37500 Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS)

Name of the Procedure:

Vascular Endoscopy, Surgical, with Ligation of Perforator Veins, Subfascial (SEPS)

Summary

Subfascial Endoscopic Perforator Surgery (SEPS) is a minimally invasive surgical procedure used to treat chronic venous insufficiency by ligating (tying off) perforator veins under the fascia (a layer of connective tissue). This procedure helps in improving blood flow and reducing symptoms associated with venous diseases.

Purpose

• Condition Addressed: Chronic venous insufficiency, venous ulcers, varicose veins.
• Goals: To improve venous circulation, reduce symptoms like swelling, pain, and ulceration, and enhance the patient's quality of life.

Indications

• Pain or swelling in the legs due to poor venous circulation.
• Non-healing venous ulcers.
• Presence of varicose veins with associated symptoms.
• Patients who have not responded well to conservative treatments like compression therapy.

Preparation

• Pre-procedure Instructions: Fasting for at least 8 hours before the surgery.
• Medication Adjustments: Possibly discontinuing blood thinners as advised by the doctor.
• Diagnostic Tests: Doppler ultrasound to map the veins and assess blood flow.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision and Access: Small incisions are made near the affected veins.
3. Endoscope Insertion: A small endoscope (a camera) is inserted through the incisions to visualize the veins.
4. Vein Ligation: The perforator veins are identified and ligated using special instruments.
5. Closure: The incisions are then closed with sutures or adhesive.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Surgeon (usually a vascular surgeon)
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Common Risks: Infection, bleeding, bruising, recurrence of symptoms.
• Rare Complications: Deep vein thrombosis (DVT), nerve damage, anesthesia-related complications.

Benefits

• Expected Benefits: Improved blood flow, reduced leg pain and swelling, healing of venous ulcers.
• Realization of Benefits: Most patients notice improvements within weeks, with continued benefits as the healing progresses.

Recovery

• Post-procedure Care: Keeping the leg elevated, wearing compression stockings as advised, avoiding strenuous activities.
• Recovery Time: Typically 1 to 2 weeks for initial recovery, with full recovery in about 4 to 6 weeks.
• Follow-up: Regular follow-up appointments to monitor healing and vein function.

Alternatives

• Conservative Treatments: Compression stockings, lifestyle changes, medications.
• Other Procedures: Sclerotherapy, laser ablation, radiofrequency ablation.
• Comparison: SEPS is minimally invasive with a shorter recovery time compared to some traditional surgical methods.

Patient Experience

• During the Procedure: The patient is under anesthesia and should not feel pain.
• After the Procedure: Mild discomfort or pain managed with prescribed painkillers, possible swelling and bruising at the incision sites. Adherence to post-operative instructions greatly aids in recovery and comfort.