Treatment of Perforating Veins - Review of Techniques
Abstract
Introduction/Objectives: Incompetent perforating veins are implicated in venous ulcers and varicose veins recurrence. Complete closure of all perforating veins is the only predictor of ulcer healing. Review and comparison of techniques to conclude on the best treatment option is the objective of this article.
Methods: Open surgery, subfascial endoscopic perforator surgery (SEPS), percutaneous ablation of perforating veins (PAP) (chemical and thermal) and embolization were analyzed and compared. Results: Open surgery has an ulcer-healing rate of 89% with recurrence of 23%. SEPS has an ulcer-healing rate of 90% and recurrence of 11%. Wound complication rate with SEPS is 5%. Sclerotherapy has an ulcer healing rate up to 67,6%. PAP has near 100% immediate closure rate, but decreases during follow-up.
Discussion: SEPS has better ulcer-healing rate, and decreases recurrence. The major disadvantage of PAP is missed perforators, and long-term series are lacking.
Conclusion: PAP is safe with minimal complications equal to SEPS, has advantages compared to surgery, but there are no studies on ulcer-healing and recurrence rates. Due to that, SEPS continues to be the choice/gold standard for the treatment of incompetent perforating veins. A combination of SEPS and PAP may result in better outcomes.
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References
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12. O’Donnell, TF. The role of perforators in chronic venous insufficiency. Phlebology 2010; 25(1): 3-10.
13. TenBrook JA, Lafrati MD, O’Donnell TF, et al. Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. J Vasc Surg 2004; 39:583-589.
14. Proebstle TM, Herdemann S. Early results and feasibility of incompetent perforator vein ablation by endovenous laser treatment. Dermatol Surg 2007; 33(2): 162-168.
15. Zerweck C, Hodenberg E, Knittel M, Zeller T, Schwarz T. Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim. Phlebology 2014; 29: 30-36.
16. Masuda EM, Kessler DM, Lurie F, Puggioni A, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006; 43: 551-557.
17. Garcarek J, Janczak D, Kurcz J, et al. Use of Gianturco Wallace and Tornado coils in perforators embolization in chronic venous ulcers treatment. Polim Med 2012; 42(3-4): 151-158.
18. Pierik EG, van Urk H, Hop WC, Wittens CH. Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: a randomized trial. J Vasc Surg 1997; 26: 1049-1054.
19. Gloviczki P, Bergan JJ, Rhodes JM, et al. Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group. J Vasc Surg 1999; 29: 489-502.
20. Kalra M, Gloviczki P, Noel AA, et al. Subfascial endoscopic perforator vein surgery in patients with post thrombotic venous insufficiency: is it justified? Vasc Endovasc Surg 2002; 36: 41-50.
21. Van Gent W, Wittens C. Influence of perforating vein surgery in patients with venous ulceration. Phlebology Online 2013; 0(0): 1-6.
22. Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. J Vasc Surg 2003; 37: 545-51.
23. Chang DW, Levy D, Hayashi RM, et al. Ultrasound-guided radiofrequency ablation (VNUS) can be used to treat perforator incompetence: 1-year results and how to do it. Vascular 2005; 13: 518.
24. Lumsden A, Chang D, Peden E, Gale S. Ultrasound guided percutaneous radiofrequency obliteration for treatment of perforating vein incompetence. In: Presented at the Society for Clinical Vascular Surgery Annual Meeting, March 2006.
25. Murphy R. Comparison of radiofrequency and laser for perforator treatment. American College of Phlebology, Poster Session, November 2006.
26. Yilmaz S, Ceken K, Alparslan A, Durmaz S, Sindel T. Endovenous laser ablation and concomitant foam sclerotherapy: experience in 504 patients. Cardiovasc Intervent Radiol 2012; 35(6): 1403-1407
2. Siqueira JJP, Siqueira LCD. Úlceras varicosas – Tratamento clinico e curativos. In: Merlo I, Parente JB, Komlós PP.Varizes e telangiectasias: diagnostico e tratamento. São Paulo: Revinter; 2006. 313-324.
3. Lopez AP, Phillips TJ. Venous Ulcers. Wounds 1998; 10(5): 149-157.
4. Rhodes JM, Kalra M, Gloviczki P. The management of incompetent perforating veins with open and endoscopic surgery. In: Gloviczki P. Handbook of venous disorders. Third edition. London: Hodder Arnold; 2009. 523-535.
