Automatic Sclerosant Injection Technique of Mechanochemical Ablation with ClariVein Using a Syringe Pump for the Treatment of Varicose Veins

Introduction Endovenous mechanochemical ablation (MOCA) is an increasingly popular non-thermal non-tumescent technique used to treat axial reflux in patients with superficial venous incompetence. However, the optimal management of varicose tributaries following this technique is unknown and may impact on patient outcomes. This study compares MOCA with concomitant phlebectomy (MOCAP) versus ablation with sequential phlebectomy if required (MOCAS). Methods Patients with symptomatic Comprehensive Classification System for Chronic Venous Disorders (CEAP C2–C6) unilateral axial reflux were studied. Patient choice determined whether concomitant treatment of varicosities was carried out. The primary outcome was the Aberdeen Varicose Veins Questionnaire (AVVQ) at one year. Secondary outcomes included: Venous Clinical Severity Scores (VCSS), EuroQol 5-Domain quality of life scores, complications, procedure duration, procedural and post-operative pain scores and need for secondary procedures. Outcomes were assessed at baseline and then one week, six weeks, six months and one year post intervention. Results Fifty patients underwent MOCAP and 33 patients MOCAS. The two groups were comparable at baseline. MOCAP was associated with lower (better) AVVQ scores at six weeks (3.4 (0.5–6.0) vs. 6.1 (1.8–12.1); P = 0.009) and at six months (1.6 (0.0–4.5) vs. 3.34 (1.8–8.4); P = 0.009) but by one year the difference was no longer statistically significant (1.81 (0.0–4.5) vs. 3.81 (0.2–5.3); P = 0.099). MOCAP was associated with longer procedural duration (45 min (36–56) vs. 30 min (25–37); P < 0.001) and higher maximal periprocedural pain (31 (21–59) vs. 18 (7–25); P = 0.001). VCSS at all time points were lower in favour of MOCAP (0 (0–1) vs. 1 (0–3); P < 0.001). MOCAP was associated with fewer episodes of clinically significant thrombophlebitis (6 of 50 (12%) vs. 10 of 33 (30%); P = 0.039) and lower numbers of secondary procedures (2 (4%) vs. 6 (18%); P = 0.032). Conclusion Concomitant treatment of tributary varicosities following MOCA improves quality of life and clinical severity, while reducing rates of re-intervention and post-operative thrombophlebitis compared to sequential treatment. The penalty is a modest increase in procedural duration and discomfort. Further evidence from longer-term follow-up is needed.

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Mechanochemical ablation of varicose veins with N-Butyl Cyanoacrylate: Six-month follow-up

Annals of Medical Research ◽

10.5455/annalsmedres.2019.04.223 ◽

2019 ◽

pp. 1

Author(s):

Tumay Bekci ◽

Alptekin Tosun

Keyword(s):

Varicose Veins ◽

Mechanochemical Ablation

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Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer

Vascular ◽

10.1177/1708538113516320 ◽

2013 ◽

Vol 22 (5) ◽

pp. 375-377 ◽

Cited By ~ 4

Author(s):

Hayley M Moore ◽

Tristan RA Lane ◽

Ian J Franklin ◽

Alun H Davies

Keyword(s):

Saphenous Vein ◽

Local Anaesthetic ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Venous Ulcer ◽

Venous Ulceration ◽

First Case ◽

Mechanochemical Ablation ◽

Cannulation Technique ◽

Endovenous Treatment

We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation.

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Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: The Multicentre Venefit™ versus ClariVein® for varicose veins trial

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514551085 ◽

2014 ◽

Vol 31 (1) ◽

pp. 61-65 ◽

Cited By ~ 38

Author(s):

R Bootun ◽

TRA Lane ◽

B Dharmarajah ◽

CS Lim ◽

M Najem ◽

...

Keyword(s):

Quality Of Life ◽

Radiofrequency Ablation ◽

Randomised Controlled Trial ◽

Pain Score ◽

Varicose Veins ◽

Controlled Trial ◽

Early Results ◽

Mechanochemical Ablation ◽

Randomised Controlled

Objective Endovenous techniques are, at present, the recommended choice for truncal vein treatment. However, the thermal techniques require tumescent anaesthesia, which can be uncomfortable during administration. Non-tumescent, non-thermal techniques would, therefore, have potential benefits. This randomised controlled trial is being carried out to compare the degree of pain that patients experience while receiving mechanochemical ablation or radiofrequency ablation. The early results of this randomised controlled trial are reported here. Methods Patients attending for the treatment of primary varicose veins were randomised to receive mechanochemical ablation (ClariVein®) or radiofrequency ablation (Covidien® Venefit™). The most symptomatic limb was randomised. The primary outcome measure was intra-procedural pain using a validated visual analogue scale. The secondary outcome measures were change in quality of life and clinical scores, time to return to normal activities and work as well as the occlusion rate. Results One-hundred and nineteen patients have been randomised (60 in the mechanochemical ablation group). Baseline characteristics were similar. Maximum pain score was significantly lower in the mechanochemical ablation group (19.3 mm, standard deviation ±19 mm) compared to the radiofrequency ablation group (34.5 mm ± 23 mm; p < 0.001). Average pain score was also significantly lower in the mechanochemical ablation group (13.4 mm ± 16 mm) compared to the radiofrequency ablation group (24.4 mm ± 18 mm; p = 0.001). Sixty-six percent attended follow-up at one month, and the complete or proximal occlusion rates were 92% for both groups. At one month, the clinical and quality of life scores for both groups had similar improvements. Conclusion Early results show that the mechanochemical ablation is less painful than the radiofrequency ablation procedure. Clinical and quality of life scores were similarly improved at one month. The long-term data including occlusion rates at six months and quality of life scores are being collected.

