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.
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.
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.
Risks / Benefits
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.
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.
Recovery and Outlook
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.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons
Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:
Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.
Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.
IVC Filter Retrieval Clinic - to make an appointment, call Vascular Medicine at 216.444.4420. Ask for Dr. Bartholomew in the Filter Retrieval Clinic. Your appointment will include a consultation with Dr. Bartholomew and the physicians who will perform the IVC filter retrieval procedure.
You may also use our MyConsult second opinion consultation using the Internet.
The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:
Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Becoming a Patient
- Vascular Disease Overview
- Venous Diseases
- Atherosclerosis - Arterial Diseases
- Blood Clotting Disorders (Hypercoagulable States)
- Carotid Artery Diseases
- Fibromuscular Dysplasia (FMD) and Spontaneous Coronary Artery Dissection
- Aortic Aneurysm
- May Thurner Syndrome
- Thoracic Outlet Syndrome
- Vein and Vascular
- All Miller Family Heart & Vascular Institute Treatment Guides
Diagnostic tests are used to diagnose your abnormal heartbeat and the most effective treatment method.
Our webchats and video chats give patients and visitors another opportunity to ask questions and interact with our physicians.
- Vascular Disease, Peripheral Arterial Disease & Thrombosis webchats and video chats
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- Visit Health Essentials - Read articles on vascular disorders and healthy living on Health Essentials
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Why choose Cleveland Clinic for your care?
Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.