Endoscopic subfascial discission of perforating veins

Summary

The insufficiency of perforating veins is thought to be crucial in the pathogenesis of varicose and postphlebitic ulcers as well as postoperative varicose vein recurrence. Their eradication is a valid and effective therapeutic concept. No presently available technique has yielded satisfactory results, hence our efforts to develop a new method: the endoscopic subfascial discission of perforating veins (ESDP). It involves performing a small incision in an area remote from the point of trophic disturbance and allows the operator to accurately and atraumatically perform a subfascial discission of the perforating veins where they join the deep veins under direct endoscopic control. Our initial experience with the technique showed promising results: 78%–93% good and very good results depending on the clinical parameters applied. These are the results of a follow-up period of up to 14 months. During that time, none of our patients developed a complication or recurrence. Our technique has many advantages over traditional techniques of perforator vein eradication: (1) more accurate localization; (2) improved wound healing, (3) dependable occlusion; (4) immediate postoperative mobilization of the patient. We feel that ESDP represents a major advance in the development of better methods of subfascial perforator vein eradication. Greater experience and a longer follow-up period will, however, be required to confirm this initial observation.