Subfascial Endoscopic perforator surgery (SEPS) for Chronic Venous Insufficiency ? Our initial experience

Mayank Jayant, Viney Kumar, Robin Kaushik, Rajeev Sharma, Ashok Attri

Chronic venous insufficiency presents with spectrum of clinical features ranging from pain/heaviness of affected limb to nonhealing ulcers. Venous hypertension due to valvular reflux or obstruction is pathophysiological event leading to development of Chronic venous insufficiency. Perforator incompetence plays a major role in this insufficiency. Hauer introduced minimally invasive technique of perforator ligation i.e Sub fascial Endoscopic perforator ligation(SEPS) in 1985.An observational study over a period of year involving 38 patients (48 limbs) of Chronic venous insufficiency with CEAP Class C4 to C6 undergoing SEPS was conducted with follow up ranging from 11months to 2 months. 48 limbs in 38 patients of Chronic venous insufficiency with following distribution of CEAP classification, C6-4, C5-6 and C4-8 underwent Subfascial Endoscopic perforator surgery (SEPS) using Harmonic scalpel along with or without ligation and stripping procedures. These patients were observed for ulcer healing and symptom relief. 8(33%) patients with ulcer showed complete healing in 8 weeks and 24 (92%) at 12 weeks and 26 (100%) at 16 weeks. Venous Clinical Severity Score (VCSS) showed significant decrease at 12 weeks. One patient had surgical site infection. One patient showed recurrence of ulcer after complete healing which was attributed to Saphenofemoral insufficiency which developed 7 months after SEPS. SEPS is an excellent minimally invasive procedure for perforator ablation in patients with severe (C5,C6) chronic venous insufficiency