MECHANO-CHEMICAL ABLATION (MOCA, CLARIVEIN) – IN EASTERN EUROPE ONLY AVAILABLE IN OUR HEALTH CENTRE!
The new procedure, developed in the United States in 2009, combines two methods. One of them is the catheter form of sclerotherapy well-known and used for many years, the other is a mechanical ablation performed with a special catheter. The advantage of this hybrid method is the penetration to the vein through the skin, the endovenous (inside the vein) treatment, the minimal local anaesthesia used only on the area of the penetration (no need for anaesthesia) and the short operation time. As there is no heat effect during the operation, the chances of nerve injury are reduced to the minimum.
During the mechano-chemical method a superficial injury is caused with a thin wire at a high speed (3500 turns/minute) on the inner surface of the vein thus the delivered sclerosing solution can be much more effective. During the procedure the sclerosing solution is injected to the lumen of the vein through the opening of the catheter close to the revolving wire (the same material is used to treat the smaller veins). The mechanic and chemical effect together result in the closing of the treated vein with the same efficiency as in endothermal ablations. The entire device is a 1.3 mm-diameter disposable catheter.
After washing the surgical area with an antiseptic solution and sterile isolating it, the ClariVein catheter is inserted to the lumen of the main vein trunk and led to the afflux in the groin or popliteal. A vein with a maximum 12 mm diameter can be treated with this method. We determine the starting point of the treatment and position the catheter onto it. The treatment is performed top down slowly pulling back the ClariVein catheter with sclerotherapy going on, under ultrasound. After treating the main vein trunk and a prior consultation, the treatment of the side branches may also be performed in one session with microsurgery method, in local anaesthesia, through a needle stick with a small hook. The advantage of the latter method is that no broad veins remain winding under the skin, they do not cause a 3-6 month inconvenience and irritating bundles after the operation. The immediate treatment of minor side branches is not required, their spontaneous withdrawal can be expected, and the remaining side branches can be removed with sclerotherapy after 10-12 weeks.
At the end of the surgery the feet shall be actively moved, and then 2nd degree compression stockings are applied to the limb. This aims at compressing the treated varicose vein trunk for rapid and effective healing and preventing the possible emergence of haematomas. Patients can get up right after the operation and shall walk for about half an hour. Subsequently we control them and they are allowed to leave for their homes and return to daily activities. Compression is required for 48 hours day and night (may be taken off during showers), then wearing them is recommended for two weeks along normal daily routine. 1-2 frequent 10-minute walks are recommended every day. Control examinations are performed in a week, then in one, three and six months following the procedure.
Based on recent clinical studies (Elias, USA; de Vries, the Netherlands and Mueller, USA) ClariVein surgical procedures are entirely safe, no complications have been noted during the operations, only minimal bleeding around the treated vein has been observed, however, it has not caused complaints or pain to the patient and absorbed within a few days. There has been an inflammation in the side branches of the treated vein trunk (8%) which only required taking a minimal amount of painkillers beside the applied compression and healed spontaneously. Based on several examinations the occlusion rate was over 90% which is the same as the results achieved with other methods. Currently more than 25 000 patients have been treated with this method worldwide and due to its advantages it is becoming more and more popular. In Hungary – and all over Eastern Europe – ClariVein operations are only available at us, its safety is guaranteed by both the special training and the experience gained during previous operations.
VEIN BLOCKING WITH TISSUE GLUE (VENASEAL, SAPHEON) – AVAILBALE FROM 2015
Cyanoacrylate has long been used as tissue glue; it is part of the surgical procedures in many fields of surgery. Cyanoacrylate monomers are clean, colourless, low density liquids that rapidly disperse or immediately polymerize when contacting the negative anions of water or blood. If cyanoacrylate contacts blood or plasma, strong glue is formed. The polymerisation of the material causes a minimum damage on the inner surface of the vein and induces immune response. The adhesive n-butil cyanoacrylate with a small amount of bio-compatible additive, which slows polymerisation and increases viscosity and forms flexible glue, was developed by Sapheon particularly for varicose vein operations.
Its introduction to varicose vein dilation treatment began two years ago when a catheter was successfully developed with which the glue can be delivered to the desired location in the long vein trunk. The glue itself is a well-known and widely used cyanoacrylate, in this case special version of it which polymerize when contacting liquid and then produces its effect. The Sapheon cyanoacrylate is a form modified with a biocompatible additive and has higher viscosity, slower polymerization and forms flexible glue for greater safety. Based on clinical examination the glue injected into the body is absolutely safe and non-toxic.
