Ligation with mini-phlebectomy in perforating vein insufficiency

Background: Perforating vein insufficiency is an important factor for the development and progression of varicose veins. The aim of this study was to evaluate the mid-term results of perforating vein ligation with mini-phlebectorny. Methods: Twenty-nine patients (15 males, 14 females; mean age 39 11 years) underwent perforating vein ligation with mini-phlebectomy for varicose veins. According to the CEAP classification, 2, 3, 21, and 3 patients had class 2, 3, 4, and 5 venous disease, respectively. The incompetent perforating veins were marked with Doppler ultrasonography on the day of operation. Operations were performed under local and spinal anesthesia in 10 patients and 19 patients, respectively. Nine patients underwent only mini-phlebectomy and Cockett I-II-III perforating vein ligations under local anesthesia, while the remaining patients also underwent great saphenous vein stripping for severe venous insufficiency. The mean follow-up period was 18.7 +/- 16.5 months. Results: A total of 76 perforating veins were ligated, including 26 (34.2%) Cockett I, 24 (31.6%) Cockett II, 22 (29%) Cockett III perforating veins, and four (5.3%) Boyd's perforating veins. Hyperpigmentation at the incision sites was seen in 12 patients. Clinical complaints of 26 patients (89.7%) improved significantly. Three patients with deep venous insufficiency complained of pain in the postoperative period. None of the patients developed varicose vein recurrences, and pre-existing chronic venous insufficiency affecting below the knee improved in 14 patients. Although the use of compression stockings was recommended to all the patients in the postoperative period, only 14 patients (48.3%) reported regular use. Conclusion: Even though subfascial endoscopic perforator vein surgery is widely used for perforating vein ligation in patients with varicose veins due to venous insufficiency, perforating vein ligation with mini-phlebectomy can be a good alternative in selected cases because it is cheaper, easier, safe, and effective.