Subfascial endoscopic perforator vein surgery

NICE interventional procedures guidance [IPG59] Published date:

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The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on subfascial endoscopic perforator vein surgery in June 2004. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in January 2009 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

  • Description

    The procedure is used for patients with either healed or active ulcers (CEAP classifications 5 or 6), caused by chronic venous insufficiency, in whom incompetent calf perforating veins are thought to be an important contributing factor, particularly where conservative management (such as leg elevation, compression therapy and medication) has failed. Deep venous occlusion and/or infected ulcers are usually contraindications to SEPS.

    SEPS is a minimally invasive alternative to open subfascial perforator vein surgery.

    Preoperative evaluation is performed by duplex scanning of the superficial, deep and perforator venous systems to diagnose both valvular incompetence and obstruction. During the operation, the limb is exsanguinated and two endoscopic ports are placed in the subfascial space in the calf at sites remote from the area of venous ulceration. A space-maker balloon is introduced and inflated in this subfascial space to improve access. Carbon dioxide is then insufflated to facilitate dissection. The incompetent perforating veins are clipped and divided with endoscopic scissors or, alternatively, coagulated and divided with an ultrasonic coagulator (harmonic scalpel).

  • OPCS4.6 Code(s)

    For endoscopic subfascial ligation surgery of perforating veins:

    L83.2 Subfascial ligation of perforating vein of leg

    Y76.3 Endoscopic approach to other body cavity

    For perforating veins that are clipped and divided with endoscopic scissors, the following OPCS-4 codes are appropriate:  

    L83.8 Other specified other operations for venous insufficiency

    Y76.3 Endoscopic approach to other body cavity

    Y07.2 Clipping of organ NOC

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding

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