5. Kiguchi MM, Hager ES, Winger DG, et al. Factors that influence perforators thrombosis and predict healing: perforator sclerotherapy for venous ulceration without axial reflux. J Vasc Surg 2014; 59 (5): 1368-76.
6. Steve Elias. Percutaneous ablation of perforating veins. In: Gloviczki P. Handbook of venous disorders. Third edition. London: Hodder Arnold; 2009. 523-535.
7. Gan S, Qian S, Zhang C, Mao J, Li K, Tang J. Combined subfascial endoscopic perforator surgery and endovenous laser treatment without impact on the great saphenous veins or management of lower-extremity varicose veins. Chin Med J 2013; 126 (3): 405-408.
8. Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomized controlled study. Lancet 2004; 363: 1854-1859.
9. Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999; 53: 149-153.
10. Koroglu M, Eris HN, Aktas AR, Kayan M, et al. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Act Radiol 2011; 52(3): 278,184.
11. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S.
12. O’Donnell, TF. The role of perforators in chronic venous insufficiency. Phlebology 2010; 25(1): 3-10.
13. TenBrook JA, Lafrati MD, O’Donnell TF, et al. Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery. J Vasc Surg 2004; 39:583-589.
14. Proebstle TM, Herdemann S. Early results and feasibility of incompetent perforator vein ablation by endovenous laser treatment. Dermatol Surg 2007; 33(2): 162-168.
15. Zerweck C, Hodenberg E, Knittel M, Zeller T, Schwarz T. Endovenous laser ablation of varicose perforating veins with the 1470-nm diode laser using the radial fibre slim. Phlebology 2014; 29: 30-36.
16. Masuda EM, Kessler DM, Lurie F, Puggioni A, et al. The effect of ultrasound-guided sclerotherapy of incompetent perforator veins on venous clinical severity and disability scores. J Vasc Surg 2006; 43: 551-557.
17. Garcarek J, Janczak D, Kurcz J, et al. Use of Gianturco Wallace and Tornado coils in perforators embolization in chronic venous ulcers treatment. Polim Med 2012; 42(3-4): 151-158.
18. Pierik EG, van Urk H, Hop WC, Wittens CH. Endoscopic versus open subfascial division of incompetent perforating veins in the treatment of venous leg ulceration: a randomized trial. J Vasc Surg 1997; 26: 1049-1054.
19. Gloviczki P, Bergan JJ, Rhodes JM, et al. Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: lessons learned from the North American subfascial endoscopic perforator surgery registry. The North American Study Group. J Vasc Surg 1999; 29: 489-502.
20. Kalra M, Gloviczki P, Noel AA, et al. Subfascial endoscopic perforator vein surgery in patients with post thrombotic venous insufficiency: is it justified? Vasc Endovasc Surg 2002; 36: 41-50.
21. Van Gent W, Wittens C. Influence of perforating vein surgery in patients with venous ulceration. Phlebology Online 2013; 0(0): 1-6.
22. Tawes RL, Barron ML, Coello AA, et al. Optimal therapy for advanced chronic venous insufficiency. J Vasc Surg 2003; 37: 545-51.
23. Chang DW, Levy D, Hayashi RM, et al. Ultrasound-guided radiofrequency ablation (VNUS) can be used to treat perforator incompetence: 1-year results and how to do it. Vascular 2005; 13: 518.
24. Lumsden A, Chang D, Peden E, Gale S. Ultrasound guided percutaneous radiofrequency obliteration for treatment of perforating vein incompetence. In: Presented at the Society for Clinical Vascular Surgery Annual Meeting, March 2006.
25. Murphy R. Comparison of radiofrequency and laser for perforator treatment. American College of Phlebology, Poster Session, November 2006.
26. Yilmaz S, Ceken K, Alparslan A, Durmaz S, Sindel T. Endovenous laser ablation and concomitant foam sclerotherapy: experience in 504 patients. Cardiovasc Intervent Radiol 2012; 35(6): 1403-1407
Published
2014-12-31
How to Cite
COSTA ALMEIDA, Carlos Eduardo Perdigão.
Treatment of Perforating Veins - Review of Techniques.
Revista Portuguesa de Cirurgia, [S.l.], n. 31, p. 27-33, dec. 2014.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/377>. Date accessed: 20 apr. 2024.
Section
Review Article
