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Venoscopic obliteration of variceal tributaries using monopolar electrocautery. Preliminary report
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
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.
Conclusion:
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.