Endoscopic Perforator Ligation for Venous Stasis Disease: Value of Intraoperative Ultrasound Guidance

Videoscopic perforator ligation (VPL) is emerging as a safe and viable alternative to open techniques. Complete ligation of all perforators is crucial to reversal of venous stasis consequences. A review of the authors' experience with 19 VPLs revealed six missed perforators when completeness was evaluated by intraoperative duplex scanning. Two were paratibial, three were in the distal part of the compartment, and one was outside the compartment. Three were ligated videoscopically and three by direct subfascial ligation. Nonhealed ulcers proved to have retained perforators requiring direct ulcer excision and perforator ligation. The authors conclude that intraoperative duplex scanning allows more thorough perforator ligation and eliminates retained perforator problems.