The Management of Chronic Venous Ulcers and the Benefit of Subfascial Endoscopic Perforator Vein Surgery

Murray Asch, Peter G. Kalman, Gregory (Greg) Moneta, Peter Gloviczki

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    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 languageEnglish (US)
    Pages (from-to)103-117
    Number of pages15
    JournalPerspectives in Vascular Surgery and Endovascular Therapy
    Volume13
    Issue number2
    DOIs
    StatePublished - 2000

    Fingerprint

    Varicose Ulcer
    Veins
    Venous Insufficiency
    Therapeutics
    Ulcer
    Hemodynamics
    Saphenous Vein
    Varicose Veins
    Ligation
    Registries
    Hypertension
    Morbidity
    Wounds and Injuries
    Infection

    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 journalArticle

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