Boersma D, van Haelst S T W, van Eekeren R R J P, Vink A, Reijnen M M J P, de Vries J P P M, de Borst G J
Department of Vascular Surgery, University Medical Centre, Utrecht, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Surgery, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands.
Department of Vascular Surgery, University Medical Centre, Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2017 Feb;53(2):290-298. doi: 10.1016/j.ejvs.2016.11.024. Epub 2016 Dec 23.
OBJECTIVE/BACKGROUND: Mechanochemical endovenous ablation (MOCA) has been developed as a tumescentless technique to ablate saphenous veins and to avoid heat induced complications and post-procedural pain. The mechanism of action of MOCA is poorly understood. The present experiments were conducted to determine the effect of MOCA on vein wall injury and sclerosis in an animal model.
A total of 36 lateral saphenous veins (LSVs) were treated in 18 goats according to the human protocol. Veins from nine goats were evaluated 45 min after the procedure, while in the remaining nine, the treated veins were evaluated 6 weeks later. All treated veins were divided equally over three treatment groups: (i) MOCA, (ii) mechanical ablation without the sclerosant, and (iii) liquid sclerotherapy alone. The histological effects of treatment on the vein wall were systematically evaluated.
The average diameter of the LSV was 4.0 ± 0.5 mm. Technical success was achieved in all but one LSV (35/36; 97%), with a median procedure time of 14 min (range 9-22 min). In the acute group, histological examination showed that mechanical ablation (alone or MOCA) induced severe injury to the endothelium in 82% but no damage to other layers of the vein wall. Mechanical ablation led to vasoconstriction. After 6 weeks follow-up, four of six MOCA treated veins were occluded. The occluded segments consisted mainly of fibrotic lesions probably evolved from organised thrombus. No occlusions were observed after sclerotherapy or mechanical treatment alone. No major complications occurred during procedures or follow-up.
MOCA is associated with an increased occlusion rate compared with its separated components of mechanical ablation or sclerotherapy. The occlusion consists of cellular fibrotic material likely to be evolved from organised thrombus with fibrotic alterations to the surrounding media and adventitia. This study underlines the hypothesis that the additive use of MOCA increases the effectiveness of sclerosants alone by inducing endothelial damage and probably vasoconstriction.
目的/背景：机械化学静脉内消融术（MOCA）已被开发为一种无肿胀技术，用于消融大隐静脉并避免热诱导并发症和术后疼痛。MOCA的作用机制尚不清楚。进行本实验以确定MOCA在动物模型中对静脉壁损伤和硬化的影响。
根据人体方案，对18只山羊的36条外侧大隐静脉（LSV）进行治疗。9只山羊的静脉在手术后45分钟进行评估，而其余9只山羊的治疗静脉在6周后进行评估。所有治疗的静脉平均分为三个治疗组：（i）MOCA，（ii）不使用硬化剂的机械消融，（iii）单纯液体硬化疗法。系统评估治疗对静脉壁的组织学影响。
LSV的平均直径为4.0±0.5mm。除一条LSV（35/36；97%）外，所有手术均获得技术成功，中位手术时间为14分钟（范围9-22分钟）。在急性组中，组织学检查显示机械消融（单独或MOCA）在82%的情况下导致内皮严重损伤，但对静脉壁的其他层没有损伤。机械消融导致血管收缩。随访6周后，6条MOCA治疗的静脉中有4条闭塞。闭塞段主要由可能由机化血栓演变而来的纤维化病变组成。单纯硬化疗法或机械治疗后未观察到闭塞。手术或随访期间未发生重大并发症。
与机械消融或硬化疗法的单独成分相比，MOCA的闭塞率增加。闭塞由细胞纤维化物质组成，可能由机化血栓演变而来，周围中膜和外膜有纤维化改变。本研究强调了这样一种假设，即MOCA的联合使用通过诱导内皮损伤和可能的血管收缩，增加了单纯硬化剂的有效性。
