A Modiied 3-Way Tap to Enhance the Stability and Uniformity of Sclerosant Foam.

BACKGROUND: The Tessari method, mixing air with the sclerosant through a 3-way tap and 2 syringes, is the most widely used method to prepare foam in foam sclerotherapy. Uniform foam with smaller bubbles has great clinical significance for venous insufficiency. We aim to modify the traditional 3-way tap to produce more uniform and stable foam with smaller bubbles. METHODS: The traditional 3-way tap was modified by inserting a porous film within its channel. EXPERIMENT DESIGN: the foam was prepared with 2 mL polidocanol plus 8 mL air plus 0.05 mL hyaluronic acid; group 1, foam prepared with 20 quick passes through a traditional 3-way tap; and groups 2-7, foam prepared using the modified 3-way tap, with 10, 12, 14, 16, 18, and 20 quick passes, respectively. The uniformity of the foam was observed under optical microscopy, and the size of bubbles quantified using the Nano measurement software. The stability of the foam was evaluated using the foam half-life time. RESULTS: The foam half-life times of groups 1-7 were 306.4, 257.4, 285.6, 304.4, 318.6, 330.2, 331.3 sec, respectively. The modified tap also produced a more uniform distribution of smaller bubbles (group 7) compared with traditional tap (group 1). CONCLUSIONS: Modified 3-way tap enhanced the stability of the sclerosant foam, with a more uniform distribution of smaller bubbles.

The V-Block Occlusion Stent and Sclerotherapy Device for Varicose Vein Treatment: A Retrospective Analysis.

BACKGROUND: The procedure aims to show our results with a novel nontumescent, nonthermal technique to treat varicose veins. The V-block occlusion stent is a minimally invasive device for treating reflux of the great saphenous vein (GSV). It is an office-based procedure that does not require tumescence anesthesia. The V-block stent is a self-expandable device that functions as a vein occluder and blood clot trap. Once the V-block is in place, further treatment of the saphenous vein such as ultrasound-guided sclerotherapy can be performed. The V-block device is intended to eliminate the possibility of forwarding passage of clot and sclerosant (embolization) to the deep and pulmonary circulations. METHODS: Patients were treated in an outpatient setting with the V-block occluding device. Follow-up was performed using duplex ultrasound to assess occlusion of the saphenous vein as well as the Aberdeen Varicose Vein Questionnaire and Venous Severity Scoring to determine changes in quality of life after the procedure. Patients were followed up at 1 week, 1 month, and 3 months after V-block placement. Duplex scanning was performed to confirm GSV occlusion at all follow-up visits. After deployment of the occlusion stent, a maximum of 2% polidocanol foam was injected with a double barrel syringe which simultaneously evacuated blood from the greater saphenous vein. Follow-up assessment for safety included evaluation of potential complications, device migration, and potential injury at the deployment site. RESULTS: Fifty-one symptomatic subjects with documented GSV reflux were enrolled in the study. Complete occlusion of the GSV was achieved in 98% of the patients during the 7-day postprocedural visit. There was no injury at the deployment site. No migration of the V-block device was observed. No deep vein thrombosis or any other complication was recorded. One patient of the 50 patients and 51 procedures experienced an adverse event, phlebitis that resolved under conservative therapy within 4 days with no residual effect. There was a significant improvement in the Aberdeen Vein quality of life measurements and the pain scores. After 3 years, 18 patients were willing to undergo a duplex follow-up examination. The occlusion rate after 3 years was 77.8. There were no device-related complications after this period. CONCLUSIONS: The study demonstrated a good safety and performance profile without any major adverse events. The primary end point of vein occlusion and obliteration was met.

Catheter-directed Sclerotherapy for Ovarian Endometrioma: Short-term Outcomes.

