Subfascial endoscopic perforator vein surgery in XXXX with post-thrombotic @entity4096 --is it justified?

@entity1 @entity1066 @entity4165 @entity4096 @entity340 @entity1211
Previous results following subfascial endoscopic perforator vein surgery were reported to be worse in post-thrombotic syndrome than in limbs with primary @entity340 . This report comprises a larger @entity1 cohort with longer follow-up. The goal of this study was to determine if subfascial endoscopic perforator vein surgery is justified in @entity1 with post-thrombotic @entity4096 . The clinical data of 91 consecutive @entity1 who underwent subfascial endoscopic perforator vein surgery with or without superficial reflux ablation over a 7-year period from May 1993 to June 2000 were retrospectively analyzed. Fifty-four females and 37 males (median age, 53 years; range, 20-77) underwent 103 subfascial endoscopic perforator vein surgery procedures. Forty-two limbs were classified as C6 (active @entity1066 ), 34 as C5 (healed @entity1066 ), and 24 as C4 ( @entity4165 ). Thirty procedures were performed in post-thrombotic limbs. Concomitant superficial reflux ablation was performed in 74 limbs (72%); saphenous vein stripping had been previously performed in 29 (28%). Deep @entity1211 was present in 89% of limbs; 13% had venous outflow obstruction on plethysmography. Cumulative @entity1066 in post-thrombotic limbs was not significantly different from limbs with primary @entity340 ; 30-, 60-, and 90-day healing rates were 44%, 72%, and 72% vs 39%, 70%, and 87%, respectively (p = 0.35). On univariate analysis, the presence of @entity1066 greater than 2 cm in diameter was associated with delayed @entity1066 (p = 0.02). Cumulative @entity1066 in all limbs was 4%, 20%, and 27% at 1, 3, and 5 years, respectively. Ulcer recurrence in post-thrombotic limbs was higher than in limbs with primary @entity340 at 1, 3, and 5 years; 16%, 47%, and 56% vs 0%, 8%, and 15%, respectively (p = 0.001). Recurrent @entity1066 were small, superficial, and easier to heal. Clinical improvement was significant even in post-thrombotic limbs; median clinical score decreased from 9.5 to 3 (p = 0.001), and median outcome score was +2 (mean 1.9; range, -1 to 3). Median clinical score in @entity1 with primary @entity340 improved from 6 to 1.5 (p = 0.0001). Subfascial endoscopic perforator vein surgery with superficial reflux ablation promoted @entity1066 , improved clinical outcome, and resulted in a low long-term @entity1066 rate in limbs with primary @entity340 . Despite good clinical outcome in post-thrombotic limbs, @entity1066 was high. These results imply that the role of subfascial endoscopic perforator vein surgery with superficial reflux ablation in @entity1 with post-thrombotic limbs continues to be controversial.
