RCT: Technical success rates of mechanochemical ablation are inferior to thermal option

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Sari Vähäaho

Three-year results of a randomised controlled trial reveal that, while mechanochemical ablation (MOCA) is a “feasible treatment option” in an outpatient setting, its technical success rates are inferior compared to endovenous thermal ablation. The findings were recently published online in the Journal of Vascular Surgery: Venous and Lymphatic Disorders.

The authors, Sari Vähäaho (Helsinki University, Helsinki, Finland) and colleagues, add that the use of MOCA in large calibre veins “should be carefully considered”.

The authors explain that MOCA is a non-thermal, non-tumescent method of treating saphenous vein insufficiency. “The feasibility and short-term results of MOCA are good,” they write. However, its long-term outcomes are “unknown”. In order to address this knowledge gap, Vähäaho et al performed a randomised study to compare MOCA with endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the setting of unilateral great saphenous vein.

Vähäaho and colleagues invited venous outpatient clinic patients with varicose veins (Clinical-Etiological-Anatomical-Pathophysiological [CEAP] class C2–4) caused by great saphenous vein insufficiency were invited to participate in the study; in total, 132 patients filled the inclusion criteria and were willing to participate.

They randomised patients to treatment (2:1:1 for MOCA, EVLA, and RFA, respectively). The state of the great saphenous vein with duplex Doppler ultrasound examination and the disease-specific quality of life were assessed at one month, one year, and three years after the treatment.

Vähäaho et al write that some patients declined to continue in the study after randomisation; in total, 117 patients underwent treatment.

The authors report that at three years, the occlusion rate was significantly lower with MOCA than with either EVLA to RFA (82% vs. 100%, p=0.005) and that quality of life was similar between the groups.

They add that in the MOCA group, great saphenous veins that were preoperatively over 7mm in diameter were more likely to recanalise during the follow-up period, and that the partial recanalisations of the proximal great saphenous vein observed at one year progressed during the follow-up.


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