Purpose To evaluate the effectiveness of catheter-directed sclerotherapy (CDS) with 95% ethanol in patients with primary or recurrent ovarian endometriomas. Materials and Methods In this prospective study, 14 participants (mean age, 32 years; range, 20-44 years) who underwent CDS for ovarian endometrioma from March 2015 to December 2017 were evaluated. Diagnosis was based on symptoms and imaging studies. To assess the impact of CDS on ovarian reserve, serum anti-Müllerian hormone (AMH) was measured before CDS and 6 months after CDS. Serum cancer antigen 125 (CA-125) levels were also measured at the same time points. Follow-up US was performed 1, 3, and 6 months after CDS and biannually thereafter to monitor potential cyst size change and recurrence. Comparison of AMH, CA-125, and cyst size before and after CDS was performed by using the paired t test or Wilcoxon signed-rank test. Results Mean endometrioma size decreased from 5.8 cm ± 2.2 to 1.1 cm ± 1 (P ˂ .001). During a mean follow-up of 12.7 months (range, 6.1-23.0 months), there were no recurrences of endometrioma. Pain was relieved in all participants, with a decrease in serum CA-125 level (P = .001). There was no difference in serum AMH level before and 6 months after CDS, indicating well-preserved ovarian function (4.29 ng/mL ± 2.47 vs 4.36 ng/mL ± 1.94, respectively; P > .875). There were no procedure-related complications. Conclusion Catheter-based sclerotherapy with 95% ethanol can lead to better short-term clinical outcomes and well-preserved ovarian function for patients with endometriomas. © RSNA, 2018.

Role of dual red imaging to guide intravariceal sclerotherapy injection of esophageal varices (with videos).

BACKGROUND AND AIMS: Dual red imaging (DRI) is a novel image-enhanced endoscopy technique that can increase the visibility and predict the depth of esophageal varices (EVs). The recurrence rate of EVs after endoscopic injection sclerotherapy (EIS) reportedly decreases by intravariceal injection of a sclerosant. We evaluated prospectively whether the EIS success rate was increased by DRI compared with the white-light imaging (WLI) mode. METHODS: A total of 79 patients with EVs were randomly divided into the DRI (n = 40) and WLI (n = 39) groups. The primary endpoint was the success rate of intravariceal injection on the first EIS puncture. The secondary endpoint was the recurrence rate. A variable puncture needle was used, and the length was adjusted according to the EV visibility change by DRI. In the WLI group, DRI was not used. RESULTS: The success rate of the first puncture was significantly higher in the DRI group than in the WLI group (80.0% vs 46.2%; P = .0018). The cumulative recurrence rate was significantly lower in the DRI group (P = .031). The sum of the depth and luminal diameter of EVs was investigated by EUS. The Pearson correlation coefficient between this value and the needle length was higher in the DRI group than in the WLI group (r = 0.878 vs 0.603). CONCLUSIONS: DRI increased the EIS success rate and decreased the recurrence rate. This resulted from the puncture needle adjustment to the appropriate length via EV depth prediction by DRI.

Influence of Syringe Volume on Foam Stability in Sclerotherapy for Varicose Vein Treatment.

BACKGROUND: Despite the popularity of sclerotherapy for treating varicose veins, it still exhibits various problems, such as pulmonary embolism, deep-vein thrombosis, phlebitis, and visual disorders. OBJECTIVE: To investigate syringe volume influence on foam stability, obtain the foam decay rule, and provide a reference for clinics. MATERIALS AND METHODS: Five types of syringes are used to prepare foam at room temperature with various liquid-gas ratios. Foam decay process experiments were performed 5 times and recorded by video. The stability indices used include drainage time, half-life, bubble diameter, bubble surface density, and drainage rate. RESULTS: The 30 and 2-mL syringes, respectively, recorded the highest and lowest drainage speeds. Foam drainage time and half-life, differences varied between 15 and 70 seconds, and 20 and 100 seconds, respectively. Foam bubble diameters were distributed over 0.1 to 2.0 mm with roughly 200 to 700 bubbles per square centimeter. CONCLUSION: Increased syringe volume causes the bubble diameter to increase. Thus, foam dispersion increases and foam half-life decreases; hence, foam becomes unstable. It is, thus, better to use a small syringe several times to prepare foam in clinics using segmented injections.

[Cryocompression sclerotherapy of reticular veins and teleangiectasias]. / Kriokompressionnaia skleroterapiia retikuliarnykh ven i teleangioéktazov.

