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

Angioscopy has been widely used in the diagnosis and management of vascular disorders and in particular in coronary artery disease. However, few applications have been developed in the diagnosis or management of venous disease. Endovenous angioscopy was performed to explore applications of this modality in phlebology. Procedures were performed in a sterile setting. Access was obtained by ultrasound guidance and a 9F introducer sheath. An 8.5F videoscope was used to visualize target veins. Continuous saline irrigation was used to displace blood and to clear the visual field. Fifteen procedures were performed. We describe diagnostic or interventional applications of endovenous angioscopy that include diagnosis and characterization of chronic venous occlusion, deployment of venous stents, angioscopy-guided thrombectomy, foam sclerotherapy, and endovenous laser ablation. Chronic venous occlusion was observed to be fibrotic rather than thrombotic. Endoscopic imaging of the venous system has great potential to improve access and to guide endovenous interventions. Chronic venous occlusion in post-thrombotic syndrome is a fibrotic process, and chronic venous fibrosis is a better description of the type of occlusion and should replace chronic venous thrombosis.