Restauração de sistema venoso profundo associada a cirurgia endoscópica subfascial de perfurantes insuficientes Reconstruction of the deep venous system associated with subfascial endoscopic perforator surgery (SEPS)

The authors present a case report and support that a complete diagnosis and the association of various adequate therapeutic techniques are crucial. The case involves a 37 year-old, male patient with stab-wound in the left groin, which had been operated eight years before and did not present edema or recurrent ulcers in the limb. Ascending venography evidenced obstruction of the femoral vein below the saphenofemoral junction. The saphenous vein was anastomosed to the popliteal vein above the knee. The ulcer healed but recurred two years later. Doppler ultrasonography evidenced four insufficient perforator veins and patent saphenopopliteal anastomosis. After subfascial endoscopic perforator surgery (SEPS), the ulcer healed. There was no recurrence after a follow-up period of four years. We conclude that it is crucial to perform a complete diagnosis and to associate several therapeutic techniques. Resumo Relato de caso e demonstracao de que o diagnostico completo e a associacao de tecnicas terapeuticas adequadas sao fundamentais. Os autores relatam o caso de um paciente de 37 anos, do sexo masculino, apresentando trauma de veia femoral esquerda, que havia sido ligada ha 8 anos e nao apresentava edema e ulceras recorrentes de perna. A flebografia identificou uma interrupcao da veia femoral abaixo da juncao com a safena. Realizou-se anastomose entre safena e veia poplitea acima do joelho. A ulcera cicatrizou e recidivou apos 2 anos. A ultrasonografia Doppler demonstrou quatro perfurantes insuficientes e anastomose safena-poplitea pervia. Apos cirurgia endoscopica subfascial de perfurantes insuficientes, a ulcera cicatrizou. Nao houve recidiva apos periodo de seguimento de 4 anos. Conclui-se ser importante a realizacao de diagnostico completo, assim como a associacao de varias tecnicas terapeuticas.