Bishawi M, Bernstein R, Boter M, Draughn D, Gould C F, Hamilton C, Koziarski J
SUNY at Stony Brook, Department of Surgery, Stony Brook, NY, USA
The Advanced Vein Treatment Center, Las Vegas, NV, USA.
Phlebology. 2014 Jul;29(6):397-400. doi: 10.1177/0268355513495830. Epub 2013 Jul 2.
There are several endovenous methods to ablate the saphenous vein, all of which require tumescent anesthesia. This report was designed to evaluate the efficacy of a tumescent-free technique using mechanochemical ablation (MOCA).
This was a prospective observational multicenter report on the efficacy of MOCA in selected patients with lower extremity chronic venous disease. Demographic information, clinical and procedural data were collected on a customized database. The distribution and extent of venous reflux and the closure rate of the treated veins were assessed with duplex ultrasound. Pain was evaluated during the procedure and postoperatively using an analog scale. The presence and severity of complications were recorded. Patient improvement was assessed by clinical-etiology-anatomy-pathophysiology (CEAP) class and venous clinical severity score (VCSS).
There were 126 patients that were included at baseline, 81% females, with a mean age of 65.5 ± 14 years. The average BMI was 30.5 ± 6. The mean diameter of the great saphenous vein in the upper thigh was 7.3 mm and the mean treatment length was 38 cm. Adjunctive treatment of the varicosities was performed in 11% of patients during the procedure. Closure rates were 100% at one week, 98% at three months, and 94% at six months. Post-procedure complications included hematoma 1%, ecchymosis 9%, and thrombophlebitis 10%. There were no cases of venous thromboembolism. There was significant improvement in VCSS (p < 0.001) for all time intervals.
MOCA of the saphenous veins has the advantage of endovenous ablation without tumescent anesthesia, making it an almost pain-free procedure. High occlusion rates with significant clinical improvement can be achieved with this method at short term.
有多种静脉内方法可用于消融大隐静脉，所有这些方法都需要肿胀麻醉。本报告旨在评估使用机械化学消融（MOCA）的无肿胀技术的疗效。
这是一份关于MOCA在选定的下肢慢性静脉疾病患者中的疗效的前瞻性观察性多中心报告。人口统计学信息、临床和手术数据收集于一个定制数据库。使用双功超声评估静脉反流的分布和程度以及治疗静脉的闭合率。在手术过程中和术后使用视觉模拟量表评估疼痛。记录并发症的发生情况和严重程度。通过临床-病因-解剖-病理生理学（CEAP）分级和静脉临床严重程度评分（VCSS）评估患者的改善情况。
共有126例患者纳入基线研究，其中81%为女性，平均年龄65.5±14岁。平均体重指数为30.5±6。大腿上段大隐静脉的平均直径为7.3mm，平均治疗长度为38cm。11%的患者在手术过程中对静脉曲张进行了辅助治疗。一周时闭合率为100%，三个月时为98%，六个月时为94%。术后并发症包括血肿1%、瘀斑9%和血栓性静脉炎10%。无静脉血栓栓塞病例。所有时间间隔的VCSS均有显著改善（p<0.001）。
大隐静脉MOCA具有无需肿胀麻醉的静脉内消融优势，使其几乎成为无痛手术。该方法在短期内可实现高闭塞率并带来显著的临床改善。
