3. Treatment of perforating veins
Which perforating veins should be treated?
J-J. Guex
The role of perforating veins in the pathogenesis of chronic venous disease (CVD) is controversial. Now the question being debated is: should we treat perforators and if so, which perforator(s)? The usual attitude is to not treat medial leg perforating veins, irrespective of whether they are incompetent or not. That is why their incompetence in primary disease is a consequence of great saphenous vein (GSV) reflux, which is shown by their disappearance after GSV ablation. No data was published on the efficacy of dissecting perforators in terms of clinical results or recurrences. The treatment of medial leg perforating veins can be of value if they have a diameter more than 5 mm, reflux more than 0.5 seconds, if they remain large and refluxing after GSV ablation, if there is no incompetent GSV, or if there is a significant varicose cluster above the perforating veins.
Foam or endovenous laser?
E. Rabe
Both methods are safe and effective, but no randomized controlled trials were conducted to compare them. Both methods have theirs pros and cons. The laser method delivers defined energy into the targeted vein, however, it is expensive and there may be problems with access to the vein. Sclerotherapy is cheap, the vein can be easily accessed, but there is no defined concentration of sclerosing agent, which can also migrate into the deep vein.
Subfacial endoscopic perforating vein surgery: is there still a place in 2014?
P. Gloviczki
As a previous supporter of subfascial endoscopic perforator surgery (SEPS), the author presented a view on the place of this method in phlebology today. He concluded that the role of SEPS is limited to rare and refractory cases of venous ulcers, cases of short and large perforators, and if percutaneous techniques, such as thermoablation or sclerotherapy, are not available.
