Controlled cryosurgery of varices of the lower extremities. A new therapeutic approach. Apropos of 350 cases

: The idea of applying cryosurgery to the treatment of lower extremities varicose veins originated in 1978 from three developments: The increasing abundance of experimental and clinical observations of the vascular effect of low temperatures. The development of a more suitable, flexible instrumentation, in collaboration with the Atomic Energy Commissary. The intrinsic advantages of cryosurgery, a painless and less aggressive method, which may be applied to fragile or elderly patients, without general anesthesia. In a first phase (1979-1981) fifty, fragile, elderly or obese patients were treated. All presented a long saphenous reflux. The method demonstrates its feasibility and validity. Two obstacles limit a broader application to the ambulatory treatment of surgical varicose veins: The absence of a strict per-operative control of the ice ball forme at the tip of the cooling device. The conditions of surgery, painful for the patient and un for the physician, because of a bulky, rigid or flexible, instrumentation, which is not very adapted to venous catheterization and does not permit treatment above the knee fold. A second phase of clinical applications started in 1982. Vascular cryoprobes were developed. Because of a better adaptation, they permit the catheterization of most saphenous trunks, in their entirety, and also the control of tissues freezing by measuring the low frequency bioelectric impedance. This study describes: The biological and experimental bases on which rest the venous applications. Cryosurgical instrumentation that we have created and developed. An endoluminal controlled cryosurgical technique of the saphenous trunks. This technique was applied since 1982 to three hundred patients suffering from reflux with ostial incontinence. The results are analyzed in view of clinical and histological findings. The correlation between the absence of venous repermeation and the elevation of per-operative low frequency impedance values, and a follow-up beyond five years for the first patients seem sufficient to justify the present publication, the presentation of this material and to co-ordinate the start of a multicentric study.