[Ostial valves in a patient with varicose veins. Endoscopic examination]

Twenty three endoscopies were performed, including six of the great saphenous region, fourteen of the small saphenous region and three involving the region of the medial gemellar perforators. Two types of valves may be seen on the basis of their endoscopic appearances: certain valves have a transparent appearance with very thin valvular tissue which tears easily when a catheter is passed against the direction of venous flow. These valves are located in the main saphenous veins and their collaterals, at a distance from bifurcations and the point of entry of perforating veins. The only type of lesion seen affecting these valves was tearing of their tissue. Their sole role appears to be to favourize the progression of venous flow in an anterograde direction. Other valves have an opaque appearance with valvular tissue thickened by an actual fibromuscular skeleton and strengthening of the free edge to form a lip. These resist counter-grade catheterisation and may prevent progression of the endoscope or of a stripper. These valves are located at the ostium of the terminal portions of the saphenous veins and directly proximal to the point of entry of certain collaterals and perforators. The latter, when reflux is present, behave as ostial valves, playing the role of an anti-reflux system as well as favourizing preferential hemodynamic circuits which explain certain varicose cartographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)