Effectiveness and outcome of subfacial endoscopic perforator surgery in patients of lower limb chronic venous insufficiency

Abstract

Background: Chronic venous insufficiency (CVI) is a progressive condition that significantly impacts quality of life, particularly in its advanced stages (clinical, etiological, anatomical, and pathophysiological [CEAP] C4–C6), which are often associated with skin changes and venous ulcers. Perforator vein incompetence plays a critical role in CVI pathophysiology. Subfascial endoscopic perforator surgery (SEPS) offers a minimally invasive approach to treating this underlying pathology.

Aims and Objectives: The aim of this study was to assess the effectiveness of SEPS in promoting ulcer healing and reversal of skin changes in patients with advanced CVI with perforator incompetence. Secondary objectives were to evaluate post-surgical morbidity, patient satisfaction, and complications associated with SEPS.

Materials and Methods: This prospective cohort study was conducted over 12 months in a tertiary care hospital and included 73 patients with CEAP C4–C6 disease. All patients underwent SEPS under spinal anesthesia. Outcomes were assessed using the venous clinical severity score (VCSS), ulcer size, and post-operative complications over three follow-up visits at 1 week, 1 month, and 3 months.

Results: The mean pre-operative VCSS was 7±2.37. At 3 months, 86.3% of patients achieved complete ulcer healing, and the mean VCSS significantly improved to 4.29±1.51 (P<0.05). Ulcer size reduced markedly from 2.38±0.19 cm2 at 1 week to 1.80±0.15 cm2 at 1 month (P<0.0001). Minor complications were observed in 12.33% of cases, with no major adverse events.

Conclusion: SEPS is a safe and effective surgical intervention for managing advanced CVI with perforator incompetence. It significantly enhances ulcer healing and clinical severity scores with minimal morbidity. Larger, multicentric studies are needed to confirm long-term benefits.