ClariVein - Endovenous mechano-chemical ablation
1. Introduction
The Plymouth Vein Clinic is one of the first specialist vein centres in the South West to introduce this new "walk in, walk out" treatment for varicose veins. ClariVein® is special catheter with a rotating tip. The catheter also allows controlled delivery and dispersal of a sclerosant drug which is injected as the catheter is gradually withdrawn along the vein. In this way it combines the actions of mechanical damage to the lining of the vein by the rotating wire tip with the chemical action of the sclerosant drug, hence, the term mechano-chemical ablation.
2. Procedure
The procedure using ClariVein® requires insertion only of a thin catheter under local anaesthesia, not a large vascular sheath. The rotating tip of the ClariVein® device, combined with the targeted delivery of the sclerosant drug are used to occlude the vein. No tumescent anaesthetic is required, and hence there are no multiple injections, no internal leg pressure, less chance of nerve injury, or pain and bruising as a result of heat energy or surgical procedures.
3. Potential advantages over endovenous thermal ablation
During endovenous radiofrequency or laser thermal ablations treatments, tumescent anaesthesia is used to protect the surrounding tissue. This involves multiple injections of local anaesthetic plus saline fluid into the tissues surrounding the vein. In addition to the multiple injections required,this causes internal pressure on the leg which can be uncomfortable. No tumescent anaesthetic is required with ClariVein, and hence there are no multiple injections and the procedure is less painful. This is a potential advantage of ClariVein® over thermal ablation catheter techniques.
4. Longer term outcome
ClariVein® is a new technique so long term follow up of patients is not yet available to compare the resultswith Laser or Radiofrequency over periods of longer than one year. Published data so far suggests that ClariVein® is as effective as these techniques at the 6 month and the 12 month stage after treatment, and further follow up of cases is needed to assess effectiveness in the longer term - this information will be published in the open medical literature as it is acquired. ClariVein® is approved by NICE with special measures for consent, follow up and audit.
The wire tip rotates at 60 revs/second and damages the vein lining (intima). As the catheter is gradually withdrawn along the length of the vein a sclerosant drug is dispersed through the catheter tip. The combination of mechanical and chemical damage closes the vein. Because no heat is generated there is no need for tumescent anaesthesia thus avoiding multiple inections which makes the procedure far less painful than thermal ablation using laser or radiofrequency.
This image shows the left leg 3 weeks after ClariVein treatment. The right leg has not been treated yet. The varicose veins in the treated left leg were far worse than those shown in the untreated right leg.