Subfascial Endoscopic Perforator Surgery (SEPS) is a specialised minimally invasive surgical technique that plays
a significant role in the management of chronic venous insufficiency (CVI) and venous ulcers, which are often
associated with chronic venous insufficiency. It offers an effective alternative to traditional surgical methods, with
benefits such as reduced recovery time and improved surgical outcomes. This condition is characterised by the
failure of venous valves in the legs, leading to increased pressure in the veins and the eventual development of
ulcers. SEPS addresses this issue by targeting the perforating veins, which connect the superficial and deep
venous systems in the leg.
The procedure begins with a small incision in the leg, through which an endoscope is inserted. The endoscope,
equipped with a camera and light, allows to visualise the subfascial space of the leg, which is the area beneath the
layer of fascia covering the muscles. The malfunctioning perforator veins are then identified. Once located, these
veins are disrupted or ligated, effectively reducing the venous pressure in the affected area. This reduction in
pressure aids in the healing of venous ulcers and alleviates symptoms associated with CVI.
SEPS offers several advantages over traditional surgical methods. Its minimally invasive nature results in less
postoperative pain, reduced risk of infection, and quicker recovery times. Moreover, the use of endoscopic
techniques provides better visualization of the surgical area, leading to more precise and effective treatment. This
precision is particularly important in avoiding damage to surrounding tissues and structures.
However, patient selection and consideration of potential risks are crucial in the planning of this procedure.
Additionally, not all patients with venous ulcers are suitable candidates for SEPS and the decision to use this
approach depends on individual patient factors and the severity of their condition.