Mechanochemical ablation catheter as effective as current endothermal techniques

Society for Vascular SurgeryJun 10 2012

In its first human trial, the mechanochemical ablation (MOCA) catheter was efficacious at two years as current endothermal techniques, but without the need of tumescent anesthesia. In addition, MOCA was more effective than results of foam sclerotherapy of the great saphenous vein (GSV) and is another alternative modality for most incompetent GSV's and small saphenous veins (SSV's). Detailed results were presented today at the 66th Vascular Annual Meeting presented by the Society for Vascular Surgery®.

According to author Steve Elias MD, FACS, FACPh, Director of the Division of Vascular Surgery Vein Programs of Columbia University NY, MOCA utilizes a liquid sclerosant (sodium tetradecyl sulfate or aethoxysclerol) and a mechanical rotating wire to accomplish occlusion of incompetent GSV or SSV. The procedure is performed with local anesthesia at the access site only. It can be characterized as mechanically enhanced sclerotherapy performed in an office setting.

Thirty GSV's in 29 patients underwent micropuncture access with local anesthesia only. Through a 5 Fr.(1.7mm) micropuncture sheath the MOCA catheter was passed to a position 2 cm from the saphenofemoral junction. Catheter wire rotation was begun for three seconds at 3500 rpm. With the wire rotating, infusion of sclerosant (1.5 percent 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.

At one year 29 of 30 GSV were successfully treated. Primary closure rate 96.7 percent. At two years 24 patients were examined and all 24 remain closed. No deep venous thrombosis, nerve or skin injury occurred. Average total procedure time was 14 minutes and catheter treatment time was five minutes. The MOCA technique has been modified as the technique has evolved; lower volumes are now used based on diameter and length of vein treated. Catheter placement is begun closer to the saphenofemoral junction (1 cm.), wire rotation starts and sclerosant is infused 2 cm from the SFJ.