Meta-analysis of subfascial endoscopic perforator vein surgery (SEPS) for chronic venous insufficiency
- 1 February 2009
- journal article
- research article
- Published by SAGE Publications in Phlebology: The Journal of Venous Disease
- Vol. 24 (1), 8-16
- https://doi.org/10.1258/phleb.2008.008005
Abstract
Objectives The degree of benefits and risks, and the role of subfascial endoscopic perforator vein surgery (SEPS) in the management for chronic venous insufficiency (CVI) remains uncertain. Methods A multiple health database search was performed including Medline, Embase, Ovid, Cochrane Database of Systematic Reviews, and Cochrane Database of Abstracts of Reviews of Effectiveness, on all studies published between 1985 and 2008 that reported on health outcomes in patients with CVI treated with SEPS and comparing this therapy with the conventional Linton procedure. Three studies, which compared SEPS with conventional surgery, were included in the present meta-analysis. Results Between SEPS and Linton groups, there was a significant lower rate of wound infections for SEPS (odds ratio [OR] 0.06 [95% confidence interval (CI) 0.02 to 0.25]) and a significantly reduced hospital stay for SEPS (OR –8.96 [95% CI –11.62 to –6.30]). In addition, SEPS was associated with a significant reduced rate of recurrent ulcers (mean follow-up 21 months) (OR 0.15 [95% CI 0.04–0.62]). There was no significant difference between the groups in the following dimensions: rate of hospital re-admission (OR 0.21 [95% CI 0.03 –1.31]), death at six months (OR 3.00 [95% CI 0.11–78.27]), ulcer healing rate at four months (OR 0.44 [95% CI 0.09–2.12]), and the rate of deep vein thrombosis (DVT) (OR 0.35 [95% CI 0.01–8.85]). Conclusion From the level of evidence available by now it seems that SEPS, used as a part of a treatment regimen for severe CVI, benefits most patients in the short term regarding ulcer healing and the prevention of ulcer recurrence. It can be safely performed with less early postoperative complications compared with the Linton procedure. However, further prospective randomized trials are required to define the long-term benefits of SEPS.Keywords
This publication has 31 references indexed in Scilit:
- Is the nihilistic approach to surgical reduction of superficial and perforator vein incompetence for venous ulcer justified?Journal of Vascular Surgery, 2002
- Subfascial endoscopic perforator vein surgery: indications and resultsVascular Medicine, 1999
- Subfascial Perforator Vein Ablation: Comparison of Open versus Endoscopic TechniquesJournal of Endovascular Therapy, 1999
- Mid-term results of endoscopic perforator vein interruption for chronic venous insufficiency: Lessons learned from the North American Subfascial Endoscopic Perforator Surgery registryJournal of Vascular Surgery, 1999
- Early Benefits of Subfascial Endoscopic Perforator Surgery (SEPS) in Healing Venous UlcersAnnals of Vascular Surgery, 1997
- Safety, feasibility, and early efficacy of subfascial endoscopic perforator surgery: A preliminary report from the North American registryJournal of Vascular Surgery, 1997
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986
- Beta blockade during and after myocardial infarction: An overview of the randomized trialsProgress in Cardiovascular Diseases, 1985
- THE COMMUNICATING VEINS OF THE LOWER LEG AND THE OPERATIVE TECHNIC FOR THEIR LIGATIONAnnals of Surgery, 1938