Background: Previously, subfascial ligation of perforator veins to treat ve
nous ulceration in the lower extremities required long skin incisions throu
gh diseased skin and subcutaneous tissue. This was known as "the Linton ope
ration." In 1985, Hauer described an endoscopic technique for ligating inco
mpetent perforator veins; this seminal contribution marked the advent of su
bfascial endoscopic perforator surgery (SEPS).
Methods: From 1996 to 1998, we prospectively collected data on 41 patients
with chronic venous insufficiency (CVI) who underwent a SEPS procedure at o
ur institution. Preoperative assessment consisted of color-flow duplex ultr
asound scanning, as well as ascending and descending phlebography.
Results: Some 45 SEPS procedures were performed on the 41 patients. Ages ra
nged from 42 to 84 years (mean, 60). Active venous ulcers were present in 3
7 legs; healing occurred within 9 weeks in 33 of them. No new ulcers develo
ped in the follow-up period, a mean of 44 weeks.
Conclusion: The results suggest that the SEPS procedure incorporated into t
he overall treatment plan for patients with CVI produces active healing wit
h a minimum of postoperative complications. The study demonstrates the safe
ty and efficiency of this procedure; it also underscores the important role
incompetent perforator veins have in the formation of venous ulcers.