The Chronic Venous Insufficiency is a cosmopolitan disease afflicting a huge amount of the general population. Its most severe clinical manifestation is the venous ulcer (Clinical status 6) or a healed ulcer (Clinical status 5).
The ulcers are more prevalent in patients with a past history of Deep Venous Thrombosis (DVT) and usually are a consequence of the conjunctions of venous diseases.
The incompetent perforators are directly related to the onset of the venous ulcers.
Therefore the treatment at all levels is fundamental to the resolution of such cases.
Based on this concept I use a differentiated technique of Subfascial Endoscopic Perforators Surgery (SEPS). With this modified technique and correction of the concomitant venous diseases I was able to reach 82% healing rate within 60 days and downsize of symptoms in all of the patients.
The most frequent association was with Iliac Vein stenosis or occlusion being the major exponent the Cocket / May-Thurner Syndrome.
The treatment of the root cause is fundamental to maintain a long term healing.
The superficial trunks reflux are also a great contributor to this condition and its approach is fundamental.
The key to successfully treat those patients is the correct identification of the multiple levels of the venous disease and adequately intervene in each of those levels.
Therefore we may surgically approach the patient with an opened wound, treat the causes and obtain therapeutic success in the majority of cases.
The open venous ulcer for longer than 10 years presents a risk to degeneration into cancer, known as Marjolin ulcer.
The healing of the venous ulcer and the prevention of its recurrence still constitutes a great challenge to the vascular surgeon.
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