Venoscopic Obliteration of Variceal Tributaries Using Monopolar Electrocautery

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.