Mechanical-Chemical Endovenous Ablation: A New Tumescentless Technique

Abstract

The minimally invasive management of vein disease continues to evolve. Endothermal methods to ablate the great and small saphenous veins involve the use of tumescent anesthesia for analgesia and compression with possible adjunctive intravenous sedation. Foam sclerotherapy of the great and small saphenous veins has been attempted with mixed results. A new endovenous device that does not require tumescent anesthesia or intravenous sedation, ClariVein® (Vascular Insights LLC, Conn), was evaluated. The ClariVein® catheter utilizes endovenous mechanical vein wall destruction with a rotating wire and the simultaneous infusion of a liquid sclerosant (Sotradecol®) to enhance venous ablation. This endovenous mechanical treatment is unique. This Institutional Review Board-sanctioned study evaluated the safety and efficacy of this technique. The ClariVein device was utilized in 30 patients with great saphenous vein incompetence. All procedures were performed in office with only local anesthesia at the access site. No tumescent anesthesia or intravenous sedation was employed. Ultrasound guidance similar to other endovenous procedures was used. Post treatment care was similar to endovenous thermal ablative procedures. Total procedure time was less than 15 minutes. Access was at the lowest level of incompetence but no lower than below the knee. Results at one week, one month, and three months will be presented including occlusion rates greater than 90%. Complication rates and symptom resolution will be discussed. The unique endomechanical ablative aspect of the ClariVein coupled with a safe FDA approved liquid sclerosant represents a further simplification and advancement in the treatment of venous disease. This is accomplished without the tumescent anesthesia currently required for endothermal methods and an early success rate comparable to these methods.