Compression serves as an important component for carrying out successful and safe phlebosclerosing treatment. At the same time, the necessity of wearing compression hosiery or bandages is associated with known limitations and objections of patients, especially in a hot season. We comparatively assessed efficacy of usual compression stockings and a short-term pneumatic bandage with cryoelements while carrying out sclerosing treatment of dilated intradermal veins. Our open prospective observational study included a total of fifty 18-to-35-year-old women. After performing standardized sclerotherapy of reticular veins and telangiectasias on the symmetrical portions of the lower limbs, a pneumatic cryocompression bandage with a pressure of 50 mmHg was applied onto one of the limbs for 15 minutes, with a class 2 compression (RAL standard) medical stocking put on the other limb to be worn by the patients at daytime for 10 days. We assessed completeness of obliteration of the target veins, frequency of the development of typical undesirable events (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as the composite discomfort score according to an 11-point visual analogue scale. It was determined that using the pneumatic bandage with cryoelements as compared with the traditional compression stockings significantly decreased the frequency of the development of typical undesirable events after phlebosclerosing treatment, such as formation of ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis. Significance of differences was revealed as early as 7 days after sclerotherapy, to be increasing during further dynamic follow up. By convenience for the patients, the use of the short-term pneumatic cryobandage was four times better than wearing the compression stockings. A conclusion was drawn that while carrying out sclerotherapy of reticular veins and telangiectasias short-term pneumatic cryocompression by efficacy and safety was not inferior to the traditional medical stockings (RAL standard) and made it possible to significantly decrease the incidence of the known undesirable events after phlebosclerosing treatment.

[Development of Automatic Preparation Device of Sclerosing Foam Based on Tessari Method].

Based on the principle of manual preparation of sclerosing foam with Tessari method,using the analysis of user requirements and combining it with theory of mechanics,we designed an automatic equipment.The device could be used to replace the manual operation,and could overcome the shortcomings of manual sclerosing foam preparation,such as the difficulty in controlling of pushing speed and stroke and poor reproducibility.This automatic device has the functions of adjustable pushing speed,pushing frequency,pushing stroke and is suitable for a variety of different types of syringes.It can not only provide quantitative parameters for the study of foam properties,but also be used for the standardization of clinical sclerosing foam.The experimental study on"the effect of pushing speed on the stability of foam"was carried out with using the device,and the experimental results were quite satisfactory.

Mechanochemical Endovenous Occlusion of Varicose Veins Using the ClariVein® Device.

INTRODUCTION: In the last decade, minimally invasive endothermal ablation techniques have replaced surgery for the treatment of superficial venous insufficiency to reduce postoperative complications and recovery time and to improve quality of life. To avoid the risks of nerve damage and need for tumescent anesthesia to improve patient comfort, an alternative heatless technique has been introduced recently. METHODS: Endovenous mechanochemical occlusion using the ClariVein® catheter (Vascular Insights LLC, Quincy, MA) is a new technique combining mechanical injury to the venous endothelium coupled with simultaneous catheter-guided infusion of a liquid sclerosant. This produces irreversible damage to the endothelium resulting in fibrosis of the vein. RESULTS: The technique is related to a low complication rate and a success rate of 96% at two years and sustained quality of life improvement. This closure rate is comparable to endothermal techniques, but significantly less postoperative pain and earlier return to normal activities and work has been reported with endovenous mechanochemical occlusion. CONCLUSION: Mechanochemical occlusion using ClariVein® has proven to be safe and effective and has several advantages compared to endothermal techniques. The possibility of retrograde ablation of distal SSV insufficiency in C6 ulceration is considered a significant advantage. Randomized comparative studies with long-term follow up will continue to define the definite place of mechanochemical occlusion.

[COMPARISON OF INTRAOPERATIVE SCLEROOBLITERATION AND ECHOSCLEROOBLITERATION EFFICIENCY OF VARICOSE DISEASES OF THE LOWER EXTREMITIES C6 CLASS IN PATIENTS BY TYPE II DIABETES MELLITUS].

The experience of surgical treatment of 50 patients for varicose disease of lower extremities, complicated by trophic ulcers, in the presence of diabetes mellitus type II were analysed. During surgery in patients of the 1st group performed a combined phlebectomy, group 2--scleroobliteration and echoscleroobliteration. Using fleboscleroobliteration method helped reduce the frequency of early postoperative complications in (6.5 +/- 1.3) times.

Devices for the endoscopic treatment of hemorrhoids.

Multiple endoscopic methods are available to treat symptomatic internal hemorrhoids. Because of its low cost, ease of use, low rate of adverse events, and relative effectiveness, RBL is currently the most widely used technique.

Low temperature offers better foam stability.

