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Angioscopy: Direct visualization of chronic venous occlusion, May-Thurner syndrome, and other applications in

Mina Kang1, Claudia Hurwitz1, Tom Exner2

  • 1Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.

Journal of Vascular Surgery. Venous and Lymphatic Disorders
|August 25, 2019
PubMed

Insights

Endovenous angioscopy offers new diagnostic and interventional applications in phlebology. This technique revealed chronic venous occlusion is fibrotic, not thrombotic, improving venous disease management.

Area of Science:

  • Phlebology
  • Vascular Surgery
  • Medical Imaging

Background:

  • Angioscopy is established for coronary artery disease but underutilized in venous disease diagnosis and management.
  • Limited exploration of angioscopy's potential in phlebology.
  • Need for advanced visualization techniques in venous disorders.

Purpose of the Study:

  • To explore and describe the diagnostic and interventional applications of endovenous angioscopy in phlebology.
  • To evaluate the utility of endovenous angioscopy for characterizing venous occlusions.
  • To assess the feasibility of angioscopy-guided interventions in venous disease.

Main Methods:

  • Performed endovenous angioscopy in a sterile setting using ultrasound guidance for access and a 9F introducer sheath.
  • Utilized an 8.5F videoscope with continuous saline irrigation to visualize target veins and clear the visual field.
  • Conducted fifteen procedures to explore various diagnostic and interventional applications.

Main Results:

  • Successfully performed fifteen endovenous angioscopy procedures.
  • Demonstrated applications including diagnosis of chronic venous occlusion, venous stent deployment, angioscopy-guided thrombectomy, foam sclerotherapy, and endovenous laser ablation.
  • Observed that chronic venous occlusion is predominantly fibrotic, not thrombotic.

Conclusions:

  • Endoscopic imaging of the venous system holds significant potential for enhancing access and guiding endovenous interventions.
  • Chronic venous occlusion in post-thrombotic syndrome is characterized by fibrosis.
  • The term 'chronic venous fibrosis' is proposed as a more accurate description than 'chronic venous thrombosis'.
Abstract

Keywords:
AngioscopyChronic venous thrombosisEndovenous laser ablationMay-Thurner syndromePost-thrombotic syndrome

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