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      TÉCNICA DE LIGADURA SUBFASCIAL MINI-INVASIVA DE VENAS PERFORANTES DE LAS PIERNAS Translated title: Treatment of incompetent perforator leg veins by minimally invasive subfascial ligation

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          Abstract

          La insuficiencia de venas perforantes es una forma de insuficiencia venosa de extremidades inferiores que se manifiesta por hiperpigmentación cutánea localizada, desarrollo de úlceras venosas o recurrencia de várices previamente operadas. Su tratamiento comprende desde cirugías cruentas como la ligadura subfascial abierta a técnicas percutáneas de radiofrecuencia o láser con resultados alejados desconocidos. Dentro de las técnicas mínimamente invasivas se encuentra la cirugía de ligadura subfascial de perforantes con mini-incisiones descrita por Queral, de eficacia demostrada y que hemos realizado y perfeccionado exitosamente en los últimos años. Se describen detalles de la técnica y de la planificación pre-operatoria de pacientes con esta patología.

          Translated abstract

          Perforator vein incompetence is a specific form of lower extremitiy venous insufficiency characterized by localized hyperpigmentation, venous ulceration or recurrence of varicose veins. Surgical treatment ranges from the extensive conventional open subfascial ligation to percutaneous radiofrequency or laser techniques with unknown late outcome. A minimally invasive technique of subfascial ligation through small incisions described by Queral, with acceptable results, has been successfully used and improved in recent years by our group. Details of the technique and pre-operative managment are described.

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          Most cited references14

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          THE COMMUNICATING VEINS OF THE LOWER LEG AND THE OPERATIVE TECHNIC FOR THEIR LIGATION.

          R Linton (1938)
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            Duplex ultrasonography scanning for chronic venous disease: patterns of venous reflux.

            Patterns of flow in superficial and deep veins and outward flow in medial calf perforators were studied by duplex ultrasonography scanning in 1653 lower limbs in 1114 consecutive patients. This study compares results in 776 limbs with primary uncomplicated varicose veins with those in 166 limbs with the complications of lipodermatosclerosis or past venous ulceration. Duplex scanning determined whether superficial and deep veins were occluded or showed reflux and whether outward flow occurred in medial calf perforators with calf muscle contraction. Two proximal deep veins were occluded. When limbs with primary uncomplicated varicose veins, lipodermatosclerosis, or past ulceration were compared, superficial reflux alone was seen in 55%, 39%, and 38%, deep reflux alone was seen in 2%, 7%, and 8%, and combined superficial and deep reflux was seen in 18%, 34%, and 48%, respectively. Superficial reflux affected the long saphenous system alone in 58%, 57%, and 40%, the short saphenous system alone in 18%, 18%, and 26%, and both the long and short saphenous systems in 24%, 25%, and 34%, respectively. Limbs with ulceration more frequently showed superficial reflux (p < 0.05), and all limbs with complications more frequently showed short saphenous reflux (p < 0.05) and deep reflux (p < 0.01) specifically in the posterior tibial veins (p < 0.01). Outward flow was seen in medial calf perforators in 57%, 67%, and 66%, respectively; it occurred more frequently in all limbs with complications (p < 0.05). Isolated outward flow in perforators without superficial or deep reflux was seen in 10%, 10%, and 2%, respectively. Most limbs with complications had superficial reflux either alone or combined with deep reflux, and few had deep reflux alone. Reflux was more frequent in posterior tibial veins for limbs with complications compared with those with uncomplicated primary varicose veins. Outward flow in perforators was common in limbs with complications and with uncomplicated primary varicose veins, but isolated outward flow in perforators was uncommon. Treatment directed to the superficial veins alone may be sufficient for most patients with complications.
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              Incompetent perforating veins are associated with recurrent varicose veins.

              we suspected incompetent perforating veins of having a role in the development of recurrent varicose veins in some patients. The aim was to look for an association between perforators and recurrent varicose veins.
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                Author and article information

                Journal
                rchcir
                Revista chilena de cirugía
                Rev Chil Cir
                Sociedad de Cirujanos de Chile (Santiago, , Chile )
                0718-4026
                September 2014
                : 66
                : 5
                : 489-493
                Affiliations
                [01] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Cirugía Vascular y Endovascular Chile
                Article
                S0718-40262014000500016 S0718-4026(14)06600500016
                10.4067/S0718-40262014000500016
                1dced9c6-eff9-457e-aa07-350b2a307dc1

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 17 March 2014
                : 23 April 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 5
                Product

                SciELO Chile

                Categories
                TÉCNICAS QUIRÚRGICAS

                Leg veins,tratamiento,mini invasiva,perforantes,Venas de las piernas,minimally invasive,treatment,perforator

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