Mechanochemical ablation versus cyanoacrylate glue closure for treatment of incompetent saphenous veins in C2-C4 patients: Three-year outcomes of a single-centre, single-operator experience.

Abstract

ObjectivesTo compare anatomical and clinical outcomes of mechanochemical ablation (MOCA; ClariVein®) and cyanoacrylate glue closure (CAG; VenaSeal™) for the treatment of incompetent great saphenous veins (GSV) and small saphenous veins (SSV) in patients classified as CEAP C2-C4, with follow-up to 3 years.MethodsRetrospective analysis of a prospectively maintained single-centre, single-operator database. Allocation to MOCA or CAG followed anatomical suitability and patient preference. Duplex follow-up was at 3 and 8 weeks and 6, 12, 24 and 36 months. The primary endpoint was complete occlusion. The venous segment was the unit of analysis; Kaplan-Meier estimates were compared by log-rank test and proportions by Fisher's exact test.ResultsA total of 214 venous segments were treated with MOCA (196 GSV, 18 SSV) and 161 with CAG (148 GSV, 13 SSV). Cohorts were comparable in vein diameter and segment length; CAG patients were older (median 45 vs 39 years). GSV occlusion at 24 months was 94.4% (95% CI 90.2-96.8) for MOCA and 96.6% (95% CI 92.3-98.5) for CAG (Fisher p = .441; log-rank p = .329). SSV occlusion was 77.8% (95% CI 54.8-91.0) in 18 MOCA segments and 100% (95% CI 77.2-100) in 13 CAG segments (Fisher p = .120; log-rank p = .075); with only 31 SSV segments the estimate is imprecise, and the non-significant result is not evidence of equivalence. Three-year results were identical to 24-month data. Symptom improvement was documented in both groups without obvious deterioration in association with late recanalisation; assessment was qualitative, without a validated instrument.ConclusionsCAG showed numerically higher GSV and SSV occlusion than MOCA at two and 3 years, but no difference reached statistical significance and the cohorts were not randomised. No obvious symptomatic deterioration was documented with late MOCA recanalisation, supporting a clinically led rather than duplex-led re-treatment strategy. Adequately powered randomised trials with 3-year follow-up are required.