| Abstrakt: |
Background: Mechanical Occlusion Chemically Assisted Ablation (MOCA) is a well-known method for treating varicose veins. Being a non-thermal technique it offers some advantages over the popular laser and radiofrequency ablation. There are several issues and criticisms regarding MOCA. Some authors report that a huge amount of sclerosing agent is going into the deep veins, which increases the risk of DVT. Another issue is that tributary veins should be left untreated or treated only with miniphlebectomies. The aim of the study is to compare the results of the treatment of patients with chronic venous disease with the mechanochemical ablation method using the classical and aspiration method. Material and method: For a period of 5 years, more than 500 people passed through the Clinic and were treated with mechanochemical ablation. Of these, over 300 people went through a full three-year followup of the treatment results. The patients are divided into two homogeneous groups: group A - Classic MOCA (cMOCA) and group B - Aspiration MOCA (aMOCA). Patients in the two groups were compared in terms of method success - clinical and anatomical, complications, recurrences, improvement in CIVIQ-20 and VCSS scores, and satisfaction. The whole concept consists of inserting a 45 cm long 6 fr sheath in the GSV. Once the sheath is positioned ClariVein® catheter is advanced through the sheath. In contrast to the traditional protocol we use 3% Polidocanol foam instead of liquid. Once the procedure has started and the initial 3-4 second of stationary rotation of the device has passed, we insert а 20 cc syringe to the sheath and put it in aspiration mode so that the foam we use is drowned back into the syringe. Results: In the primary analysis of the results, it was found that the aspiration method of performing mechanochemical ablation resulted in a better anatomical success rate (92% aMOCA vs. 80% cMOCA) with a similar clinical success rate (95% aMOCA vs. 92% cMOCA), lower number of complications (two major complications of deep vein thrombosis in the cMOCA group compared to 0 in aMOCA with a similar percentage of mild complications such as hematomas, edema, hyperpigmentation, etc.), fewer relapses (5% of patients in the aMOCA group according to the indicator "Partial recanalization up to 20 cm - sonographically demonstrable, but without subjective complaints" compared to 12% of patients in the group with MOCA) and similar satisfaction of the patient. Conclusion: Using the aspirational technique when performing MOCA has the potential of significant increase in efficacy of the procedure and at the same time to reduce the potential side effects keeping patient satisfaction levels high. [ABSTRACT FROM AUTHOR] |
