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A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2016 March;23(1):68-75
A novel technique for closure of the perforator vein using the ClariVein® Occlusion Catheter
Rami O. TADROS, Peter L. FARIES, Kyle REYNOLDS, Chien Yi PNG, Sung Yup KIM, Windsor TING
Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
BACKGROUND: Perforator vein closure in patients with perforator incompetence and severe manifestation of venous disease is well described. In addition to surgical techniques, both laser and radiofrequency are commonly used to occlude incompetent perforator veins. We describe a unique application of the ClariVein® Occlusion Catheter to treat perforator insufficiency and review outcomes.
METHODS: A retrospective review of a maintained database was performed on all patients undergoing venous closure using the ClariVein® Occlusion Catheter. Patients treated for perforator insufficiency were identified and CEAP classification, indications for treatment, technical details, and follow-up data were recorded. Endpoints included technical success, symptom resolution, wound healing, and deep venous thrombosis (DVT) rates. Inclusion criteria for perforator closure included symptomatic patients with clinical class 4 or greater, 4 mm diameter, and reflux by Duplex.
RESULTS: A total of 131 veins were targeted with the ClariVein® Occlusion Catheter, of which, four perforator veins were treated in four patients. The clinical classifications were: C4 disease in two patients, C5 disease in one patient, and C6 disease in one patient. The etiology was primary disease in all cases. One patient had great saphenous vein (GSV) closure prior to perforator closure and three patients had the GSV and perforator closure in the same sitting. One perforator was accessed directly. This patient had a prior GSV closure and an active ulceration. The ulcer healed in three weeks after failing two months of conservative care. One perforator was accessed in an antegrade fashion via the GSV. Two were accessed in a retrograde fashion via the GSV after occluding the more proximal GSV. The intrinsic angle of the catheter was used to cannulate the perforator in all cases approached from the GSV with the aid of ultrasound guidance. Closure of the perforators was completed in all cases using only the mechanical component without the use of sclerosant. Technical success was achieved in all cases. Follow-up duplex confirmed perforator closure in all cases with no reported DVT. Symptom resolution was seen in all cases.
CONCLUSIONS: The ClariVein® Occlusion Catheter can successfully be used for primary perforator closure or for concomitant GSV and perforator closure. The technical success is high and several approaches to using this technique can be employed. No DVTs were seen in this series.