ClariVein^®, mechanochemical endovenous ablation: patient selection and perspective

Figures & data

Figure 1 The ClariVein^® mechanochemical ablation catheter.

Note: Photo courtesy of Merit Medical.

Figure 2 (A) Device inside the vein. (B) Mechanism action of action (Wire rotating and sclerosant injection).

Figure 3 Introduction of the catheter via sheath.

Figure 4 Ultrasound images showing tip of MOCA catheter.

Figure 5 Picture showing connection of syringe containing sclerosant to treatment device.

Notes: Initially a three-way tap, this has now been replaced by a built in non-return valve.

Table 1 Published prospective studies of mechanochemical ablation for saphenous reflux

Study author, Year	Vein	CEAP	Sample size (No. of limbs)	Diameter (mm)	Type of Sclerosant	Technical success	Anatomical success	Recanalize	Follow-up
Elias et al, 2012^13	GSV	C2-4a	30	8.1 mm (5.5–13)	STS 1.5%	100	96 (6 months)	1 vein	6 months
van Eekeren et al, 2011^21	GSV	C2-4	30	6.1 mm	POL 1.5%	100	87	N/A	6 weeks
Boersma et al, 2012^22	SSV	C2-6	50	4.8 (3.5–7)	POL (1.5 & 2%)	100	94 (44 out of 47)	3 veins	12 months
van Eekeren et al, 2014^23		C2-5	105	5.5 (5.0–7.0)	POL (l.5&2%)	99	88 (90 out of 102)	12 veins	12 months
Bishawi et al, 2014^26	GSV	C1-6	126	7.3±2.6	STS 1.5% and POL 1.5%	100	94 (120 out 126)	6 veins	6 months
Deijen et al, 2016^27	GSV/SSV	C2-6	506	N/A	POL (l.5&2%)	100	90% (92 for GSV 84% for SSV)	49 veins	12 weeks
Kim et al, 2017^28	GSV	C2-4	126	7.6	STS 1.5% (84) and POL 1.5% (16)	100	92% (65 out 126)	5 veins	24 months
Tang et al, 2017^29	GSV/SSV/	C2-C6	371	GSV 6.4 SSV 5	STS 2%	100	GSV 97 SSV 100	1 vein	8 weeks

Table 2 Published comparative studies of MOCA of superficial veins

Study author, Year	Vein	CEAP	Sample size (No. of limbs)	Diameter (mm)	Type of Sclerosant	Technical success	Anatomical success	Follow-up
van Eekeren et al, 2013^17 RFA Vs MOCA	GSV	Cl-6	68	RFA 5.7 MOCA 6.8	POL (1.5 and 2%)	N/A	N/A	6 weeks
Lane et al, 2016^11 RFA Vs MOCA	GSV/SSV	C2-6	170	7	STS 2%	N/A	93% for RFA 87% for MOCA	6 months
Leung et al, 2017^30 EVLA Vs MOCA	GSV/SSV	N/A	82	N/A	N/A	N/A	94% for EVLA 92% for MOCA	6 months
Khor et al, 2018^31	GSV/SSV	C2-5	180	GSV 5.6± 1.0 mm SVV 4.2± 1.2 mm	STS 2.0 %	100%	84.8% for GSV 94.3% for SSV	12 months

Table 3 MOCA advantages and disadvantages

Advantage	Disadvantage
• No need for an energy generator.	• Vein diameter if >20-24 mm
• Handheld (portable)	• Dose limitation of sclerosant
• Non-heated base, so no tumescence is required (reduce procedural time)	• May be difficult in partially occluded or fibrotic
• No risk of nerve injury when treating any below-knee segment of vein	• Compression stocking required
• Multiple, bilateral truncal vein to be ablated at the same session	• Pullback and inject sclerosant simultaneously
• Safe in a very superficial vein	• A learning curve for optimal results
• Access can be made retrograde in advanced venous disease	• Potential risk from sclerosant
• Steerable catheter so able to traverse tortuous veins	• Single use
• Available in different lengths