SEPS (subfascial endoscopic perforator surgery) was devised as a surgical procedure to dissect incompetent perforating veins (IPVs) under the skin of lipodermatosclerosis (C4b) and refractory ulcers (C6) at lower leg and in our country it was authorized by the National Insurance System in 2014. We have performed SEPS, but we have also experienced IPVs that SEPS cannot handle, and one of the solutions was percutaneous ablation of perforators (PAPs). PAPs were performed on 102 IPVs out of 65

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... in 63 cases. Although the equipment used has changed, currently we uses a 1470 nm laser device and laser fiber with a small outer diameter, and the average linear endovenous energy density is 68.1±14.9 J/cm. The advantage of PAPs was that the IPV occlusion could be confirmed in real time by intraoperative ultrasonography, and our intraoperative occlusion rate was 100%. In addition, IPV at sites that could not be treated with SEPS for anatomical reasons could also be treated. We reported on the current status of PAPs that we are conducting in comparison with SEPS.