Endoscopic perforator vein division with ablation of superficial reflux improves venous hemodynamics

J. M. Rhodes, P. Gloviczki, L. Canton, T. V. Heaser, Thom W Rooke

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Purpose: Hemodynamic consequences of incompetent perforator vein interruption have not been well documented. The effects of perforator interruption, with or without ablation of superficial venous reflux, on venous function in patients with advanced chronic venous insufficiency was studied. Methods: Calf muscle pump function, venous incompetence, and outflow obstruction were assessed by means of strain-gauge plethysmography (SGP) before and within 6 months after subfascial endoscopic perforator surgery (SEPS). SEPS was performed with laparoscopic instrumentation and CO2 insufflation. Concomitant high ligation or saphenons vein stripping was performed in 24 limbs (77%). Results: Twenty-six patients, 18 women and 8 men, with a mean age of 50 years (range, 20 to 77 years) underwent SEPS. Preoperative evaluation confirmed superficial reflux in 65% of limbs, deep venous reflux in 77% of limbs, and perforator incompetence in 97% of limbs. All limbs had advanced venous dysfunction (C3, C4, C5, c6). All active ulcers (C6, n = 12) healed after surgery (mean, 32 ± 3 days), and only I recurred during a mean follow-up period of 11 months (range, I to 43 months). Clinical score improved from 6.58 ± 0.50 to 2.19 ± 0.25 (P < .0001). Improved calf muscle pump function was demonstrated by means of postoperative SGP and was indicated by increased refill volume (RV: 0.27 ± 0.06 vs 0.64 ± 0.10 mL/100 mL tissue, P < .01). Venous incompetence also improved, as evidenced by prolonged duration to refill after exercise (T90:7.71 ± 1.20 vs 16.71 ± 1.98 seconds, P < .001) and a decrease in RV after passive drainage (3.23 ± 0.19 vs 2.63 ± 0.15 mL/100 mL tissue, P < .01). Improved refill rate (RR) correlated with improvements in clinical scores (P < .01, r = 0.77). Conclusion: SEPS with ablation of superficial reflux improved calf muscle pump function, reduced venous incompetence, and produced excellent midterm clinical results. However, functional improvement directly related to SEPS requires further investigation. This study supports adding SEPS to ablation of superficial reflux in patients with advanced chronic venous insufficiency.

Original languageEnglish (US)
Pages (from-to)839-847
Number of pages9
JournalJournal of Vascular Surgery
Volume28
Issue number5
StatePublished - 1998

Fingerprint

Veins
Hemodynamics
Extremities
Venous Insufficiency
Plethysmography
Muscles
Insufflation
Ulcer
Ligation
Drainage
Exercise

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Endoscopic perforator vein division with ablation of superficial reflux improves venous hemodynamics. / Rhodes, J. M.; Gloviczki, P.; Canton, L.; Heaser, T. V.; Rooke, Thom W.

In: Journal of Vascular Surgery, Vol. 28, No. 5, 1998, p. 839-847.

Research output: Contribution to journalArticle

Rhodes, J. M. ; Gloviczki, P. ; Canton, L. ; Heaser, T. V. ; Rooke, Thom W. / Endoscopic perforator vein division with ablation of superficial reflux improves venous hemodynamics. In: Journal of Vascular Surgery. 1998 ; Vol. 28, No. 5. pp. 839-847.
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AU - Gloviczki, P.

AU - Canton, L.

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AU - Rooke, Thom W

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N2 - Purpose: Hemodynamic consequences of incompetent perforator vein interruption have not been well documented. The effects of perforator interruption, with or without ablation of superficial venous reflux, on venous function in patients with advanced chronic venous insufficiency was studied. Methods: Calf muscle pump function, venous incompetence, and outflow obstruction were assessed by means of strain-gauge plethysmography (SGP) before and within 6 months after subfascial endoscopic perforator surgery (SEPS). SEPS was performed with laparoscopic instrumentation and CO2 insufflation. Concomitant high ligation or saphenons vein stripping was performed in 24 limbs (77%). Results: Twenty-six patients, 18 women and 8 men, with a mean age of 50 years (range, 20 to 77 years) underwent SEPS. Preoperative evaluation confirmed superficial reflux in 65% of limbs, deep venous reflux in 77% of limbs, and perforator incompetence in 97% of limbs. All limbs had advanced venous dysfunction (C3, C4, C5, c6). All active ulcers (C6, n = 12) healed after surgery (mean, 32 ± 3 days), and only I recurred during a mean follow-up period of 11 months (range, I to 43 months). Clinical score improved from 6.58 ± 0.50 to 2.19 ± 0.25 (P < .0001). Improved calf muscle pump function was demonstrated by means of postoperative SGP and was indicated by increased refill volume (RV: 0.27 ± 0.06 vs 0.64 ± 0.10 mL/100 mL tissue, P < .01). Venous incompetence also improved, as evidenced by prolonged duration to refill after exercise (T90:7.71 ± 1.20 vs 16.71 ± 1.98 seconds, P < .001) and a decrease in RV after passive drainage (3.23 ± 0.19 vs 2.63 ± 0.15 mL/100 mL tissue, P < .01). Improved refill rate (RR) correlated with improvements in clinical scores (P < .01, r = 0.77). Conclusion: SEPS with ablation of superficial reflux improved calf muscle pump function, reduced venous incompetence, and produced excellent midterm clinical results. However, functional improvement directly related to SEPS requires further investigation. This study supports adding SEPS to ablation of superficial reflux in patients with advanced chronic venous insufficiency.

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