Vascular Insights

Abstract:

Introduction: In the last decade, minimally invasive endothermal ablation techniques have replaced surgery for the treatment of superficial venous insufficiency to reduce postoperative complications and recovery time and to improve quality of life. To avoid the risks of nerve damage and need for tumescent anesthesia to improve patient comfort, an alternative heatless technique has been introduced recently. Methods: Endovenous mechanochemical occlusion using the ClariVein® catheter (Vascular Insights LLC, Quincy, MA) is a new technique combining mechanical injury to the venous endothelium coupled with simultaneous catheter-guided infusion of a liquid sclerosant. This produces irreversible damage to the endothelium resulting in fibrosis of the vein. Results: The technique is related to a low complication rate and a success rate of 96% at two years and sustained quality of life improvement. This closure rate is comparable to endothermal techniques, but significantly less postoperative pain and earlier return to normal activities and work has been reported with endovenous mechanochemical occlusion. Conclusion: Mechanochemical occlusion using ClariVein® has proven to be safe and effective and has several advantages compared to endothermal techniques. The possibility of retrograde ablation of distal SSV insufficiency in C6 ulceration is considered a significant advantage. Randomized comparative studies with long-term follow up will continue to define the definite place of mechanochemical occlusion.

Authors:

Marianne E. Witte, MD, FEBVS, Consultant Vascular Surgeon, Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands, Michel M. P. J. Reijnen, MD, PhD, Consultant Vascular Surgeon, Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands, Jean-Paul de Vries, MD, PhD, Consultant Vascular Surgeon, Department of Surgery, Antonius Hospital, Nieuwegein, The Netherlands, Clark J. Zeebregts, MD, PhD, Professor of Vascular Surgery, Consultant Vascular Surgeon, Department of Surgery, (Division of Vascular Surgery), University Medical Center, University of Groningen, Groningen, The Netherlands

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