Abstract
Elastic compression is the primary treatment modality of venous ulcers. Local ulcer treatment is important to enhance granulation and prevent or treat infection, while surgical treatment is aimed at correcting the underlying venous stasis and ambulatory venous hypertension. This debate reviews the pros and cons of surgical treatment for venous incompetence and discusses current evidence to support the use of subfascial endoscopic perforator vein surgery (SEPS). Ablation of superficial reflux with high ligation and stripping of the incompetent saphenous vein, done together with avulsion of varicose veins, remains the main surgical treatment of chronic venous insufficiency. Level 1 evidence of clinical and hemodynamic improvement directly related to interruption of incompetent perforators is currently not available. The North American SEPS registry experience and reports from larger centers, however, provide data on rapid ulcer healing, low morbidity, and decreased wound complications from endoscopic perforator interruption. SEPS, together with ablation of the superficial reflux, when present, can be offered to surgical candidates with advanced chronic venous insufficiency and venous ulcers. While improvement in post-thrombotic patients may be modest, those with primary valvular incompetence will have a predictably good clinical outcome and improved hemodynamic results. The superiority of surgical treatment over optimal medical management remains to be established in a prospective randomized, multi-center trial. The North American Venous Ulcer Surgery (NAVUS) Trial has been designed to answer the role of ablation of the superficial reflux, with or without SEPS, in the treatment of venous ulcers.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 103-117 |
| Number of pages | 15 |
| Journal | Perspectives in Vascular Surgery and Endovascular Therapy |
| Volume | 13 |
| Issue number | 2 |
| DOIs | |
| State | Published - 2000 |
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Keywords
- endoscopy SEPS
- perforating veins
- surgery
- Venous ulcers
ASJC Scopus subject areas
- Surgery
- Cardiology and Cardiovascular Medicine
Cite this
The Management of Chronic Venous Ulcers and the Benefit of Subfascial Endoscopic Perforator Vein Surgery. / Asch, Murray; Kalman, Peter G.; Moneta, Gregory (Greg); Gloviczki, Peter.
In: Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 13, No. 2, 2000, p. 103-117.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The Management of Chronic Venous Ulcers and the Benefit of Subfascial Endoscopic Perforator Vein Surgery
AU - Asch, Murray
AU - Kalman, Peter G.
AU - Moneta, Gregory (Greg)
AU - Gloviczki, Peter
PY - 2000
Y1 - 2000
N2 - Elastic compression is the primary treatment modality of venous ulcers. Local ulcer treatment is important to enhance granulation and prevent or treat infection, while surgical treatment is aimed at correcting the underlying venous stasis and ambulatory venous hypertension. This debate reviews the pros and cons of surgical treatment for venous incompetence and discusses current evidence to support the use of subfascial endoscopic perforator vein surgery (SEPS). Ablation of superficial reflux with high ligation and stripping of the incompetent saphenous vein, done together with avulsion of varicose veins, remains the main surgical treatment of chronic venous insufficiency. Level 1 evidence of clinical and hemodynamic improvement directly related to interruption of incompetent perforators is currently not available. The North American SEPS registry experience and reports from larger centers, however, provide data on rapid ulcer healing, low morbidity, and decreased wound complications from endoscopic perforator interruption. SEPS, together with ablation of the superficial reflux, when present, can be offered to surgical candidates with advanced chronic venous insufficiency and venous ulcers. While improvement in post-thrombotic patients may be modest, those with primary valvular incompetence will have a predictably good clinical outcome and improved hemodynamic results. The superiority of surgical treatment over optimal medical management remains to be established in a prospective randomized, multi-center trial. The North American Venous Ulcer Surgery (NAVUS) Trial has been designed to answer the role of ablation of the superficial reflux, with or without SEPS, in the treatment of venous ulcers.
AB - Elastic compression is the primary treatment modality of venous ulcers. Local ulcer treatment is important to enhance granulation and prevent or treat infection, while surgical treatment is aimed at correcting the underlying venous stasis and ambulatory venous hypertension. This debate reviews the pros and cons of surgical treatment for venous incompetence and discusses current evidence to support the use of subfascial endoscopic perforator vein surgery (SEPS). Ablation of superficial reflux with high ligation and stripping of the incompetent saphenous vein, done together with avulsion of varicose veins, remains the main surgical treatment of chronic venous insufficiency. Level 1 evidence of clinical and hemodynamic improvement directly related to interruption of incompetent perforators is currently not available. The North American SEPS registry experience and reports from larger centers, however, provide data on rapid ulcer healing, low morbidity, and decreased wound complications from endoscopic perforator interruption. SEPS, together with ablation of the superficial reflux, when present, can be offered to surgical candidates with advanced chronic venous insufficiency and venous ulcers. While improvement in post-thrombotic patients may be modest, those with primary valvular incompetence will have a predictably good clinical outcome and improved hemodynamic results. The superiority of surgical treatment over optimal medical management remains to be established in a prospective randomized, multi-center trial. The North American Venous Ulcer Surgery (NAVUS) Trial has been designed to answer the role of ablation of the superficial reflux, with or without SEPS, in the treatment of venous ulcers.
KW - endoscopy SEPS
KW - perforating veins
KW - surgery
KW - Venous ulcers
UR - http://www.scopus.com/inward/record.url?scp=84992882810&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84992882810&partnerID=8YFLogxK
U2 - 10.1177/153100350001300216
DO - 10.1177/153100350001300216
M3 - Article
VL - 13
SP - 103
EP - 117
JO - Perspectives in Vascular Surgery and Endovascular Therapy
JF - Perspectives in Vascular Surgery and Endovascular Therapy
SN - 1531-0035
IS - 2
ER -