THERMAL AND NON-THERMAL METHODS OF TREATMENT OF PATIENTS WITH PRIMARY VARICOSЕ DISEASES OF THE LOWER LIMBS OF STAGE C2

Treatment results of primary varicose disorders has been shown. The experience of using of thermal (endovenous laser ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 58 patients was analyzed. In the group of patients who underwent endovenous laser obliteration, reflux was not detected. In the group of patients with mechanochemical obliteration, reflux was determined in 3 patients (27.2%) at follow-up after 3 months required supplementation with foam sclerobliteration. In the group of patients with the introduction of bio glue, reflux was determined in 1 patient (20%) at the examination after 3 months. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a reliable method of threatment, the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. Non-thermal methods require further research and widespread implementation in practice.

Comparison of mechanochemical ablation versus ligation and stripping for the treatment of incompetent small saphenous vein

Objective to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. Methods This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. Results A total of 60 limbs (73.3% women, mean age 54.7 ± 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 ± 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 ± 2.3 days vs. OS 14.2 ± 3.8 days, p < .0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. Conclusion MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS.

Choosing the Best Treatment Approach for Axial Vein Reflux: Thermal versus Nonthermal Approaches

Chronic venous insufficiency is a common and treatable medical condition which has a high morbidity if left untreated, progressing to lower extremity edema, skin changes of lipodermatosclerosis, and venous ulceration. Treatment options have significantly expanded over the last several decades, shifting away from the traditional surgical approach to more minimally invasive procedures such as endoluminal venous laser ablation or radiofrequency ablation. Even more recently, several techniques using nonthermal methods to ablate varicose veins have been developed, which offer the advantage of not requiring labor-intensive and painful tumescent anesthesia to protect the surrounding tissues. These techniques include mechanochemical ablation, cyanoacrylate closure, or polidocanol microfoam injection and can be offered to a wider range of patients without the need for sedation while offering similar closure rates and improved postprocedure symptom profile. Furthermore, certain patient characteristics which might preclude or complicate the use of thermal ablation methods might not pose a problem with nonthermal nontumescent methods.

Histopathological analysis of incompetent great saphenous veins after mechanochemical ablation treatment – An ex-vivo experiment

Background The endovascular technique of mechanochemical ablation (MOCA) has become popular in treating patients with saphenous reflux. We reported the histopathological findings in human ex-vivo incompetent great saphenous veins following treatment with saline, polidocanol, mechanical ablation and MOCA using ClariVein device. Methods Twenty-four vein GSV specimens were obtained via traditional surgery and treated with four methods: Group A: 0.9% normal saline (NS); Group B: 3% polidocanol; Group C: mechanical ablation + 0.9% NS; Group D: mechanical ablation + 3% polidocanol (MOCA). Hematoxylin and eosin (HE), Masson’s trichrome and immunohistochemical staining were performed on each specimen and integrated optical densities were measured with vWF and a-SMA stains and statistically evaluated. vWF staining was used to assess endothelial damage and a a-SMA staining was used to assess media injury. Results HE and Masson’s trichrome staining of Groups C and D revealed severe damage to the endothelium and media compared to Groups A and B. The statistical result of vWF staining showed the damage of endothelium was significantly increased by Group D compared to Groups A, B and C. The statistical result of a-SMA staining showed the damage of media was significantly increased by Groups C and D compared to Groups A and B. Conclusions The mechanism of MOCA was caused by both endothelium damage and media tearing. The damage of endothelium was significantly increased by MOCA when compared with mechanical ablation alone.