Perforating Vein Surgery

The first to suggest selective interruption of perforators to treat varicose veins was probably Remy in 1901. In 1938, Linton proposed a medial subfascial approach to treat incompetent perforators. In 1953, Cockett and Jones proposed the epifascial ligature of medial ankle perforators. Two years later, Felder recommended that the fascial incision for perforating vein ligature should be placed in the posterior midline of the calf in order to avoid placing the lower end of the incision over the ulcer itself or in the compromised skin of the medial leg: the so-called "posterior stocking seam approach." Glauco Bassi and Robert Muller used a hook for transcutaneous stripping of perforators through small incisions. Special instruments have been proposed to facilitate subfascial perforator interruption, like those of Albanese (1965) and Edwards (1976). The use of endoscopy to interrupt perforator in the subfascial space goes back to 1985 by Hauer, but only extensive technical improvements allowed its even wider and safer use.12 Despite new techniques and instrumentations, the problem still remains open: Which perforators must be treated? And when?13-14

0 0

Post a comment