陳建彰醫師的部落格

http://www.cvsclinic.com.tw

Mechano-Chemical Endovenous Ablation

以機械與化學方式做靜脈腔內閉合術(MOCA)

最近這一、兩年國外正在發展的靜脈曲張最新治療方式。短期報告不錯，長期報告尚未出來，本診所持續密切觀察中。以下為最近的一份短期成果報告

文章連結: http://jevtonline.org/doi/abs/10.1583/11-3394.1

Endovenous Mechanochemical Ablation of Great Saphenous Vein Incompetence Using the ClariVein Device: A Safety Study
Journal of Endovascular Therapy: June 2011, Vol. 18, No. 3, pp. 328-334

使用ClariVein裝置以血管腔內機械合併化學方式阻斷大隱靜脈逆流的報告: 安全性研究

Abstract
Purpose: To evaluate the feasibility and safety of endovenous mechanochemical ablation (MOCA) for the treatment of great saphenous vein (GSV) incompetence.

Methods: The newly developed ClariVein device uses a technique that combines mechanical endothelial damage using a rotating wire with the infusion of a liquid sclerosant. Heating of the vein and tumescent anesthesia are not required; only local anesthesia is utilized at the insertion site. In a pilot study, 30 limbs in 25 patients (18 women; mean age 52 years) with GSV incompetence were treated with MOCA using polidocanol at 2 centers. Initial technical success, complications, patient satisfaction, and classification by venous clinical severity score (VCSS) were assessed 6 weeks after the treatment.

Results: Initial technical success of MOCA was 100%. There were no major adverse events. Minor complications consisted of 9 local ecchymoses at the puncture site and superficial phlebitis that resolved within a week in 4 limbs. Duplex ultrasonography at 6 weeks showed 26 (87%) of 30 veins were completely occluded; 3 veins showed partial recanalization in the proximal (n=2) and distal GSV. One patient had full segment recanalization and was successfully retreated. The VCSS significantly improved at 6 weeks (p<0.001). Patient satisfaction was high, with a median satisfaction of 8.8 on a 0–10 scale.

Conclusion: This study showed that endovenous MOCA, using polidocanol, is feasible and safe in the treatment of GSV incompetence. Larger studies with a prolonged follow-up are indicated to prove the efficacy of this technique in terms of obliteration rates.