Abstract
The problem with all reviewed papers is that the results are influenced by concomitant treatments and the assumption that the incompetent perforating veins were treated properly. The study of van Gent and Wittens 1 van Gent W. Wittens C. Influence of perforating vein surgery in patients with venous ulceration. Phlebology. 2015; 30: 127-132 Crossref PubMed Scopus (14) Google Scholar showed that, if you treat the incompetent perforators well, the recurrence rate of an ulcer decreases significantly. This finding shows the importance of persistent incompetent perforating veins in ulcer recurrence. Therefore, in this well-performed systematic review we miss the information; for if indeed all incompetent perforators were occluded and we can only conclude that, with the existing techniques and gathered documentation, we do not have proof that incompetent perforators need to be treated. However, the right conclusion needs to be that incompetent perforators do matter in the pathophysiology of a venous leg ulcer, but that we failed to treat them properly with existing techniques. Therefore, we need to improve existing techniques and especially we need to check after 3 months and 1 year to determine whether the treated incompetent perforators remain occluded and if so document what the outcome is. 2 Ho V.T. Adkar S.S. Harris E.J. Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord. 2022; 10: 955-964 Google Scholar Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiencyJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 10Issue 4PreviewIncompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurements, size, and the CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification. The objective of the present study was to systematically review and synthesize the current literature regarding the surgical management of IPVs, including open ligation, subfascial endoscopic perforator surgery (SEPS), endovascular laser ablation, ultrasound-guided sclerotherapy, and radiofrequency ablation. Full-Text PDF
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