BACKGROUND: The foam's structural longevity, linked to the effectiveness of sclerotherapy, depends on preparation conditions. The factors enhancing the treatment's effectiveness and efficacy are still under discussion. METHODS: We conducted an in vitro preclinical research, which included 144 independent trials. A total of 8 combinations involving 18 trials were designed according to settings of +4°C and room temperature (20-22°C), liquid-to-air ratios of 1/1 and 1/4, and polidocanol concentrations of 0.5% and 1% using the modified Tessari method. Our study aimed to examine the effect of air ratio, agent temperature, and polidocanol concentration on stability by assessing the foam half-time (FHT) and defining the optimal preparation conditions. RESULTS: The mean FHT was 117 ± 30.4 s. The longest FHT was in a 1:4 air-to-sclerosant ratio at +4°C, regardless of the sclerosant concentration (for %0.5 mean FHT: 146.2 ± 13.9 s, for % 1 mean FHT: 146.9 ± 18 s). There was a significant interaction among the three variables on FHT (p = 0.001). Temperature emerged as the primary factor (F(1, 136) = 124, p < 0.001, ηp2 = 0.477), with lower temperatures markedly enhancing the longevity (p < 0.001). Preparation at a temperature of 4°C resulted in an extended FHT of 32.5 s compared to 22°C (95% CI: 24.06-41.04 s). CONCLUSION: The temperature, agent concentration, and gas ratio significantly influence the stability of the physician-compounded foam. The low temperature at +4°C may offer better FHT for sclerotherapy.

Three-dimensional power Doppler transanal ultrasonography, to monitor haemorrhoidal blood flow after Doppler-guided ALTA sclerosing therapy.

AIM: The study aimed to use power Doppler imaging (PDI) transanal ultrasonography to produce three-dimensional power Doppler angiography images of haemorrhoidal tissue and to monitor the effects of Doppler-guided aluminium potassium sulfate and tannic acid (DGALTA) sclerotherapy. METHOD: Ninety-six haemorrhoids in 43 patients were examined using PDI transanal ultrasonography, and DGALTA sclerotherapy was performed from April 2011 to April 2012. DGALTA sclerotherapy was conducted using a four-step injection process with pulse wave Doppler ultrasound under perianal local anaesthesia. RESULTS: A three-dimensional power Doppler angiography image of the blood flow in haemorrhoidal tissue was produced using PDI transanal ultrasonography. The cross-sectional area of blood flow in the haemorrhoidal tissue (PDI area) significantly decreased after DGALTA sclerotherapy. The PDI areas in the preoperative state and 1 and 3 months after treatment were 0.35±0.27, 0.03±0.05 and 0.04±0.05 cm(2) (P<0.0001). CONCLUSION: A three-dimensional power Doppler angiography image of the haemorrhoidal tissue was technically possible and showed blood flow in the haemorrhoidal tissue to be significantly decreased after DGALTA sclerotherapy.

Histology of saphenous veins after treatment with the ClariVein® device - an ex-vivo experiment.

BACKGROUND: Endovenous treatment modalities are used increasingly to treat varicose veins. The ClariVein® catheter is a new endoluminal mechanico-chemical obliteration technique which can be used without tumescent anesthesia. It is still unclear what changes the mechanical tip of the catheter has on the walls of the vein. PATIENTS AND METHODS: Five great saphenous vein specimens were obtained atraumatically by crossectomy. Then the veins were treated ex vivo with the ClariVein® catheter without sclerotherapy. The activated catheter rotating tip (3 500 U/min) was steadily withdrawn at 1-2 mm per second. Subsequently, histological and immunohistochemical investigations of treated (cv) and untreated specimens (plain) were performed. A 4-point score was calculated to compare the results. RESULTS: The mechanical part of the catheter caused a subtle incomplete destruction of the endothelium (endothelium cv: 2.2 vs. plain: 1, p = 0.04). Changes in the media or adventitia were not seen. Immunohistochemical presentation of the endothelium of the intima was demonstrated with antibodies against CD31 (cv: 3.4 vs. plain: 2.8), CD34 (cv: 3.8 vs. plain: 3.2) and factor VIII (cv: 2.2 vs. plain: 1, p = 0,004). CONCLUSIONS: The mechanical part of the ClariVein® catheter caused a subtle incomplete destruction of endothelium, which was confirmed histologically and immunohistochemically. The reduced expression of factor VIII in the treated vein could be caused by the release of preformed factor VIII granules due to the minimal mechanical irritation.

