Columbia University and Medical Center, Englewood, NJ.
OBJECTIVES: The mechanochemical ablation catheter utilizes a liquid sclerosant (sodium tetradecyl sulfate or aethoxysclerol) and a mechanical rotating wire to accomplish occlusion of incompetent GSV or SSV. The procedure does not require tumescence and is performed with local anesthesia at the access site only. It can be characterized as mechanically enhanced sclerotherapy performed in an office setting.
METHODS: Thirty GSVs in 29 patients underwent micropuncture access with local anesthesia only in this first in man study. Through a 5 Fr. micropuncture sheath the MOCA catheter was passed to a position 2 cms. from the saphenofemoral junction. Catheter wire rotation was begun for 3 seconds at 3,500 rpm. With the wire rotating, infusion of sclerosant (1.5% sodium tetradecyl sulfate) and catheter pullback (1.5 mm./sec) was begun simultaneously. A total of 12 cc. of sclerosant was used for each GSV. The procedure does not require the instillation of tumescent anesthesia.
RESULTS: At 1 year 29 of 30 GSV were successfully treated. Primary closure rate 96.7%. At 2 years 24 patients were examined. All 24 remain closed. No DVT, nerve or skin injury occurred. Average total procedure time was 14 minutes. Catheter treatment time was 5 minutes. The MOCA technique has been modified; lower volumes are now used based on diameter and length of vein treated. Catheter placement is closer to SFJ (1 cm.).
CONCLUSIONS: MOCA is as efficacious at 2 years as current endothermal techniques without the need of tumescent anesthesia and more effective than reported results of foam sclerotherapy of the GSV. It is another alternative modality for most incompetent GSVs and SSVs.
AUTHOR DISCLOSURES: S. Elias, Covidien Inc., Consulting fees or other remuneration (payment), Vascular Insights LLC, Consulting fees or other remuneration (payment).
Posted April 2012