LINC, Christine Teichert, MD University Medicine of Rostock, Dept. of diagnostic and interventional radiology, Germany
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1 Comparison of the efficacy, safety, the primary and secondary technical success of the endovenous nonthermal, tumescensless mechanochemical ablation of varicose veins with the subjective outcome using different score-systems LINC, 2017 Christine Teichert, MD University Medicine of Rostock, Dept. of diagnostic and interventional radiology, Germany
2 Disclosure I have nothing to declare
3 MOCA-Study Background The most endovenous interventions for great (GSV) and small saphenous vein (SSV) insufficiency require thermal energy and instillation of tumescence anaesthesia MOCA is a tumescentless technique combining endovenous mechanical intimal injury with simultaneous infusion of a liquid sclerosans (polidocanol) to obliterate the veins MOCA has scientifically evidenced to be safe for the treatment of great saphenous vein insufficiency Bishawi M et al. Mechanochemical ablation in patients with chronic venous disease: a prospective multicenter report, phlebology july 2014, vol 29 no.6,
4 MOCA-Study Objective The prospective study aimed to determine the quality of life and regard the development of pain in social sphere of life before and 6 weeks, 6 month, 1 and 2 years after an operative intervention on varicose veins compared to the technical success and concerning the development of secondary varicosis
5 MOCA-Study Methods prospective study of consecutive patients, treated for GSV and SSV insufficiency with MOCA follow-up the improvement of the health-related quality of life using the modified version of the Tübinger Questionnaire, TLQ-CVI with 48 items) clinical examination using the CEAP-Score and VDS Additional using PDI to regard the development of pain and indeed duplex ultrasound before and after intervention, after 6 weeks, 6 month,1 and 2 years
6 MOCA-Study Patients inclusion criteria Gender: female, male Age: years Patients with duplex proven venous insufficiency of the GSV or SSV (CVI > C2) great saphenous vein diameter: 5-17 mm small saphenous vein diameter: 3-10 mm Length of GSV or SSV incompetence: > 10 cm unilateral or bilateral GSV/ SSV incompetence consent declaration of the patient
7 MOCA-Study Patients exclusion criteria pregnancy acute thrombophlebitis acute deep venous thrombosis occluded deep venous system allergy or intolerance against Hydroxypolyaethoxydodecanol, Polyethylenglycol- Monododecylether (Polidocanol) CVI independent symptoms of the leg, eg. peripheral arterial disease, neuropathy, lymphedema known or suspected pulmonalarterial embolism coagulation disorder
8 MOCA-Study Treatment using the ClariVein catheter (Vascular Insights, USA ) with Polidocanol under ultrasound guidance without tumescence anaesthesia without periinterventional antibiotics therapy periinterventional low molecular weight heparin post intervention compression stockings class II for 24 hours permanent followed by daytime wearing for 14 days
9 MOCA-Study Results 67 interventions on 52 patients (21m, 31f) 66 GSV und 1 SSV 2 year-results: - 36 interventions on 24 patients with - group 1: Jahre 19 patients - group 2: Jahre 17 patients - male: 12, female: 24-8/24 patients with previous Vein-stripping
10 MOCA-Study before after
11 MOCA-Study Ultrasound example: 66 years old woman, before MOCA
12 6 weeks after MOCA MOCA-Study
13 6 month after MOCA MOCA-Study
14 6 month after MOCA MOCA-Study
15 MOCA-Study 1 year after MOCA 2 years after
16 MOCA-Study periinterventional complications: 6/40 vein spasm 1/40 system malfunction postinterventional complications: hematoma: 7/40 Local phlebitis and pressure pain over the course: 7/40 No major- or minor complications
