Learning objectives
- To describe the mechanism of a mechanochemical endovenous ablation (MOCA).
- To review indications and contraindications.
- To discuss outcomes,
possible complications,
feasible alternatives and radiologist’s role in endovenous treatment of varicose veins.
Background
Varicose veins are swollen,
deformed,
tortous veins,
that can occur anywhere,
but mostly they appear as branches of the great saphenous vein and small saphenous vein,
located in the subcutaneous tissues of the legs [1].
They are caused by a weakening of the vessel wall and incompetent valves,
which results in reflux of blood and venous hypertension [2].
They are a common problem in modern society,
affecting around one third of adults [2-5],
occuring morefrequently in women than men [5,
6].
Although the age of...
Findings and procedure details
Patients are put in the reversed Trendelenburg position.
An ultrasound is perfromed to better demonstrate the target vein for access,
the saphenofemoral junction,
perforators,
tributaries,
diameter and treatment length (Fig. 5).
First,
a micropuncture access with a4 Fr introducer sheathis obtained under an ultrasound and flushed with a saline liquid (Fig. 6).When using a 4 Fr sheath,
the incision wound is small enough,
that no infiltrative local anesthesia and cutaneous suturing afterwards is needed.
Theinfusion catheteris then inserted through the sheath and the distal tip...
Conclusion
Mechanochemical ablation is a novel,
radiation-free,
minimally invasive endovenous treatment on a walk-in–walk-out basis.
It has few complications and a good clinical improvment.
It requires a knowledge of duplex ultrasound and vascular interventional skills,
which radiologists do poses or have the potential to master.
During their residency and post-residency training,
they acquire a broad spectrum of other ultrasound based diagnostics and interventional skills,
such as in abdomen and musculoskeletal system,
as well as develop manual dexterity from more complex vascular interventional procedures,
such as percutaneous...
References
1.) Lin F,
Zhang S,
Sun Y,
Ren S,
Liu P.
The management of varicose veins.
International surgery.
2015 Jan;100(1):185-9.
2.) Campbell B.
Varicose veins and their management.
Bmj.
2006 Aug 3;333(7562):287-92.
3.) Callam MJ.
Epidemiology of varicose veins.Br J Surg.1994;81:167–173.
4.) Robertson L,
Evans C,
Fowkes FG.
Epidemiology of chronic venous disease.
Phlebology.
2008;23:103–111.
5.) Maurins U,
Hoffmann BH,
Lösch C,
Jöckel KH,
Rabe E,
Pannier F.
Distribution and prevalence of reflux in the superficial and deep venous system in the general population –...