SEPS is done for
|D||A – V fistula|
Subfascial endoscopic perforator vein surgery
a. The procedure is used for patients with either healed or active ulcers (CEAP classifications 5 or 6), caused by chronic venous insufficiency, in whom incompetent calf perforating veins are thought to be an important contributing factor, particularly where conservative management (such as leg elevation, compression therapy and medication) has failed.
b. Deep venous occlusion and/or infected ulcers are usually contraindications to SEPS.
c. SEPS is a minimally invasive alternative to open subfascial perforator vein surgery.
d. Preoperative evaluation is performed by duplex scanning of the superficial, deep and perforator venous systems to diagnose both valvular incompetence and obstruction.
e. During the operation, the limb is exsanguinated and two endoscopic ports are placed in the subfascial space in the calf at sites remote from the area of venous ulceration.
f. A space-maker balloon is introduced and inflated in this subfascial space to improve access.
g. Carbon dioxide is then insufflated to facilitate dissection.
h. The incompetent perforating veins are clipped and divided with endoscopic scissors or, alternatively, coagulated and divided with an ultrasonic coagulator (harmonic scalpel).