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Subfascial Endoscopic Perforator Surgery (SEPS)

What is subfascial endoscopic perforator surgery (SEPS) for venous disease?

SEPS is a minimally invasive surgical technique used to treat chronic venous ulcers caused by perforating veins that may have been damaged due to deep vein thrombosis or chronic venous insufficiency.

Why is this procedure performed? Why do I need this procedure?

The goal of treatment is to heal the ulcer to prevent serious complications or to prevent ulcer recurrence. Patients with chronic venous ulcers may have developed chronic venous insufficiency as a result of damage to their perforating veins, which are veins located above the ankle that carry blood from the superficial veins into the deep veins. If not corrected, patients may experience prolonged symptoms of severe chronic venous insufficiency and recurrent venous stasis ulcer formation.

Each patient is evaluated, and treatment will be individualized for the patient’s circumstances.

Where is the procedure performed and who performs this procedure?

Surgical treatments are performed in the hospital or outpatient setting by a vascular surgeon.

What are the risks and potential complications of the procedure?

Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you. This is generally a very safe procedure, causing relatively little pain and, in most cases, is well-tolerated. However, as with any surgical procedure, there are risks, including bleeding, infection, injury to the nerves and arteries that are adjacent to the veins, and recurrence of symptoms despite adequate ligation of the perforator vein.

Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.

How do I prepare for the SEPS procedure?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to perform the procedure. You may need to discontinue certain medications before the procedure. Your healthcare team will provide specific instructions to help you prepare.

What happens during SEPS?

You will receive a sedative and a regional anesthesia, or you may receive general anesthesia.

Physicians make several small incisions in your leg and insert a catheter with a balloon on its tip. Using the balloon to separate the surrounding tissues from the veins, the culprit veins are identified after the insertion of a telescope to allow visualization of the space. Once the veins are identified, they are occluded with a clip.

How long does the procedure last?

The procedure itself generally takes two to three hours. This is typically performed in the outpatient setting, and you can anticipate returning home a few hours after the surgery. Full recovery will take one to two weeks, but healing of venous stasis ulcers may take longer.

What happens after the procedure?

Your surgeon will give you specific instructions you need to follow after the surgery until your incision heals adequately. Typically, these will involve rest and leg elevation. In addition, special wound care instruction may be given if you have an active venous stasis ulcer.

Are there any side effects of the treatment?

The surgery is performed through small incisions and has a low rate of wound complications. But as with any surgical procedure, you will feel somewhat tired for a few weeks. In addition, you may have pain at the sites of the incision, or numbness in some regions of the leg and foot.

What are typical results of the procedure?

Your doctor will discuss the results of the procedure with you, but outcomes are generally good. SEPS should decrease venous hypertension and increase circulation. The majority of patients undergo SEPS to treat chronic or recurrent venous stasis ulcers. If these ulcerations are due to an incompetent perforator, ligation of these perforators results in ulcer healing.

How do I find out if I am a candidate for this procedure?

To find out if you are a candidate for this procedure, please call the Vascular Surgery Department at 216.444.4508 or 800.223.2273 ext. 4-4508.