Subfascial Endoscopic Perforator Vein Surgery SEPS for Chronic Venous Insufficiency

PETER GLOVICZKI, MANJU KALRA, and ALESSANDRA PUGGIONI

Surgical interruption of incompetent perforating veins was first suggested by Linton in 19381 to treat patients with venous ulcers. The rationale for ligating incompetent perforators was to decrease ambulatory venous hypertension in patients with advanced venous disease by decreasing abnormal transmission of pressure from the deep to the superficial veins. Linton's original operation, that required a long skin incision, resulted in a high rate of wound complications. Subsequently proposed operations using shorter skin incisions were either incomplete or, similar to Linton's operation, resulted in frequent wound complications. Subfascial endoscopic perforator vein surgery (SEPS) was developed to replace the open techniques and it became instantly popular because of the minimally invasive nature of the procedure combined with a lesser rate of wound complications. SEPS has been an effective, minimally invasive technique to interrupt incompetent medial perforating veins of the leg.2-25

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