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An investigation on the influence of glycerin on sclerosant foam stability

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2010.010028 ◽

2011 ◽

Vol 26 (6) ◽

pp. 232-234 ◽

Cited By ~ 9

Author(s):

J D Peterson ◽

M P Goldman

Keyword(s):

Half Life ◽

Foam Stability ◽

Varicose Veins ◽

Injection Technique ◽

Foam Sclerotherapy ◽

System Technique ◽

Negative Effect ◽

Sodium Tetradecyl Sulphate ◽

Time Required ◽

Disposable Plastic

Background Foam sclerotherapy is an increasingly popular modality in the treatment of varicose veins. Foam stability varies according to foam composition, volume and injection technique. Materials and methods A disposable plastic connector was used to create foam from 0.50% sodium tetradecyl sulphate (STS) mixed with varying volumes of glycerin. As a measure of foam stability, the half liquid time was defined as the time required for half of the original volume of sclerosing solution to settle. Three recordings were determined for each of the three mixtures of sclerosant foam. Results The time for sclerosing solution to settle to half of its initial volume was found to be 89 seconds for 0.50% STS alone, 117.7 seconds with the addition of 0.1 mL of 72% glycerin, and 114.7 seconds with the addition of 0.2 mL of 72% glycerin. Conclusion The small volumes of glycerin added to STS prolonged the half liquid time of STS foam up to 35%. As glycerin alone is unable to be foamed with the double-syringe system technique there may be a point at which further addition of glycerin has a negative effect on the half-life of foam.

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Using a Syringe Pump during Mechanochemical Ablation Is Not Mandatory, but It Is Easy to Control

Vascular Specialist International ◽

10.5758/vsi.200068.r ◽

2020 ◽

Vol 36 (4) ◽

pp. 273-274

Author(s):

Insoo Park

Keyword(s):

Syringe Pump ◽

Mechanochemical Ablation

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Experience of application of mechanochemical scleroobliteration in treatment for recurrence of lower extremity varicose vein disease

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj202028157-66 ◽

2020 ◽

Vol 28 (1) ◽

pp. 57-66

Author(s):

Alidzhon D. Gaibov ◽

Okildzhon Ne’matzoda ◽

Shakhnoza M. Burieva ◽

Egan L. Kalmykov

Keyword(s):

Lower Extremity ◽

Saphenous Vein ◽

Varicose Veins ◽

Invasive Procedure ◽

Sulfate Solution ◽

Chronic Venous Disease ◽

Long Term Results ◽

Venous Disease ◽

Mechanochemical Ablation ◽

Complete Obliteration

Aim. Evaluation of the effectiveness of mechanochemical scleroobliteration in treatment for recurrent lower extremity varicose veins (VVD). Materials and Methods. A retrospective analysis of the results of examination and treatment of 19 patients (17 women and 2 men, average age 36.34.5 years) with recurrences of VVD, in whom mechanochemical sclerotherapy as the main method of treatment was used. In all cases, mechanochemical ablation of the superficial venous trunks was performed using Phlebogriph catheter. As a hardener, 3% sodium tetradecyl sulfate solution (fibro-vein) was used in the volume not more than 10 ml per procedure. Results. According to the CEAP classification, 15 patients had C2 and 4 patients had C3 class. Recurrence of VVD in one lower extremity was diagnosed in 17 (89.5%) patients, and bilateral in 2 (10.5%). In 6 (31.6%) cases, recurrence occurred in 5 or more years after the first operation, in 8 (42.1%) patients after 3-5 years, in 5 (26.3%) after 1-3 years. The diameter of varicose veins before treatment according to color duplex scanning (CDR) was 7.90.8 mm. The duration of the detected saphenofemoral reflux (n=10) with the trunk of the great saphenous vein (GSV) left on the hip was 5.71.4 s, with the length 31.231.4 mm. With the preserved зtrunk of the GSV, crossectomy was performed in combination with mechanochemical scleroobliteration. Crossectomy was also performed in two patients with repeated dilation of the trunk of the small saphenous vein (SSV) followed by mechanochemical scleroobliteration. In two cases, insufficient shin perforants were ligated from mini-incisions, and in two more cases, foam scleroobliteration of them was performed. Within 3 weeks after the procedure, a good result was recorded in 94.7% of cases in the form of complete occlusion of sclerotized veins with the absence of reflux in them. Only in one observation incomplete occlusion of the sclerotized vein on the hip was noted, which required a repeated procedure. Long-term results were studied in 19 patients, in 94.7% of who complete obliteration of sclerotized veins and improvement of the clinical course of chronic venous disease were recorded. Conclusion. Mechanochemical scleroobliteration has proven to be an effective method of treatment for lower extremity VVD being a minimally invasive procedure.

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