In July 2013, the National Institute of Health and Clinical Excellence (NICE) recommended “endothermal” ablation (meaning endovenous thermal ablation) is the first line treatment for truncal venous reflux in varicose veins. The initial endovenous thermoablation devices were radiofrequency ablation and endovenous laser ablation. More recently, Glue (cyanoacrylate), endovenous steam and Clarivein (mechanochemical ablation or MOCA) have entered the market as new endovenous techniques for the treatment of varicose veins. Glue and Clarivein do not require tumescent anaesthesia and do not use heat and therefore termed non-tumescent non-thermal (NTNT). Steam both requires tumescence and is also a thermal technique (TT). This article reviews the current position of these 3 new technologies in the treatment of varicose veins.
Varicose veins in the legs: The diagnosis and management of varicose veins. National Institute of health and care excellence (NICE) CG 168, https://www.nice.org.uk/guidance/cg168 (accessed 1 March 2015).
2.
CarrollSEAmacherALPatersonJC. The results of using methyl 2-cyanoacrylate monomer in experimental surgery. Can J Surg1966; 9: 435–444.
3.
GyurkóGBornemiszaGFurkaI. Experience with tissue adhesives in 500 experimental vascular junctions. Am Surg1974; 40: 210–215.
4.
ZanettiPHShermanFE. Experimental evaluation of a tissue adhesive as an agent for the treatment of aneurysms and arteriovenous anomalies. J Neurosurg1972; 36: 72–79.
5.
KerberC. Experimental arteriovenous fistula. Creation and percutaneous catherter obstruction with cyanoacrylate. Invest Radiol1975; 10: 10–17.
6.
LunderquistABörjessonBOwmanT. Isobutyl 2-cyanoacrylate (bucrylate) in obliteration of gastric coronary vein and esophageal varices. AJR Am J Roentgenol1978; 130: 1–6.
7.
MaleuxGStockxLWilmsG. Ovarian vein embolization for the treatment of pelvic congestion syndrome: long-term technical and clinical results. J Vasc Interv Radiol2000; 11: 859–864.
8.
MinRJAlmeidaJIMcLeanDJ. Novel vein closure procedure using a proprietary cyanoacrylate adhesive: 30-day swine model results. Phlebology2012; 27: 398–403.
9.
AlmeidaJIMinRJRaabeR. Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results. Vasc Endovasc Surg2011; 45: 631–635.
10.
WhiteleyMSHoldstockJPercutaneous radiofrequency ablations of Varicose Veins (VNUS Closure). In: GreenhalghRoger M (eds). Vascular and endovascular challenges, London: BibaPublishing, 2004, pp. 361–381.
11.
Almeida JI, Javier JJ, Mackay EG, et al. Two-year follow-up of first human use of cyanoacrylate adhesive for treatment of saphenous vein incompetence. Phlebology 2014, Epub, DOI: 10.1177/0268355514532455.
12.
ProebstleTMAlmJDimitriS. The European multicenter cohort study on cyanoacrylate embolization of refluxing great saphenous veins. J Vasc Surg: Venous Lym Dis2015; 3: 2–7.
ToonderIMLamYLLawsonJ. Cyanoacrylate adhesive perforator embolization (CAPE) of incompetent perforating veins of the leg, a feasibility study. Phlebology2014; 29: 49–54.
15.
van den BosRRMilleretRNeumannM. Proof-of-principle study of steam ablation as novel thermal therapy for saphenous varicose veins. J Vasc Surg2011; 53: 181–186.
16.
ProebstleTMMoehlerTGülD. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg2005; 31: 1678–1683.
17.
ThomisSVerbrugghePMilleretR. Steam ablation versus radiofrequency and laser ablation: an in vivo histological comparative trial. Eur J Vasc Endovasc Surg2013; 46: 378–382.
18.
MlosekRKWoźniakWGruszeckiL. The use of a novel method of endovenous steam ablation in treatment of great saphenous vein insufficiency: own experiences. Phlebology2014; 29: 58–65.
19.
MilleretRHuotLNicoliniP. Great saphenous vein ablation with steam injection: results of a multicentre study. Eur J Vasc Endovasc Surg2013; 45: 391–396.
20.
van den BosRRMalskatWSDe MaeseneerMG. Randomized clinical trial of endovenous laser ablation versus steam ablation (LAST trial) for great saphenous varicose veins. Br J Surg2014; 101: 1077–1083.
21.
KendlerMAverbeckMSimonJC. Histology of saphenous veins after treatment with the ClariVein® device - an ex-vivo experiment. J Dtsch Dermatol Ges2013; 11: 348–352.
22.
TalMGDos SantosSJMaranoJP. Histologic findings after mechanochemical ablation in a caprine model with use of ClariVein. J Vasc Surg: Venous Lym Dis2015; 3: 81–85.
23.
Lee C, Li JM and Whiteley MS. Mechanochemical Ablation (MOCA®) increases endothelial damage and penetration of damage into the media layer of the vein wall compared to sclerotherapy alone - a study using histology and immunohistochemistry. Presented at: American College of Phlebology, Phoenix, November 2014.
24.
van EekerenRRHillebrandsJLvan der SlootK. Histological observations one year after mechanochemical endovenous ablation of the great saphenous vein. J Endovasc Ther2014; 21: 429–433.
25.
EliasSRainesJK. Mechanochemical tumescentless endovenous ablation: final results of the initial clinical trial. Phlebology2012; 27: 67–72.
26.
Vun S, Rashid S, Blest N, et al. Lower pain and faster treatment with mechanico-chemical endovenous ablation using ClariVein®. Phlebology 2014, Epub, DOI: 10.1177/0268355514553693.
27.
Bootun R, Lane T, Dharmarajah B, et al. Intra-procedural pain score in a randomised controlled trial comparing mechanochemical ablation to radiofrequency ablation: The Multicentre Venefit™ versus ClariVein® for varicose veins trial. Phlebology 2014, Epub, DOI: 10.1177/0268355514551085.
28.
BishawiMBernsteinRBoterM. Mechanochemical ablation in patients with chronic venous disease: A prospective multicenter report. Phlebology2013; 29: 397–400.
29.
BoersmaDvan EekerenRRWersonDA. Mechanochemical endovenous ablation of small saphenous vein insufficiency using the ClariVein® device: one-year results of a prospective series. Eur J Vasc Endovasc Surg2013; 45: 299–303.
30.
SullivanLPQuachGChapmanT. Retrograde mechanico-chemical endovenous ablation of infrageniculate great saphenous vein for persistent venous stasis ulcers. Phlebology2014; 29: 654–657.
31.
MooreHMLaneTRFranklinIJ. Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer. Vascular2014; 22: 375–357.
