Six years' experience in Mexico with the use of mechanical-ablative procedures

BACKGROUND: Treatments for venous insufficiency due to saphenous-femoral reflux have evolved in recent years; conventional surgery has been replaced in many places by thermal laser or radiofrequency ablation of the GSV and in other places by ultrasound-guided foam sclerotherapy. Mechanical-chemical ablation (MOCA) systems consist of devices that cause damage to the endothelium using physical devices such as blades and that simultaneously apply sclerosing foam into the vessel.METHODS: One hundred forty-seven patients and 260 limbs admitted for venous insufficiency were reviewed from 2017 to 2022, who underwent a non-thermal, non-tumescent endoablative procedure with Clarivein®, a device designed for mechanical-chemical obliteration. The patients used class II elastic stockings and a single dose of 40 mg subcutaneous enoxaparin was applied prophylactically. The patients were followed annually, and a CIVIQ-14 satisfaction survey was conducted.RESULTS: From the 147 patients, 65% were women and 35% were men. The procedures performed were 57% on the left side and 43% on the right side. Complications were 0.2% and corresponded to hyperpigmentation, superficial thrombophlebitis of the GSV and a DVT that resolved with oral anticoagulant treatment (rivaroxaban 15 mg every 8 hours) for one week. Anatomical closure was 97% at six years, with partial or total recanalization in 6 cases (2.8%). The CIVIQ-14 Score results show great improvement (94%).CONCLUSIONS: MOCA with Clarivein® catheter of the GSV is an excellent alternative for the management of SF reflux that does not require tumescence anesthesia and eliminates the risk of thrombosis or burn from thermal methods. The patient immediately returns to his or her usual work and the obliteration rates found are like those of other methods.