Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery
In the United States more than 6 million persons have chronic venous insufficiency and more than 500,000 have venous ulcers. Patients in whom conservative therapies fail may improve after surgical treatment of superficial and perforating venous disease, but the degree of this benefit is uncertain. W...
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| Veröffentlicht in: | Journal of vascular surgery 2004-03, Vol.39 (3), p.583-589 |
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| container_title | Journal of vascular surgery |
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| creator | TenBrook, John A Iafrati, Mark D O'Donnell, Thomas F Wolf, Michael P Hoffman, Stuart N Pauker, Stephen G Lau, Joseph Wong, John B |
| description | In the United States more than 6 million persons have chronic venous insufficiency and more than 500,000 have venous ulcers. Patients in whom conservative therapies fail may improve after surgical treatment of superficial and perforating venous disease, but the degree of this benefit is uncertain.
We performed a systematic review of health outcomes in patients with severe chronic venous insufficiency treated with surgical management that incorporated subfascial endoscopic perforator surgery (SEPS), to quantify the overall rates of surgical outcomes.
Published studies in English reporting venous ulcer healing and recurrence outcomes after SEPS were obtained from a MEDLINE search. Data regarding patient characteristics and surgical outcomes were abstracted from each study, and the outcomes were combined by using a random effects model.
Our search identified 20 studies, 1 randomized trial and 19 case series, involving 1140 treated limbs. CEAP classification was secondary cause (E
S) in 36%, deep venous involvement (A
D)in 56%, and obstructive (P
O) in 12%. Overall, after surgical treatment including SEPS, with or without concomitant superficial venous ablation, ulcers in 88% of limbs healed. Ulcers recurred in 13%, at mean time of 21 months. Risk factors for nonhealing and recurrence included postoperative incompetent perforator veins, pathophysiologic obstruction, secondary cause, and ulcer diameter greater than 2 cm. Complications and their overall rates after surgical treatment including SEPS were wound infection (6%), hematoma (9%), neuralgia (7%), and deep venous thrombosis (1%).
Our results suggest that surgical management of venous ulcer including SEPS, with or without saphenous ablation, leads to an 88% chance of ulcer healing and a 13% chance of ulcer recurrence over the short term. Randomized controlled trials are needed to discern the contributions of compression therapy, superficial venous surgery, and SEPS in the treatment of venous ulcer disease. |
| doi_str_mv | 10.1016/j.jvs.2003.09.017 |
| format | Article |
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We performed a systematic review of health outcomes in patients with severe chronic venous insufficiency treated with surgical management that incorporated subfascial endoscopic perforator surgery (SEPS), to quantify the overall rates of surgical outcomes.
Published studies in English reporting venous ulcer healing and recurrence outcomes after SEPS were obtained from a MEDLINE search. Data regarding patient characteristics and surgical outcomes were abstracted from each study, and the outcomes were combined by using a random effects model.
Our search identified 20 studies, 1 randomized trial and 19 case series, involving 1140 treated limbs. CEAP classification was secondary cause (E
S) in 36%, deep venous involvement (A
D)in 56%, and obstructive (P
O) in 12%. Overall, after surgical treatment including SEPS, with or without concomitant superficial venous ablation, ulcers in 88% of limbs healed. Ulcers recurred in 13%, at mean time of 21 months. Risk factors for nonhealing and recurrence included postoperative incompetent perforator veins, pathophysiologic obstruction, secondary cause, and ulcer diameter greater than 2 cm. Complications and their overall rates after surgical treatment including SEPS were wound infection (6%), hematoma (9%), neuralgia (7%), and deep venous thrombosis (1%).
