Vascular and Endovascular Surgeon, National Delegate c/o International
Union of Angiology, National Delegate c/o Dermatologic and Aesthetic
Surgery International League, Udine, Italy
Background. The only hemodynamic situation, which could
be an indication for SEPS is the isolated, yet significant, reflux coming
from deep system in the lower leg, without significant refluxes in saphenous
veins (GSV, SSV, AASV, etc) or other superficial veins. Such patients
are the absolute minority, but they are more often seen among ulcer patients
if compared with patients with uncomplicated varicosities, but in
RCT the recurrence rate of ulceration is more than 40% after SEPS, especially
in patients with previuos Deep Veins Thrombosys.
In these minority of patients the division of perforating veins,
with the subfascial support of an polypropylene foil give promising results
in the treatment of the venous ulcers in post-thrombotic syndrome with
low morbidity and short hospital stay.
Method. From October 1998 and February 2012, 45 patients
with chronic ulcers and previous DVT undervwent to sub-aponeurotic
interruption of perforating veins with blind/USguided technique in association
with subfascial interposition of an hand-made polypropylene foil.
Results. A 6-year FU was possible in 25 patients clinically
and with eco-Doppler. The healing rate rate was 100% after 3-months
FU.The global life table incidence of ulcer recurrence was 3% oedema
28% and parestesia 28%. Hospital stay period ranged from 1-3 days, early
post-operative complications included extensive haematoma 20% patient,
oedema in 60% patients. No DVT recurrence rate.
Conclusion. The division of perforating veins, with the subfascial
support of an polypropylene foil give promising results in the
treatment of the venous ulcers in post-thrombotic syndrome with low
morbidity and short hospital stay.
