New approaches to an old and vexing problem: improving the results of SEPS: an overview.

Lipodermatosclerosis and chronic ulceration have been longstanding and vexing problems caused by chronic venous insufficiency (CVI). While traditional approaches have been mainly medical with the use of compression, bedrest, and elevation; operative therapy for CVI has now been shown to cause earlier healing with fewer ulcer recurrences. The development of subfascial endoscopic surgery (SEPS) promises a more elegant approach applicable to outpatient or day surgery.

Target selection for surgical intervention in severe chronic venous insufficiency: comparison of duplex scanning and phlebography.

Purpose: The goal of this study was to determine whether duplex scanning (DS) alone, compared with ascending phlebography (AP) and descending phlebography (DP), would have been sufficient to guide treatment of severe chronic venous insufficiency (CVI), CEAP Clinical Classes 5 and 6.

Methods: Beginning in 1994, patients presenting to the VA Sierra Nevada Vascular Clinic with ulceration due to CVI, CEAP Clinical Classes 5 and 6, were examined with DS, AP, and DP. Phlebography mainly guided surgical interventions.

A new approach to an old and vexing problem: subfascial endoscopic perforator surgery.

Chronic venous insufficiency with venous hypertension causes leukocyte trapping, lipodermatosclerosis, and finally, skin ulceration involving the lower extremity. Perforator vein incompetence has been identified as an important contributing factor to ulceration when abnormally elevated pressure is transmitted to areas of affected skin, usually at the ankle medially. Surgical techniques for ligation of incompetent communication veins were first popularized by Linton and Dodd from 1940 to 1950.

Venous ulceration: active approaches to treatment.

Traditional treatment of venous ulceration has been conservative: elevation, wound care, compression, and patient education based on prevention. Conservative treatment will heal most ulcers over time: however, the data reflect a 29% to 59% recurrence rate with optimal care and follow-up. Recurrent ulceration results in significant cost and disability.

Venous ulceration: a cross-over study from nonoperative to operative treatment.

Purpose: This study compared 3 years of nonoperative therapy in a vascular clinic (1991 to 1993) with a proactive approach to diagnosis and operative treatment (1994 to 1995).

Methods: In the first period, 11 compliant men 48 to 69 years of age (average, 55 years) were treated without surgery using Unna's boot dressing, compression wound care, and patient education. In the second period, after duplex scans and venographic examinations when appropriate, operative interventions were performed in 10 patients.