Subfascial Endoscopic Perforator Vein Surgery in Patients with Post-Thrombotic Venous Insufficiency - Is It Justified?

Previous results following subfascial endoscopic perforator vein surgery were reported to be worse in post-thrombotic syndrome than in limbs with primary valvular incompetence. This report comprises a larger patient cohort with longer follow-up. The goal of this study was to determine if subfascial...

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Published in:Vascular and endovascular surgery 2002-01, Vol.36 (1), p.41-50
Main Authors: Kalra, Manju, Gloviczki, Peter, Noel, Audra A., Rooke, Thom W., Lewis, Bradley D., Jenkins, Greg D., Canton, Linda G., Panneton, Jean M.
Format: Article
Language:English
Subjects:
Adult
Aged
Catheter Ablation - adverse effects
Fasciotomy
Female
Follow-Up Studies
Humans
Life Tables
Male
Middle Aged
Peripheral Vascular Diseases - complications
Peripheral Vascular Diseases - mortality
Peripheral Vascular Diseases - surgery
Postoperative Complications
Retrospective Studies
Time Factors
Varicose Ulcer - etiology
Varicose Ulcer - mortality
Varicose Ulcer - surgery
Venous Insufficiency - etiology
Venous Insufficiency - mortality
Venous Insufficiency - surgery
Venous Thrombosis - complications
Venous Thrombosis - mortality
Venous Thrombosis - surgery
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Summary:Previous results following subfascial endoscopic perforator vein surgery were reported to be worse in post-thrombotic syndrome than in limbs with primary valvular incompetence. This report comprises a larger patient cohort with longer follow-up. The goal of this study was to determine if subfascial endoscopic perforator vein surgery is justified in patients with postthrombotic venous insufficiency. The clinical data of 91 consecutive patients who underwent subfascial endoscopic perforator vein surgery with or without superficial reflux ablation over a 7-year period from May 1993 to June 2000 were retrospectively analyzed. Fifty-four females and 37 males (median age, 53 years; range, 20-77) underwent 103 subfascial endoscopic perforator vein surgery procedures. Forty-two limbs were classified as C6 (active ulcer), 34 as C5 (healed ulcer), and 24 as C4 (lipodermatosclerosis). Thirty procedures were performed in post-thrombotic limbs. Concomitant superficial reflux ablation was performed in 74 limbs (72%); saphenous vein stripping had been previously performed in 29 (28%). Deep venous incompetence was present in 89% of limbs; 13% had venous outflow obstruction on plethysmography. Cumulative ulcer healing in post-thrombotic limbs was not significantly different from limbs with primary valvular incompetence; 30-, 60-, and 90-day healing rates were 44%, 72%, and 72% vs 39%, 70%, and 87%, respectively (p = 0.35). On univariate analysis, the presence of ulcer greater than 2 cm in diameter was associated with delayed ulcer healing (p = 0.02). Cumulative ulcer recurrence in all limbs was 4%, 20%, and 27% at 1, 3, and 5 years, respectively. Ulcer recurrence in post-thrombotic limbs was higher than in limbs with primary valvular incompetence at 1, 3, and 5 years; 16%, 47%, and 56% vs 0%, 8%, and 15%, respectively (p = 0.001). Recurrent ulcers were small, superficial, and easier to heal. Clinical improvement was significant even in post-thrombotic limbs; median clinical score decreased from 9.5 to 3 (p=0.001), and median outcome score was +2 (mean 1.9; range, -I to 3). Median clinical score in patients with primary valvular incompetence improved from 6 to 1.5 (p = 0.0001). Subfascial endoscopic perforator vein surgery with superficial reflux ablation promoted ulcer healing, improved clinical outcome, and resulted in a low long-term ulcer recurrence rate in limbs with primary valvular incompetence. Despite good clinical outcome in post-thrombotic limbs, ulcer recurrence
ISSN:1538-5744
1938-9116
DOI:10.1177/153857440203600108