After washing the surgical area with an antiseptic solution and sterile isolating it, with the help of ultrasound on the ankle or leg are a guide wire is lead to the lumen of the main vein trunk and is lead it to the afflux in the groin or popliteal. We determine the starting point of the VenaSeal treatment and lead the catheter to this point. We prepare and draw the glue, then fill the catheter with the adhesive material. For total safety the gluing begins 5 centimetres before the afflux, the polymerization takes half a minute on the 3-cm sections. Wearing compression stockings or elastic bandages is not required after the procedure, patients can immediately return to their normal activity. Most of the possibly dilated side branches spontaneously withdraw, if a treatment is still needed, it can be performed with sclerotherapy in 10-12 weeks.
Based on recent clinical studies (Almeida, USA, E-Scope, 7 European centres, Lawson, the Netherlands and Zierau, Germany) VenaSeal operation is completely safe, no severe complications have been observed during the procedures. During the examinations inflammatory reaction in 15% of the cases has been observed along the treated vein, which spontaneously healed when applying compression treatment. On the basis of the examinations the occlusion rate was over 92% which is the same as the results using other methods. Currently about 2000 patients are being treated with this method worldwide, its advantage is the totally painless operation and the instant mobility. In Hungary – and all over Eastern Europe – VenaSeal operations will be available from 2015, its safety is guaranteed by both the special training and the experience gained during previous operations.
Mire kell ügyelni a mechano-kémiai (MOCA, ClariVein) műtét után?
A MOCA műtét után a beteg azonnal felkelhet, és mintegy 10 percet kell hogy sétáljon, hogy a mélyvénás rendszerbe esetlegesen bekerülő kémiai anyag szövődményt, trombózist ne okozhasson, és az ilyen módon gyorsan kimosódjon a szervezetből. Ezt követően sebészi kontroll után otthonába távozhat. Trombózis megelőzésére 5 napig véralvadás-gátló injekciós kezelés javasolt. Otthonában szabadon mozoghat, még aznap zuhanyozhat, II. fokozatú kompressziós harisnya viselése 48 óráig folyamatosan, majd még 2-3 hétig nappal javasolt. A műtét után visszatérhet a szokásos mindennapi tevékenységéhez, azonban a tartós eredmény érdekében egy hétig nehéz fizikai munkát ne végezzen. Reakciómentes műtéti terület, panaszmentesség esetén egy hét után a sportolás is elkezdhető.
WHY SHOULD WE CHOOSE MODERN VARICOSE VEIN PROCEDURES?
During traditional varicose vein surgery few surgical incisions are made to expose to the main vein trunks (great saphenous vein and small saphenous vein). At the groin or the popliteal, where the blood flows into the deep vein, the side branches are tied (crossectomy), then the vein is removed with a stripper. During this procedure we cause relatively severe tissue damage and the side branches also tear which explains the significant post-operative pain and bleeding. The incision at the groin is not favourable either, because it might imply the risk of infections and encumber the daily cleaning routine. Not tying down the side branches around the junction does not increase recurrence rates; this has been proven by several examinations. Moreover, if crossectomies are performed along with modern operations (laser, radiofrequency) the re-formation of blood vessels is (neovascularization) is more likely to occur.
The minimally invasive surgical procedures without incisions, inside the vein (endovenous), have been applied for more than a decade. Based on international follow-up the efficiency of the operation and the recurrence rates are the same as the late results of the traditional varicose vein operations, however, the burden of the surgery is significantly lower, the occurrence of complications can be minimised and the improvement of life quality is clearly faster than at traditional operations. In the countries where new methods receive adequate support from insurance companies, almost exclusively the new vein surgery methods are used.
The endoluminal (laser surgery, radiofrequency ablation) surgical methods, which have spread over the past decade, apply a new, costly technique for patient comfort. The advantages of the new methods as compared to the traditional open surgical procedure:
- no surgical incision in the groin
- minimal post-operative haemorrhage among the tissues therefore minimal wound pain
- patients may get up and stand on their feet immediately after the operation, no need for hospital observation, the surgical procedures may be performed as ambulatory procedures
- the operation can be performed in local anaesthesia, no need for epidural or other anaesthesia
- due to the lack of major punctures or incisions, the aesthetical results are better
- the patient can return to work a few days after the surgical procedure, no prolonged sick-leave period
- long term results do not differ from the results of traditional operations
The disadvantage of modern surgical methods is their need for special devices and their relative expensiveness; however, these are compensated by the benefits described above. Currently the Hungarian National Health Insurance Fund Administration does not finance radiofrequency and laser interventions, therefore patients shall cover the total costs of the operation. If we not only take the price of the operation into consideration, but also the time lost at work, the discomfort and pain accompanying the operation, as well as the aesthetical results, the balance is in the favour of the modern surgical procedures.
Each varicose vein treatment is preceded by a detailed vascular surgery examination thus no subsequent complications may be caused by a wound healing disorder resulting from an undiagnosed atherosclerosis; by detecting the cause of the varicose vein disease or the chronic venous insufficiency, not only the visible skin lesion is treated but also the underlying disease
The treatment of varicose vein diseases is a complex vascular surgery task, not only cosmetology!