[Obstructive scleroobliteration as atreatment of varicocele].

Authors developed and used the method of obstructive scleroobliteration with use of occlusive balloon catheter as a treatment for 32 patients. Advantages of this method: 1. Possibility of scleroobliteration in isolated area of the left internal testicular vein and its branches. 2 Improvement of sclerosant influence on venous wall by means of aspiration of blood and contrast agent of blocked vein. 3. Decrease of contrast agent by means of it aspiration after performed phlebography. 4. Prophylaxis of negative effect (allergy, thrombotic complications) of sclerosant by means of it partial aspiration and extravasal compression of proximal part of vein. 5. No late relapse. This method allow to perform an effective scleroobliteration with exclusion of testicular vein and venous collateral without special technical skills and cost increase. Aspiration of sclerosant in a lumen of vein allows to decrease the amount of surgical complications.

Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study.

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.

An investigation into the influence of various gases and concentrations of sclerosants on foam stability.

BACKGROUND: Foam sclerotherapy is an increasingly popular modality in varicose vein treatment. Our previous work showed that the half-life of room air foam varied according to the percentage and type of sclerosant solution. MATERIALS AND METHODS: A plastic connector was used to create foam made from a combination of 0.25%, 0.50%, and 1% sodium tetradecyl sulfate (STS) and room air, carbon dioxide (CO(2)), oxygen (O(2)), or a mixture of CO(2) and O(2). To measure foam stability, the foam half-life was defined as the time it took for half the original volume of sclerosing solution to settle. RESULTS: Half-life varied according to sclerosant concentration when room air, O(2), or a mixture of CO(2) and O(2) was used for foam creation but not when CO(2) was used. Room air foam is more than 3 times as stable as CO(2) foam and 1.5 times as stable as a mixture of CO(2) and O(2). CONCLUSIONS: CO(2) foam half-life did not vary according to sclerosant solution concentration, though room air, O(2) , and CO(2)/O(2) did. The half-life of room air foam is more than 3 times as long as that of CO(2) and 1.5 times as long as that of a mixture of CO(2) and O(2). Foam half-life for room air and O(2) are similar at low concentrations of STS but differ at higher concentrations.

Percutaneous alcohol sclerotherapy of a hepatic hydatid cyst after balloon occlusion of a large biliary communication.

OBJECTIVE: To present a case of hepatic hydatid cyst with a biliary communication that was not suitable for surgery and hence necessitated sclerotherapy with absolute alcohol after occluding the biliary communication with a balloon catheter. CLINICAL PRESENTATION AND INTERVENTION: A 50-year-old Asian man presented to the surgical emergency department with a 1-year history of repeated attacks of obstructive jaundice and right hypochondrial pain. Ultrasound and contrast computed tomography revealed a cyst, and endoscopic retrograde cholangiopancreatography and cystography revealed a biliocystic communication. An indirect hemagglutination test for echinococcosis showed the presence of antibodies to Echinococcus species at a titer of 8 establishing the diagnosis of hydatid cyst. Although surgery is the accepted modality of treatment in these cases, the patient was deemed unfit for surgery due to his underlying cardiac problem. While percutaneous treatment with absolute alcohol is contraindicated in his case, it was successfully attempted after balloon occlusion of the biliocystic communication. CONCLUSION: This case showed that in this patient with hepatic hydatid disease and biliocystic communication, who was not fit for surgery, percutaneous sclerotherapy with absolute alcohol after balloon occlusion was successfully performed by an interventional radiologist.

Side effects of endoscopic variceal ligation by using Indonesian Endoscopic Ligator versus Endoscopic Variceal Sclerotherapy.

AIM: to investigate the side effects and survival of endoscopic variceal ligation by using Indonesian Endoscopic Ligator versus Endoscopic Variceal Sclerotherapy. METHODS: we studied the medical records and endoscopy reports of patients who underwent endoscopic variceal ligation (EVL) or endoscopic sclerotherapy (EST) from January 2003 until December 2006. EST was done using ethoxysclerol injection; and ligation was done using a home-made Indonesian endoscopic ligating device. Patient characteristics, side effects of EVL and EST, as well as survival and length of stay were collected. Data of side effects was analyzed by chi-square test. RESULTS: there were no statistically significant differences of patients characteristics among both groups. The side effects in EVL group (29.2%) were less frequent than the EST group (60.9%) (p = 0.009). The death side effect in the EVL group (1.0%) was less frequent than in the EST group (21.7%) (p<0.001). The four-year survival in patients who had EVL and EST were 91.7% and 16.7%, respectively (p<0.001). CONCLUSION: EVL had fewer side effects than EST in the treatment of esophageal varices bleeding. Death in the EVL group was lower than in the EST group.

