Incompetent perforating veins subfascial ligation as an important adjunct to venous surgery of the lower extremities: Evaluation of surgical results

The role of incompetent perforating veins in chronic venous disease is well established. The determination of hemodynamic alterations and perforating veins location is evaluated by physical examination, phlebography and ultrasonography. All patients with perforating veins failure underwent surgical treatment. From 1971 to 1982, 6000 patients with lower limb primary varicose veins underwent surgical treatment: 510 more patients were hospitalized for post-thrombotic disease. In 6% of patients suffering from primary varicose veins, in 18% with recurrent varicose veins and in 76% with secondary varicose veins (8.1% of all patients), subfascial ligation of incompetent perforating veins was associated with complete vein stripping. Incompetent perforating vein ligation alone was performed in 0.6% of cases. The technique is based on subfascial ligation of perforating veins through a small skin incision (2-3 cm). This procedure allows a fast healing of surgical wounds and a good esthetical result. The subfascial ligation allows a complete cure of the disease in primary varicose veins and avoids the main causes of recurrence. Moreover in the post-thrombotic disease treated by this procedure, symptoms and trophic lesions are markedly decreased and a dramatic reduction in the ulceration rate, 62.5% to 15% at ten year follow-up, is achieved.