Witte Marianne E, Holewijn Suzanne, van Eekeren Ramon R, de Vries Jean-Paul, Zeebregts Clark J, Reijnen Michel M P J
1 Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
2 Department of Surgery, Antonius Hospital, Nieuwegein, the Netherlands.
J Endovasc Ther. 2017 Feb;24(1):149-155. doi: 10.1177/1526602816674455. Epub 2016 Oct 15.
To report the midterm results of mechanochemical ablation (MOCA) for treating great saphenous vein (GSV) insufficiency.
In a 1-year period, 85 consecutive patients (median age 51.4 years; 71 women) undergoing MOCA with polidocanol in 104 limbs were enrolled in a prospective registry. The patients were evaluated at baseline and during follow-up (4 weeks and 1, 2, and 3 years) using duplex ultrasound, the CEAP (clinical, etiologic, anatomic and pathophysiologic) classification, the Venous Clinical Severity Score (VCSS), the RAND Short Form 36-Item Health Survey (RAND-SF36), and the Aberdeen Varicose Vein Questionnaire (AVVQ). Primary outcome measures were clinical and anatomic success. Secondary outcome measures included general and disease-specific quality of life and reinterventions.
Technical success (99%) was achieved in all but 1 patient in whom technical problems with the device led to conversion to another method for treatment of 2 limbs. After a median follow-up of 36 months (interquartile range 12.5, 46.3), recanalization occurred in 15 (15%) of 102 successfully treated vein segments. Anatomic success was 92%, 90%, and 87% after 1, 2, and 3 years, respectively. The VCSS improved at all time intervals compared to the preprocedure median. The clinical success at 3 years was 83%. The AVVQ and RAND-SF36 scores showed an improvement at all time intervals compared to baseline values. Between 12 and 36 months, however, a significant deterioration was observed in VCSS, which was accompanied by worsening of disease-specific and general quality of life.
In the longest follow-up of MOCA to date, this study shows MOCA to be an effective treatment modality for GSV insufficiency at midterm follow-up, but clinical results seem to drop over time.
报告机械化学消融术（MOCA）治疗大隐静脉（GSV）功能不全的中期结果。
在1年时间里，104条肢体接受聚多卡醇MOCA治疗的85例连续患者（中位年龄51.4岁；71名女性）被纳入前瞻性登记研究。在基线以及随访期间（4周、1年、2年和3年），使用双功超声、CEAP（临床、病因、解剖和病理生理）分类、静脉临床严重程度评分（VCSS）、兰德36项简明健康调查（RAND-SF36）和阿伯丁静脉曲张问卷（AVVQ）对患者进行评估。主要结局指标为临床和解剖学成功。次要结局指标包括总体和疾病特异性生活质量以及再次干预情况。
除1例患者外，所有患者均取得技术成功（99%），该例患者因设备技术问题导致2条肢体转而采用其他治疗方法。在对102条成功治疗的静脉段进行中位随访36个月（四分位间距12.5，46.3）后，15条（15%）出现再通。1年、2年和3年后的解剖学成功率分别为92%、90%和87%。与术前中位值相比，各时间点的VCSS均有所改善。3年时的临床成功率为83%。与基线值相比，AVVQ和RAND-SF36评分在各时间点均有所改善。然而，在12至36个月期间，观察到VCSS显著恶化，同时疾病特异性和总体生活质量也随之恶化。
在迄今为止对MOCA最长时间的随访中，本研究表明MOCA在中期随访中是治疗GSV功能不全的有效治疗方式，但临床结果似乎会随时间下降。
