Venoscopy in Varicose Vein Surgery: Initial Experience

Objective: To determine the number and function of valves and the location of perforators and tributaries in patients with varicose veins as a result of saphenofemoral or saphenopopliteal reflux. Design: Prospective endovascular evaluation of greater and lesser saphenous veins during varicose vein surgery. Setting: Cedars-Sinai Medical Center, Los Angeles, California, USA. Patients: Thirty-one limbs in 25 patients undergoing varicose vein surgery. Intervention: Patients underwent retrograde passage of a 2.3 mm angioscope from the junction of the saphenous and deep vein distally to the first competent valve. Main outcome measures: Based on intraoperative findings, the greater saphenous vein was preserved in eight out of 25 cases. Preoperative assessment of lesser saphenous reflux was incorrect in three out of six cases. Results: An incompetent subterminal valve was found in 16 out of 25 greater saphenous veins. In 13 out of 25 limbs, no other valves were seen to the knee. Four patients had competent thigh valves. Conclusions: Retrograde venoscopy may be of benefit in varicose vein surgery.