Endoscopic subfascial perforating vein ligation: its complementary role in the surgical management of chronic venous insufficiency.

Endoscopic methods have proven as efficacious as previous open surgical techniques for ligation of calf perforating veins. The reduced incidence of wound complications favors the minimally invasive approach regardless of the technique used. Since isolated disease of the calf perforating veins is rare, most of these procedures are performed in conjunction with superficial venous ablation. These advanced procedures are indicated for patients with skin and subcutaneous manifestations of CVI (CEAP classes 4, 5, and 6). Although the contribution of perforator ligation to the hemodynamic and clinical result is unclear, clinical symptoms and hemodynamics have significantly improved when performed as described.