CPT® Code 37500

1. Indications

The SEPS procedure is indicated for patients who exhibit the following conditions:

• Chronic Venous Insufficiency - A condition characterized by the improper functioning of the venous valves, leading to inadequate blood flow from the legs back to the heart.
• Venous Ulcerations - Open sores or wounds on the skin of the legs that occur due to poor circulation and are often associated with chronic venous insufficiency.
• Incompetent Perforator Veins - Perforator veins that fail to function properly, allowing blood to flow backward and contributing to venous hypertension and related complications.

2. Procedure

The SEPS procedure involves several critical steps to ensure effective treatment of incompetent perforator veins:

• Step 1: Ultrasound Guidance - The procedure begins with the use of ultrasound imaging to accurately identify the location of the incompetent perforator veins. This step is crucial for ensuring precise intervention during the surgery.
• Step 2: Exsanguination of the Leg - The leg is exsanguinated to minimize blood flow to the area, which helps in reducing bleeding during the procedure and enhances visibility for the surgeon.
• Step 3: Incision Creation - Two small portal incisions are made in the skin of the calf at sites that are remote from any existing venous ulcerations. These incisions are designed to provide access to the subfascial space without disturbing the ulcerated areas.
• Step 4: Introduction of Space-Maker Balloon - A space-maker balloon is inserted into the subfascial space through the incisions and inflated. This step is performed to create a larger working area, facilitating better access to the perforator veins.
• Step 5: Insufflation with Carbon Dioxide - The subfascial space is insufflated with carbon dioxide, which further expands the area and improves visibility for the surgical team.
• Step 6: Ligation of Perforator Veins - The incompetent perforator veins are then clipped or divided using endoscopic scissors. Alternatively, a harmonic scalpel may be employed to coagulate and divide the veins, ensuring effective treatment.
• Step 7: Closure of Incisions - Upon completion of the ligation, the surgical instruments are carefully removed, carbon dioxide is released from the subfascial space, and the portal incisions are closed to promote healing.

3. Post-Procedure

After the SEPS procedure, patients are typically monitored for any immediate complications. Post-procedure care may include instructions for wound care at the incision sites, recommendations for activity levels, and guidance on managing any discomfort. Patients may be advised to wear compression garments to support venous return and reduce swelling. Follow-up appointments are essential to assess healing and the effectiveness of the procedure in alleviating symptoms associated with chronic venous insufficiency and venous ulcerations.