O-078 - SEVEN-YEAR RESULTS OF A RANDOMIZED CONTROLLED TRIAL COMPARING MECHANOCHEMICAL AND THERMAL ABLATION IN THE TREATMENT OF INSUFFICIENT GREAT SAPHENOUS VEINS

TOPIC:
Venous Diseases (including Malformations)
AUTHORS:
Hurmerinta-Kurkijärvi O. (Helsinki University Hospital ~ Helsinki ~ Finland) , Halmesmäki K. (Helsinki University Hospital ~ Helsinki ~ Finland) , Vähä-Aho S. (Helsinki University Hospital ~ Helsinki ~ Finland) , Mahmoud O. (Helsinki University Hospital ~ Helsinki ~ Finland) , Venermo M. (Helsinki University Hospital ~ Helsinki ~ Finland)
Introduction:
Mechanochemical ablation (MOCA) is a nonthermal method of treating saphenous vein insufficiency. It combines mechanical injury to the intimal layer of the vein with chemical injury caused by sclerosant. The benefit compared to thermal ablation is that tumescent anesthesia is not needed. The feasibility and short-term results of MOCA are good, but its long-term results are unknown. A randomized controlled trial (RCT) was performed to compare MOCA with endovenous thermoablation (THA) using laser or radiofrequency ablation in the setting of unilateral great saphenous vein (GSV) insufficiency. Here we report the results of 7-year follow-up on this RCT.
Methods:
Venous outpatient clinic patients with varicose veins (CEAP class C2-C4) caused by GSV insufficiency were invited to participate in the study; in total, 132 patients met the inclusion criteria and were willing to participate. Patients were randomized to treatment (2:1:1 for MOCA, EVLA, and RFA, respectively). The state of the GSV with duplex Doppler ultrasound examination and the disease-specific quality of life were assessed at 1 month, 1 year, and 3 years and 7 years after the treatment. The results are presented comparing MOCA with THA.
Results:
When at 3-year follow up, 82% of the patients in the MOCA group has completely occluded GSV, at 7-year follow-up, this rate had fallen to 41%. The corresponding rates for patients who underwent THA at the baseline were 100% at 3 years and 63% at 7 years. Clinically relevant opening of GSV was seen in 15.4% of the patient in MOCA group and 4.9 % of the patients in THA group. These patients had either underwent redo ablation with laser of were scheduled to this procedure. GSV was open with reflux but without symptoms and no need for redo ablation in 15.4 % on the MOCA and in 4.9 % in the THA group. GSV was open without any reflux in 7.7% in the MOCA and 9.8% in the THA group.
Conclusion:
MOCA is a feasible treatment option in an outpatient setting, but its technical success rates are inferior compared with endovenous thermal ablation. In both groups, recanalization of GSV between 3 and 7 years from the procedure was relatively common, but the rate was higher in MOCA group. Majority of the patients remain asymptomatic despite recanalization of GSV.