgery is associated with significantly less morbidity and shorter hospital stay than open operation. Br. J. Surg. 1997;84:1364-5. DOI: https://doi.org/10.1111/j.1365-2168.1997.00600.x
Lee DWH, Chan ACW, Lam YH, et al. Subfascial endoscopic perforator vein surgery (SEPS) using the ultrasonic scalpel. Surg. Endosc. 2001;15:1491-3. DOI: https://doi.org/10.1007/s004640000370
Hambley R, Hebda PA, Abell E, et al. Wound healing of skin incisions produced by ultrasonically vibrating knife, scalpel, electrocautery, and carbon dioxide laser. J Dermatol. Surg. Oncol. 1998;14:1213-7. DOI: https://doi.org/10.1111/j.1524-4725.1988.tb03478.x
Kumar A, Agrawal PN, Garg PK. Evaluation of subfascial endoscopic perforator surgery using harmonic scalpel in varicose veins. An observational study. Int. J. Surg. 2009;7:253-6. DOI: https://doi.org/10.1016/j.ijsu.2009.04.005
Kusagawa H, Shomura S, Komada T, et al., Subfascial Endoscopic Perforator Surgery Using Screw-Type Ports Is a Very Useful Component of a Comprehensive Treatment Program for Chronic Venous Insufficiency. Ann. Vasc. Dis. 2012;5:357-63. DOI: https://doi.org/10.3400/avd.oa.12.00031
Amara JF. Laparoscopic application of ultrasonically activated scalpel. Gastrointest. Clin. North Am. 1993;3:381-92. DOI: https://doi.org/10.1016/S1052-5157(18)30585-3
Kusagawa H, Haruta N, Shinhara R, et al. Japanese SEPS study group. Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan. Phlebology. 2018;33:678-86. DOI: https://doi.org/10.1177/0268355517750523
Lin ZC, Loveland PM, Johnston RV, et al. Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers. Cochrane Database Syst Rev. 2019;3:CD012164 DOI: https://doi.org/10.1002/14651858.CD012164.pub2
Bergan JJ, Murray J, Greason K. Subfascial endoscopic perforator vein surgery; a preliminary report. Ann. Vasc. Surg. 1996;25:94-105.
Pesta W, Kurpiewski W, Kowalczyk M, et al. The place of subfascial endoscopic perforator vein surgery in advanced chronic venous insufficiency treatment. J. Vasc. Surg. 2011;6:181-9. DOI: https://doi.org/10.5114/wiitm.2011.26252
Wang MH, Jin X, Zhang SY, et al. Lateral Subfascial Endoscopic Perforating Vein surgery as treatment for Lateral perforating vein incompetence and venous ulceration. W. J. Surg. 2009;33:1093-8. DOI: https://doi.org/10.1007/s00268-009-9921-9

Supporting Agencies

None

How to Cite

Jain, S. K., Shirale (Saxena), V., Jain, M. K., & Saxena, R. K. (2022). Evaluation of stab avulsion versus subfascial endoscopic perforator surgery in the management of chronic venous insufficiency resulting from incompetent leg perforators in primary varicose veins. Veins and Lymphatics, 11(1). https://doi.org/10.4081/vl.2022.10690
Copyright (c) 2022 the Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.