Product Description	Product Technique	Endoscopic Technique Reprint	SEPS Kit
Training Courses	Educational Materials	Reimbursement Codes
SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY (SEPS) INTRODUCTION

Current treatment options for chronic venous insufficiency (CVI) include: Compression therapy Vein stripping or high ligation of the saphenous vein Subfascial Endoscopic Perforator Surgery (SEPS) Open perforator ligation - the Linton procedure Valve reconstruction In Subfascial Endoscopic Perforator Surgery (SEPS) for treatment of chronic venous insufficiency, GSI's SPACEMAKER® balloon dissection technology facilitates the creation of an endoscopic operative space in the subfascial plane of the superficial posterior compartment of the lower leg. Endoscopic clip appliers are then introduced to ligate incompetent perforating veins, as identified by pre-operative duplex scanning. This procedure can be performed on patients with active or recurrent venous stasis ulceration. In the 1930's, Robert Linton described a medial subfascial approach to incompetent perforating veins, but the available tools were not adequate. The current renewed interest in subfascial perforator vein ligation is due to the following recent technical developments: Noninvasive testing for venous anatomy and hemodynamics - color duplex ultrasound Endoscopic instrumentation and techniques Balloon dissection technology for gently creating an endoscopic operative working space Chronic Venous Insufficiency 2 - 5% of adult population have clinical manifestations of superficial or deep venous insufficiency. 1.5% of adult population have, or have had, venous stasis ulceration. Estimated annual cost for treatment of CVI in Medicare population alone approaches $200 million.