Varicose veins and varicose ulcers are some of the most common pathologies treated by General Surgeons. In the United States chronic venous insufficiency (CVI) is the 7th cause of chronic disabling disease, responsible for losing 2 million days of work, costing 3 billion dollars a year. Venous ulcers and post-thrombotic syndrome are the most serious manifestations of CVI.
Perforators, or perforating veins, of the lower limbs connect the superficial veins to the deep veins where they drain. When incompetent, perforators are implicated in venous ulcer genesis and varicose veins recurrence. All efforts to treat incompetent perforating veins can increase ulcer healing rate and decrease recurrences.
Subfascial Endoscopic Perforator Surgery (SEPS) still is the gold standard to treat incompetent perforating veins of lower limbs. Comparing to other minimal invasive techniques SEPS has the higher healing rate at six months post procedure:
SEPS - 92% healing rate / recurrence rate of 9% (author's own data)
Ultrasound guided sclerotherapy – 67,6% healing rate / recurrence rate of 32,4%
Radiofrequency ablation (RF) – 76% healing rate / recurrence rate ?
Endovascular Laser ablation (EVLA) – healing rate ? / recurrence rate ?
Both RF and EVLA need more studies to take valid conclusions. However, percutaneous ablation techniques (RF, EVLA, ultrasound guided sclerotherapy) depend on the identification of perforators with duplex ultrasound. Several studies report that a mean of 2-3 perforators can be missed in pre-operative ultrasound, which will be left untreated with percutaneous techniques. With SEPS all perforators are seen with a camera and treated (ligate and section).
Surgery C department of "Centro Hospital e Universitário de Coimbra - Hospital Geral (Covões)" (CHUC-HG) in Coimbra, Portugal, is leader in performing SEPS. Because we are a “reference centre” we can not forget our responsibility of teaching. In that setting, since 2014 we organize in Coimbra a hands-on course of subfascial endoscopic perforator surgery, “SEPS DAY”, giving the visitors the opportunity to learn about the technique and its advantages while participating in live surgeries.
This year we are organizing the 5th Edition of SEPS DAY. It will be held in Surgery C department of CHUC-HG (Covões), in the 23rd and 24th of May 2017. Visitors will have the opportunity to see, perform, and compare two techniques: one port and two port.
Feedback from previous visitors has been positive, with fellow surgeons performing SEPS throughout the country after learning it from us in “SEPS DAY”.
Dr. Carlos Eduardo Costa Almeida
General Surgeon