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Evidence summaries

Subfascial Endoscopic Perforator Surgery for Venous Leg Ulcer

Subfascial endoscopic perforator surgery (SEPS) in combination with compression therapy may improve healing of venous leg ulcers compared with compression therapy alone. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (lack of blinding), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 322 subjects with venous leg ulcers (aged 30 to 82 years). SEPS + compression therapy versus compression therapy (2 studies):The proportion of healed ulcers at 24 months increased in people treated with SEPS and compression therapy compared with compression therapy alone (RR 1.17, 95% CI 1.03 to 1.33; 1 study; n=196).There was no difference in the risk of ulcer recurrence at 24 months (RR 0.85, 95% CI 0.26 to 2.76; 2 studies, n=208).SEPS versus Linton approach (a type of open surgery, 1 study):There was no difference in ulcer healing at 24 months (RR 0.95, 95% CI 0.83 to 1.09; 1 study, n=39) or in risk of recurrence at 60 months (RR 0.47, 95% CI 0.10 to 2.30; 1 study, n=39) between SEPS and the Linton procedure.The Linton procedure was possibly associated with more adverse events than SEPS (RR 0.04, 95% CI 0.00 to 0.60; 1 study, n=39). SEPS + saphenous surgery versus saphenous surgery (1 study):There was no difference in ulcer healing at 12 months (RR 0.96, 95% CI 0.64 to 1.43; 1 study, n=22) or in the risk of recurrence at 12 months (RR 1.03, 95% CI 0.15 to 6.91; 1 study, n=75) between participants treated with SEPS and saphenous surgery versus those treated with saphenous surgery alone.Thee was no statistically significant increase in adverse events in the SEPS group (RR 2.05, 95% CI 0.86 to 4.90; 1 study, n=75).

    References

    • Lin ZC, Loveland PM, Johnston RV et al. Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers. Cochrane Database Syst Rev 2019;(3):CD012164. [PubMed]

Primary/Secondary Keywords