Subfascial endoscopic perforator surgery for venous leg ulcer

Surgical management of venous ulcer including subfascial endoscopic perforator surgery (SEPS), with or without saphenous ablation, may lead to almost 90% chance of ulcer healing and a 13% chance of recurrence in the short term.

A systematic review including 20 studies with a total of 1,031 subjects was abstracted in DARE. There was one RCT and 19 case series. The ulcer healing rate ranged from 56 to 100% with SEPS. When the studies were pooled, ulcers healed in 88% (95% CI: 83 to 92) of limbs. In a subset of 9 studies, 40% (95% CI: 27 to 53) of ulcers healed within 30 days, 64% (95% CI: 53 to 74) within 60 days, and 86% (95% CI: 77 to 92) after 60 days. Ulcer recurred in 16% (95% CI: 10, 24) of patients with CEAP class 5 disease at surgery, 16% (95% CI: 11 to 21) of patients with CEAP class 6 disease, and 13% (95% CI: 9 to 18) of patients with CEAP class 5 or 6 disease at surgery. Early adverse events included wound infection (6% of patients, 95% CI: 4 to 8), haematoma (9% of patients, 95% CI: 6 to 13), neuralgia (7% of patients, 95% CI: 6 to 9) and deep vein thrombosis (1% of patients, 95% CI: 0.7 to 3).

Comment: The quality of evidence is downgraded because the data are mainly from case series.

Ədəbiyyat

1. Tenbrook JA Jr, Iafrati MD, O'donnell TF Jr, Wolf MP, Hoffman SN, Pauker SG, Lau J, Wong JB. Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. J Vasc Surg 2004 Mar;39(3):583-9.