Our results suggest that surgical management of venous ulcer including SEPS, with or without saphenous ablation, leads to an 88% chance of ulcer healing and a 13% chance of ulcer recurrence over the short term. Randomized controlled trials are needed to discern the contributions of compression therapy, superficial venous surgery, and SEPS in the treatment of venous ulcer disease.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2003.09.017</identifier><identifier>PMID: 14981453</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Biological and medical sciences ; Chronic Disease ; Endoscopy - methods ; Humans ; Medical sciences ; Outcome Assessment (Health Care) ; Recurrence ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Varicose Ulcer - etiology ; Varicose Ulcer - physiopathology ; Varicose Ulcer - surgery ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Vascular Surgical Procedures - methods ; Venous Insufficiency - complications ; Venous Insufficiency - surgery ; Wound Healing - physiology</subject><ispartof>Journal of vascular surgery, 2004-03, Vol.39 (3), p.583-589</ispartof><rights>2004 The Society for Vascular Surgery and The American Association for Vascular Surgery</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c488t-4b02347f94829b35d151745611c29d80c8e4aff8e409d41f7f9e040df6d150633</citedby><cites>FETCH-LOGICAL-c488t-4b02347f94829b35d151745611c29d80c8e4aff8e409d41f7f9e040df6d150633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2003.09.017$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,23930,23931,25140,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15627158$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14981453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>TenBrook, John A</creatorcontrib><creatorcontrib>Iafrati, Mark D</creatorcontrib><creatorcontrib>O'Donnell, Thomas F</creatorcontrib><creatorcontrib>Wolf, Michael P</creatorcontrib><creatorcontrib>Hoffman, Stuart N</creatorcontrib><creatorcontrib>Pauker, Stephen G</creatorcontrib><creatorcontrib>Lau, Joseph</creatorcontrib><creatorcontrib>Wong, John B</creatorcontrib><title>Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>In the United States more than 6 million persons have chronic venous insufficiency and more than 500,000 have venous ulcers. Patients in whom conservative therapies fail may improve after surgical treatment of superficial and perforating venous disease, but the degree of this benefit is uncertain.
We performed a systematic review of health outcomes in patients with severe chronic venous insufficiency treated with surgical management that incorporated subfascial endoscopic perforator surgery (SEPS), to quantify the overall rates of surgical outcomes.
Published studies in English reporting venous ulcer healing and recurrence outcomes after SEPS were obtained from a MEDLINE search. Data regarding patient characteristics and surgical outcomes were abstracted from each study, and the outcomes were combined by using a random effects model.
Our search identified 20 studies, 1 randomized trial and 19 case series, involving 1140 treated limbs. CEAP classification was secondary cause (E
S) in 36%, deep venous involvement (A
D)in 56%, and obstructive (P
O) in 12%. Overall, after surgical treatment including SEPS, with or without concomitant superficial venous ablation, ulcers in 88% of limbs healed. Ulcers recurred in 13%, at mean time of 21 months. Risk factors for nonhealing and recurrence included postoperative incompetent perforator veins, pathophysiologic obstruction, secondary cause, and ulcer diameter greater than 2 cm. Complications and their overall rates after surgical treatment including SEPS were wound infection (6%), hematoma (9%), neuralgia (7%), and deep venous thrombosis (1%).
Our results suggest that surgical management of venous ulcer including SEPS, with or without saphenous ablation, leads to an 88% chance of ulcer healing and a 13% chance of ulcer recurrence over the short term. Randomized controlled trials are needed to discern the contributions of compression therapy, superficial venous surgery, and SEPS in the treatment of venous ulcer disease.</description><subject>Biological and medical sciences</subject><subject>Chronic Disease</subject><subject>Endoscopy - methods</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Outcome Assessment (Health Care)</subject><subject>Recurrence</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Varicose Ulcer - etiology</subject><subject>Varicose Ulcer - physiopathology</subject><subject>Varicose Ulcer - surgery</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vascular Surgical Procedures - methods</subject><subject>Venous Insufficiency - complications</subject><subject>Venous Insufficiency - surgery</subject><subject>Wound Healing - physiology</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhq0K1C6FB-CCcoFbwkziJI44oQpopUocKGfL64xXXiVxsJNFe-ujM6tdqTcu9uX7f3u-EeI9QoGAzed9sT-kogSoCugKwPZKbBC6Nm8UdK_EBlqJeV2ivBFvUtoDINaqvRY3KDuFsq424vnXMS00msXbLNLB098suCysiw0jpcy4hWKW1rjz1gzZaCazo5Gm5UQdaAprynqfyCTK_GRDnEPkrmnHma0zyXpO0dSHZMPMT8wU3YkI51KKx7fitTNDoneX-1b8_v7t6e4-f_z54-Hu62NupVJLLrdQVrJ1nVRlt63qHmtsZd0g2rLrFVhF0jjHJ3S9RMckgYTeNUxCU1W34tO5d47hz0pp0aNPlobBTMRTaAWo6lYhg3gGbQwpRXJ6jn408agR9Em73mvWrk_aNXSatXPmw6V83Y7UvyQunhn4eAHYiRlcNJP16YWrm7Ll3TD35cwRq-BtRM0KabLU-0h20X3w__nGP9k5ow4</recordid><startdate>20040301</startdate><enddate>20040301</enddate><creator>TenBrook, John