Minimally invasive vein surgery: its role in the treatment of venous stasis ulceration

Although traditional modalities used to treat venous disease and subsequent stasis ulceration have proved to be effective, they can have associated morbidities, such as postoperative pain, limited mobility, wound infection and dehiscence, as well as missed varicosities and/or incompetent perforator veins resulting in additional procedures. Recent advances have been made in minimally invasive vein surgery (MIVS) techniques that can decrease operative morbidity, number and size of incisions, recovery time, as well as operative time. These techniques are as durable as open procedures. The following procedures will be discussed: transilluminated powered phlebectomy, radiofrequency ablation of the greater saphenous vein closure, subfascial endoscopic perforator surgery, and percutaneous vein valve bioprosthesis. The advent of MIVS techniques allows the surgeon to manage venous pathophysiology associated with all 3 venous systems. MIVS is proving to be an important complement in the overall care of venous stasis ulceration.