Subfascial Endoscopic Perforator Surgery

Subfascial endoscopic perforator surgery, also known as SEPS, is a minimally invasive procedure performed to treat chronic ulcers that develop in damaged perforator veins as a result of deep vein thrombosis or chronic venous insufficiency. Venous ulcers are small wounds that appear on the skin when the leg veins are not functioning properly. When the veins are incapable of carrying blood back to the heart for oxygenation, ulcers may occur on the skin, resulting in pain, redness, tenderness, odor, and pus.

Reasons for SEPS

It is important to treat perforator venous ulcers once they are diagnosed in order to prevent serious complications. It is likely that patients with chronic venous ulcers have an underlying condition known as venous insufficiency. In venous insufficiency, the perforator veins have damaged valves which permit blood to pool and further distend the veins or to flow backwards instead of circulating toward the heart. SEPS in performed to correct the venous insufficiency and to resolve the ulcerated condition of the skin to prevent infection and recurrence.

There are a number of factors that contribute to the development of venous insufficiency and the development of leg ulcers. Being of increased age and being female make venous insufficiency more likely, as does a family history of vascular disease. Other risk factors for venous insufficiency may include:

  • Obesity
  • Pregnancy
  • Sitting or standing for long periods of time
  • Smoking
  • Diabetes or arthritis
  • Use of certain medications

Procedure of SEPS

The surgery is performed by a vascular surgeon while the patient is either under general anesthesia or local anesthesia and a sedative. It is usually performed as an outpatient procedure. During SEPS, the surgeon makes several small incisions into the leg, into which a laparoscope is inserted to help visualize and identify the affected veins. There is also a tiny balloon on the catheter's tip which opens the area to assist in visualization.

Once the damaged veins have been identified, they are sealed off with a clip and effectively disconnected from the circulatory system. Once these veins have been occluded, any further damage to the ulcers is minimized or eliminated. Blood is naturally redirected to other, healthier blood vessels.

Most SEPS procedures go smoothly and are successful in overcoming or diminishing venous insufficiencies and effecting proper healing of ulcers.

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Risks of SEPS

While SEPS is a safe and minimally invasive procedure and complications are rare, there are certain risks associated any surgical procedure. Risks after SEPS may include: infection, bleeding, clotting, nerve damage and a recurrence of symptoms. Healthy lifestyle changes, including those to diet and exercise decrease the chances that a patient will have a recurrence of symptoms.

Recovery from SEPS

After surgery, the patient will be required to rest and elevate the affected leg. Some fatigue and discomfort and numbness in the area is to be expected. The patient will be instructed in wound care to assist in proper healing of the ulcer(s). The recovery period is normally one to two weeks, though it may take more time for the ulcerated skin to heal.

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