A</creator><creator>Iafrati, Mark D</creator><creator>O'Donnell, Thomas F</creator><creator>Wolf, Michael P</creator><creator>Hoffman, Stuart N</creator><creator>Pauker, Stephen G</creator><creator>Lau, Joseph</creator><creator>Wong, John B</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040301</creationdate><title>Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery</title><author>TenBrook, John A ; Iafrati, Mark D ; O'Donnell, Thomas F ; Wolf, Michael P ; Hoffman, Stuart N ; Pauker, Stephen G ; Lau, Joseph ; Wong, John B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c488t-4b02347f94829b35d151745611c29d80c8e4aff8e409d41f7f9e040df6d150633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Biological and medical sciences</topic><topic>Chronic Disease</topic><topic>Endoscopy - methods</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Outcome Assessment (Health Care)</topic><topic>Recurrence</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Varicose Ulcer - etiology</topic><topic>Varicose Ulcer - physiopathology</topic><topic>Varicose Ulcer - surgery</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vascular Surgical Procedures - methods</topic><topic>Venous Insufficiency - complications</topic><topic>Venous Insufficiency - surgery</topic><topic>Wound Healing - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>TenBrook, John A</creatorcontrib><creatorcontrib>Iafrati, Mark D</creatorcontrib><creatorcontrib>O'Donnell, Thomas F</creatorcontrib><creatorcontrib>Wolf, Michael P</creatorcontrib><creatorcontrib>Hoffman, Stuart N</creatorcontrib><creatorcontrib>Pauker, Stephen G</creatorcontrib><creatorcontrib>Lau, Joseph</creatorcontrib><creatorcontrib>Wong, John B</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>TenBrook, John A</au><au>Iafrati, Mark D</au><au>O'Donnell, Thomas F</au><au>Wolf, Michael P</au><au>Hoffman, Stuart N</au><au>Pauker, Stephen G</au><au>Lau, Joseph</au><au>Wong, John B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2004-03-01</date><risdate>2004</risdate><volume>39</volume><issue>3</issue><spage>583</spage><epage>589</epage><pages>583-589</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>In the United States more than 6 million persons have chronic venous insufficiency and more than 500,000 have venous ulcers. Patients in whom conservative therapies fail may improve after surgical treatment of superficial and perforating venous disease, but the degree of this benefit is uncertain.
We performed a systematic review of health outcomes in patients with severe chronic venous insufficiency treated with surgical management that incorporated subfascial endoscopic perforator surgery (SEPS), to quantify the overall rates of surgical outcomes.
Published studies in English reporting venous ulcer healing and recurrence outcomes after SEPS were obtained from a MEDLINE search. Data regarding patient characteristics and surgical outcomes were abstracted from each study, and the outcomes were combined by using a random effects model.
Our search identified 20 studies, 1 randomized trial and 19 case series, involving 1140 treated limbs. CEAP classification was secondary cause (E
S) in 36%, deep venous involvement (A
D)in 56%, and obstructive (P
O) in 12%. Overall, after surgical treatment including SEPS, with or without concomitant superficial venous ablation, ulcers in 88% of limbs healed. Ulcers recurred in 13%, at mean time of 21 months. Risk factors for nonhealing and recurrence included postoperative incompetent perforator veins, pathophysiologic obstruction, secondary cause, and ulcer diameter greater than 2 cm. Complications and their overall rates after surgical treatment including SEPS were wound infection (6%), hematoma (9%), neuralgia (7%), and deep venous thrombosis (1%).
Our results suggest that surgical management of venous ulcer including SEPS, with or without saphenous ablation, leads to an 88% chance of ulcer healing and a 13% chance of ulcer recurrence over the short term. Randomized controlled trials are needed to discern the contributions of compression therapy, superficial venous surgery, and SEPS in the treatment of venous ulcer disease.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>14981453</pmid><doi>10.1016/j.jvs.2003.09.017</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Biological and medical sciences Chronic Disease Endoscopy - methods Humans Medical sciences Outcome Assessment (Health Care) Recurrence Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Varicose Ulcer - etiology Varicose Ulcer - physiopathology Varicose Ulcer - surgery Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vascular Surgical Procedures - methods Venous Insufficiency - complications Venous Insufficiency - surgery Wound Healing - physiology |
| title | Systematic review of outcomes after surgical management of venous disease incorporating subfascial endoscopic perforator surgery |
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