The role of perforators in chronic venous insufficiency

Phlebology
T F O'Donnell

Abstract

The treatment of incompetent calf perforating veins (ICPVs) has been ascribed an important role in the therapeutic strategy for reducing superficial venous hypertension in patients with advanced chronic venous insufficiency (C4-C6). Since the open approach to ligation of ICPVs was developed by Linton over 70 years ago, there has been an evolution toward less invasive techniques with lower morbidity. This paper will review the evidence for interruption of ICPVs through a series of systematic analyses of (1) subfascial endoscopic perforating surgery (SEPS) and (2) percutaneous thermal ablation techniques (PAPS). The effectiveness and morbidity of each approach will be discussed as well as the strength of evidence supporting that technique. While there are numerous case series that suggest that SEPS is beneficial for ulcer healing and for the prevention of ulcer recurrence, the sole two RCTs that have compared either open division or SEPS for ICPVs have failed to show a statistical advantage for ICPV ablation. The results of these studies are clouded by the inclusion of patients who received concomitant treatment of their great saphenous vein (GSV). The evidence for PAPS is based on a few (n = 5) case series in peer-reviewed journ...Continue Reading

References

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Nov 22, 2008·Perspectives in Vascular Surgery and Endovascular Therapy·Natalie MarksEnrico Ascher
May 16, 2009·Phlebology·Philip Coleridge Smith

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Citations

Dec 21, 2013·Phlebology·Wb van Gent, Cha Wittens
Feb 15, 2012·Phlebology·P Gloviczki, M L Gloviczki
Jun 14, 2016·Journal of Wound Care·Peter J FranksCarolina Weller
Jan 6, 2018·Phlebology·Hitoshi KusagawaUNKNOWN Japanese SEPS study group
Jul 30, 2019·Phlebology·Giovanni Solimeno, Pasquale Valitutti

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