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Varicose Veins of Lower Limbs


Endoscopic Subfascial Perforator Ligation (SEPS)


help in  will heal  of varicose ulcers and reduce the likelihood of  relapses.

What it's about:

Insufficient perforating veins in the lower limbs.

#varices #surgery #vascular surgery #coimbra

Lower Limb Varicose

Varicose veins, or varicose veins, are veins that become crooked, dilated, and insufficient. The etiology of these changes is not fully known, although they are hereditary and prolonged stay in orthostatism is a risk factor. Anyone who has a mother and father with varicose veins will most likely also have them at some point in their lives. Chronic venous disease can range from mild complaints with or without telangiectasias (vascular spiders), to large varicose ulcers responsible for poor quality of life and long periods of absence from work. Varicose veins are also a risk factor for venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (potentially fatal), as well as thrombophlebitis. The treatment of varicose veins aims to improve the quality of life, prevent serious complications (such as leg ulcers), help ulcers to heal and reduce relapses. In this sense, the treatment of perforating veins is an asset.



Perforating veins are veins that drain blood from the superficial venous system (when tortuous it forms the classic easily identifiable varicose veins in the legs) to the deep venous system. Through this, the blood returns to the heart and completes the circulatory cycle.

what are veins  perforations ?
Perforate the fascia, hence its name
Why should I treat spikes?
Prevent ulcers and relapses


Perforating vessels are involved in the appearance of ulcers, difficulty in healing and early recurrence of varicose veins. The treatment of insufficient perforators allows accelerating the healing of varicose ulcers, reducing the rate of ulcer recurrence and decreasing the recurrence rate of varicose veins.

When should I treat the spikes?


Perforators must be treated when insufficient. To diagnose the insufficiency, venous echodoppler is mandatory. According to the American Venous Forum, patients with active ulcer (C6) and healed ulcer (C5) should have their perforators treated. In patients with edema of venous origin (C3) and lipodermatosclerosis (C4) treatment may be beneficial. 

How to treat insufficient perforators?
Endoscopic surgery (SEPS)


Endoscopic Subfascial Perforators Ligation (SEPS) allows you to treat all leg perforators through two mini incisions and with the help of a chamber, offering the best results.  After SEPS, an ulcer healing rate > 90% was achieved and recurrence dropped to values around 11%.

Are there other mini invasive techniques?
Yes but...


There are percutaneous percutaneous ablation (PAP) techniques, but they are less effective (laser, radiofrequency and foam sclerosis). Furthermore, these techniques only treat perforators found on echodoppler. Endoscopic surgery (SEPS) treats an average of 2-3 more perforators that go unnoticed by preoperative Doppler echocardiography. This means that with other techniques these perforators would remain untreated. 

Does endoscopic surgery have complications?
rare and transient


As with all procedures, Endoscopic Subfascial Perforator Ligation (SEPS) can have complications. However, they are rare and usually transient. The most common is the presence of paresthesia on the medial aspect of the leg for several months, without affecting muscle strength and without significant repercussions on quality of life. 

Are other procedures needed?
It depends on each patient


Endoscopic Subfascial Piercing Laqueation treats the incompetent piercing system. It's a key to getting good results but it may not be enough. The superficial venous system usually also needs to be treated. For such use usually mini-incision surgery (at the same time as endoscopic surgery) and foam sclerosis.

Wear elastic stockings after SEPS?
Yes and no


After treating varicose veins, it is advisable to wear elastic stockings for the first month. Since the surgery is aimed at controlling complaints, in C0 to C3 disease, elastic stockings may be dispensed with after the first month after surgery. In chronic venous disease C4 to C6 elastic stockings should continue to be part of the daily routine.

Mother and Daughter

I had an ulcer that didn't  healed. After being operated on, it healed until the first postoperative consultation.

Mulher de negócio

Recovery was simple and quick. I've improved a lot. I am very grateful for the final result.

Young Chef

I had tingles in my leg  for a few months, but nothing special. The decrease in the ulcer that I had was evident and it overcame the anthills.

Laqueação Subfascial Endoscópica de Perfurantes
Dr. Carlos E. Costa Almeida

Laqueação Subfascial Endoscópica de Perfurantes

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