van Gent Wb, Wittens Cha
Department of Vascular Surgery, Groene Hart Hospital, Gouda, The Netherlands
Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands Department of Vascular Surgery, Universitätsklinikum Aachen, Aachen, Germany.
Phlebology. 2015 Mar;30(2):127-32. doi: 10.1177/0268355513517685. Epub 2013 Dec 19.
The exact role of perforating vein surgery is still unclear. The aim of this study is to analyze the influence of perforating vein surgery in patients with venous ulceration.
This study was part of a randomized controlled trial in which conservative and surgical treatment of venous ulceration was compared. It is a secondary analysis of prospectively gathered data. Ninety-seven active leg ulcers were surgically treated with a subfascial endoscopic perforating vein surgery (SEPS) procedure. Concomitant superficial venous incompetence was treated with flush saphenopopliteal ligation and/or saphenofemoral ligation and limited stripping of the great saphenous vein. All patients were also treated with ambulatory compression therapy. Ulcer healing and recurrences are described in detail. To measure the completeness of the SEPS procedure duplex ultrasonography was performed on each patient before and 6 weeks and 12 months after surgery. Also newly formed perforators after surgery were scored and their influence was analyzed.
Analyses were performed on 94 ulcerated legs with a mean follow-up of 29 months. In all treated legs, only 45% all perforators were treated. In 55% one (29%) or more (26%) perforators were missed. Healing was not significantly influenced by the number of remaining incompetent perforating veins, but recurrence was significantly higher in patients who had incomplete SEPS procedure (p = 0.007 log-rank). New incompetent perforating veins did not affect ulcer healing or recurrence. The plotted location of new perforators did not show a pattern. Deep vein incompetence and treatment of superficial venous incompetence had no significant influence on healing or recurrence rates in a complete or incomplete SEPS procedure.
In this series a well-performed SEPS procedure lowers the venous ulcer recurrence rate significantly, indicating the clinical importance of incompetent perforating veins in patients with an active venous ulcer.
交通静脉手术的确切作用仍不明确。本研究旨在分析交通静脉手术对静脉溃疡患者的影响。
本研究是一项随机对照试验的一部分，该试验比较了静脉溃疡的保守治疗和手术治疗。这是对前瞻性收集数据的二次分析。97例活动性下肢溃疡患者接受了筋膜下内镜交通静脉手术（SEPS）。同时存在的浅静脉功能不全采用大隐静脉-腘静脉结扎术和/或大隐静脉-股静脉结扎术及大隐静脉有限剥脱术治疗。所有患者均接受门诊压迫治疗。详细描述了溃疡愈合和复发情况。为了评估SEPS手术的完整性，对每位患者在手术前、术后6周和12个月进行了双功超声检查。还对术后新形成的穿通支进行评分并分析其影响。
对94条溃疡腿进行了分析，平均随访29个月。在所有接受治疗的腿中，仅45%的交通静脉得到了治疗。55%的患者有1条（29%）或更多（26%）交通静脉未被处理。溃疡愈合情况不受残留功能不全交通静脉数量的显著影响，但SEPS手术不完整的患者复发率显著更高（p = 0.007，对数秩检验）。新出现的功能不全交通静脉对溃疡愈合或复发没有影响。新穿通支的分布位置没有规律。深静脉功能不全以及浅静脉功能不全的治疗对完整或不完整SEPS手术的愈合率或复发率没有显著影响。
在本系列研究中，实施良好的SEPS手术可显著降低静脉溃疡复发率，表明功能不全的交通静脉在活动性静脉溃疡患者中的临床重要性。
