[The value of venous endoscopy in sclerosing therapy]

The sclerosing treatment of varices of the legs is based on palpation. Endoscopic palpation can be useful in the treatment of insufficiency of the territory of the external saphenous vein. A penetrating ulcer on the posterior surface of the thigh, with an intramuscular pathway linking the deep femoral vein with the external saphenous arch can lead to venous reflux in addition to that in the external saphenous arch. If this penetrating ulcer is overlooked, post-surgical recurrence may result within a brief period. However, a penetrating ulcer of this type cannot be detected by palpation and therefore cannot be treated by conventional sclerosis. Venous endoscopy offers a solution by permitting per-operative catheterization of the ulcer from the saphenous arch and the injection of sclerosing agents at the site of the reflux. Venous endoscopy of the saphenous arch can be of value if it makes it possible to avoid the repeated injection of rising doses. The use of chemical glues and fibrotic compounds has been discontinued due to the risk of damaging the deep veins. The future lies in a mechanical process, laser, electrocauterization or ligature.