17 Technical success: MOCA-Study after 1 year: 36/40 (90%) obliteration - 1 complete open - 3 partial proximal open (10, 20, 30 cm) ( 3 discreet proximal open between 2-5 cm) after 2 years: 29/36 (81%) obliteration (1 patient died, 1 patient move away from Rostock) - 2 complete open - 5 partial open (2x10 cm, 14 cm (pregnant), 15 and 25 cm proximal) (11 discreet proximal open between 2-5 cm)
18 MOCA-Study CEAP classification C0 C1 C2 C3 C before 6 w 6 m 1 y 2 y
19 MOCA-Study VDS (Venous Disability Score) VDS 0 VDS 1 VDS 2 VDS 3 VDS before post 6 w 6m 1 y 2 y
20 MOCA-Study PDI social activity (mean points) 3.5 PDI PDI before post 6 w 6 m 1 y 2 y
21 MOCA-Study Results of QOL using vein insufficiency diseasespecific questionnaire (modified version of the Tübinger Questionnaire, TLQ-CVI) with 48 items
22 complaints on the legs (1-11) total before: 83 % after 6 weeks: 8% after 6 month: 10% after 1 year: 5% after 2 years: 11% preinterventional group 1: 81%, group 2: 84% after 2 years: group 1: 16%, group 2: 6% preinterventional male 93%, female 77% after 2 years: male: 0%, female 17%
23 discomfort because of CVI (12-15) total before: 90 % after 6 weeks: 15 % after 6 month: 5% after 1 year: 5% after 2 years: 6% preinterventional group 1: 86%, group 2: 95% after 2 years: group 1: 5%, group 2: 6% preinterventional male: 100 %, female: 85% after 2 years: male: 0%, female: 8%
24 improved comfort when standing (16-23) total before: 53 % after 6 weeks: 73% after 6 month: 85% after 1 year: 93% after 2 years: 86% preinterventional group 1: 52%, group 2: 53% after 2 years: group 1: 79%, group 2: 94% Preinterventional male: 43%, female: 58% after 2 years: male: 100%, female: 79%
25 fears and worries (24-29) total before: 78 % after 6 weeks: 15% after 6 month: 15% after 1 year: 8% after 2 years: 8% preinterventional group 1: 57%, group 2: 100% after 2 years: group 1: 5%, group 2: 12% Preinterventional male: 57%, female: 88% after 2 years: male: 0%, female: 13%
26 self-confidence (30-40) total before: 13 % after 6 weeks: 85% after 6 month: 85% after 1 year: 93% after 2 years: 97% preinterventional group 1: 5% (beauty?), group 2: 21% after 2 years: group 1: 95%, group 2: 88% preinterventional male: 14%, female 12% after 2 years: male: 100%, female: 88%
27 sense of well being (41-42) total before: 65 % after 6 weeks: 88% after 6 month: 88% after 1 year: 93% after 2 years: 97% preinterventional group 1: 71%, group 2: 58% after 2 years: group 1: 95%, group 2: 88% Preinterventional male: 64%, female 65% after 2 years: male: 100%, female: 88%
28 global satisfaction (43-48) total before: 15 % after 6 weeks: 83% after 6 month: 85% after 1 year: 93% after 2 years: 97% preinterventional group 1: 10%, group 2: 26% after 2 years: group 1: 95%, group 2: 88% Preinterventional male: 0%, female 23% after 2 years: male: 100%, female: 88%
29 MOCA-Study Conclusion MOCA is a safe treatment option for GSV- and SSV-insufficiency with a high technical success no severe adverse events, only minor side effects this intervention is able to improve the quality of life and reduce the pain in social sphere of life MOCA needs no anesthesia short intervention time
30 but after 2 years... in 15/36 cases (42%) development of secondary varicosis of lateral saphenous branches -> CVI is a chronic disease which needs a therapy for the whole life -> good therapeutic care/ informing reduce fears and worries, increase self-confidence and global-satisfaction
31 Thank you
32 Comparison of the efficacy, safety, the primary and secondary technical success of the endovenous nonthermal, tumescensless mechanochemical ablation of varicose veins with the subjective outcome using different score-systems LINC, 2017 Christine Teichert, MD University Medicine of Rostock, Dept. of diagnostic and interventional radiology, Germany
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