A PROSPECTIVE CASE CONTROL STUDY COMPARING SHORT-TERM AND LONG-TERM OUTCOMES OF SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY AND OPEN SUBFASCIAL PERFORATOR LIGATION IN THE MANAGEMENT OF VARICOSE VEINS
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Abstract
Varicose veins are dilated, elongated, and tortuous superficial veins of the lower limbs, primarily caused by venous valve incompetence and resulting in venous hypertension. Persistent reflux leads to progressive chronic venous insufficiency (CVI), stasis eczema and chronic non-healing ulcers. [1][2] Homans in 1916, first described the key role of perforator veins (PVs), in the pathophysiology and severity of CVI and venous ulceration. [3][4][5]
Diagnosis is by clinical evaluation, Duplex Doppler imaging. [1] Clinical Aetiologic Anatomic Pathophysiologic (CEAP) classification, established in 1994, is a precise diagnostic tool to assess and categorise a chronic venous disease. [6][7]
Ligation of incompetent perforator veins remains a central component in the management of varicose veins, given their significant contribution to the pathophysiology of chronic venous insufficiency. Management approach includes conservative therapy with compression garments, minimally invasive techniques such as sclerotherapy, endovenous laser ablation, radiofrequency ablation, Subfascial Endoscopic Perforator Surgery (SEPS) and traditional open subfascial perforator ligation (OSPL). [2]
SEPS provides access to incompetent perforators through limited incisions, enabling precise identification and their ligation, even the ones missed on clinical examination or duplex doppler. [8][9]
References
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Soundarya B
Senior Resident, Department of General Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati.
Mutheeswaraiah Y
Professor and HOD, Department of General Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati.
Narendra MC
Associate Professor, Department of General Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati.
Ramesh babu S
Senior Resident, Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati.
