Subfascial Endoscopic Perforator Surgery: Retrospective Analysis of the First 50 Patients

Introduction: Subfascial Endoscopic Perforator Surgery (SEPS) is a minimally invasive technique to treat incompetent perforating veins. Incompetent perforators are implicated in venous ulcer and in varicose veins recurrence. Complete closure of all perforating veins is the only predictor of ulcer healing. Analysis of our results is the objective of this study. Methods: Fifty (50) patients with incompetent perforating veins were submitted to unilateral SEPS. Class CEAP C2-C6 patients were included. Ulcer-healing rate, ulcer recurrence rate, and complications rate were analysed. Results: CEAP distribution was: C1–0; C2–5; C3–20; C4–11; C5–2; C6–12. An ulcer-healing rate of 92% (11/12) was found at 6 months, with an average of 2.5 months until complete cicatrisation. Only one patient suffered an ulcer recurrence (9%). Complications occurred in 4 patients (8%), including 2 cases of surgical site infection (4%). Discussion: SEPS has a better ulcer-healing rate than other perforator ablation techniques. Our data match other studies data. The inclusion of patients submitted to SEPS plus GSV stripping and patients submitted only to SEPS can bring some doubts about the role of SEPS in ulcer healing. However from the patients treated only with SEPS, most of them had already been submitted to GSV removal in the past, and were now treated because of venous ulcer development and varicose veins recurrence. Conclusion: These data support the importance of SEPS in perforating veins treatment and the hemodynamic role of perforators in venous ulcer development and varicose veins recurrence.