Transparent cap-assisted endoscopic injection sclerotherapy for the treatment of patients with esophageal varices.

The aim of this study was to compare the efficacy and safety of cap-assisted endoscopic injection sclerotherapy (EIS) versus direct EIS in the management of esophageal variceal bleeding in patients with cirrhosis.This retrospective study included patients with cirrhosis and esophageal variceal bleeding who underwent EIS with or without the use of a transparent cap at Shandong Provincial Hospital between December 2014 and April 2017. Patients were divided into two groups: Group A (EIS with transparent cap, n = 50) and Group B (direct EIS, n = 45). Data collected included patients' demographics, procedure details, and rates of variceal eradication, variceal rebleeding, variceal recurrence, and survival during the follow-up period. All data were expressed as mean ±â€ŠSD. Quantitative variables were compared with Student t test; qualitative variables were compared with the Fisher exact test or chi-square test. P values less than .05 were considered significant.The mean follow-up duration was similar in both groups (16.3 ±â€Š10.2 mo in Group A and 15.5 ±â€Š9.5 mo in Group B). The volume of sclerosant (64.86 ±â€Š10.62 vs 104.73 ±â€Š21.25 ml, P = .044), mean number of sessions (2.37 ±â€Š1.15 vs 5.70 ±â€Š1.57, P = .042), time required to perform endoscopic treatment (6.57 ±â€Š1.50 vs 11.22 ±â€Š2.29 minutes, P = .049), and time to initial esophageal varices eradication (5.43 ±â€Š1.38 vs 8.93 ±â€Š1.5 wk, P = .041) were significantly smaller in the cap-assisted EIS group than in the direct EIS group. The probability of variceal recurrence and rebleeding was significantly higher in the direct EIS group than in the cap-assisted EIS group (14% versus 35.6% and 20% versus 40%). Only 22 patients (44%) developed complications in the cap-assisted group versus 30 patients (66.7%) in the EIS group (P = .039). The probability of survival was similar in both groups (86% versus 75.6%, P = .133).Modified EIS with the use of a transparent cap resulted in lower rates of esophageal variceal recurrence, rebleeding, and complications, compared with direct EIS.

An Italian experience with mechanochemical ablation of the saphenous vein since 2012.

OBJECTIVE: Mechanochemical endovenous ablation is a nonthermal method to ablate superficial incompetent veins. The aim of this paper was to assess short-term complications and 5-year follow-up outcomes. METHODS: This is a retrospective single-center study of data collected prospectively. We treated, in an outpatient setting, 395 primary, symptomatic, unilateral, incompetent varicose saphenous veins. No patients were treated bilaterally in the same session. The majority were great saphenous veins (92.3%), and the others were small saphenous veins. Procedures were performed with a mechanochemical endovenous occlusion catheter (ClariVein endovenous occlusion catheter; Merit Medical, South Jordan, Utah) and polidocanol 2% in liquid form. RESULTS: Follow-up was available for 329 patients treated between September 2012 and September 2017 with a mean follow-up time of 20 ± 18 months (range, 6-60 months). Technical success was achieved in 99.5%; in two patients, we were unable to complete the procedures because of vein spasm leading to catheter damage and inability to infuse the sclerosant. Follow-up was performed with clinical evaluation and duplex ultrasound scan at 1 week, 1 month, 6 months, and 1 year and then once every year. The overall survival rate free from recanalization was 92.4%. Anatomic success is 94% at 1 year, 91% at 2 years, 88% at 3 years, 88% at 4 years, and 84% at 5 years. The follow-up at 5 years includes 23 patients, 5 of whom presented with recanalization; moreover, in this series, in 36% of cases, the veins completely disappeared on duplex ultrasound scan. CONCLUSIONS: The ClariVein catheter is associated with a good occlusion rate, comparable with other techniques including thermal techniques, without major complications.