Venoscopic obliteration of variceal tributaries using monopolar electrocautery. Preliminary report.
BACKGROUND
Retrograde saphenous venoscopy has a diagnostic and potentially therapeutic role in the treatment of truncal varices.


OBJECTIVE
To determine whether venoscopic electrocautery of saphenous vein tributaries can eliminate reflux into varices and reduce the need for further variceal evulsion or sclerotherapy.


METHODS
Twelve patients with truncal varices underwent ligation of the saphenofemoral junction, retrograde venoscopy of the saphenous vein trunk, and endoscopic electrocautery obliteration of selected tributaries and varices.


RESULTS
Postoperative color-flow duplex studies revealed that the saphenous vein trunk was completely preserved in nine patients (75%). Portions of three saphenous vein trunks (25%) near the cannulated tributaries were thrombosed. Four patients (33.3%) did not require further sclerotherapy. These four patients usually had a cluster of varices arising from a single tributary that lay close to the saphenous vein. Seven of the eight remaining patients (58.3%) reported significant improvement from the operative procedure alone, but required additional treatment with sclerotherapy to make the results satisfactory. One patient (8.3%) experienced little improvement.


CONCLUSIONS
Venoscopic obliteration of variceal tributaries is feasible and may prove useful in the treatment of truncal varices. In selected patients, 4 of 12 (33.3%), no further treatment with sclerotherapy or evulsion was needed.
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
W S
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Gradman
D000328:Adult; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014648:Varicose Veins / Q000601:surgery*