There are many ways to treat varicose veins. One option is mechanochemical ablation (MOCA), more commonly known as ‘ClariVein’. Other established methods are endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and cyanoacrylate glue or “VenaSeal“. Essentially, all varicose vein procedures do the same thing – They close the vein that is not functioning as it should. This redirects the blood into veins which function well, and over time, varicose veins grow smaller, and the abnormal venous pressures in the leg normalize.
What’s mechanochemical ablation (ClariVein)?
ClariVein is the product most commonly used for mechanochemical ablation. In this procedure, your vein doctor makes a small incision in the middle of the lower thigh or upper calf over the greater saphenous vein. This is where the ClariVein catheter is inserted. Ultrasound is used to guide the catheter into the vein. The catheter has a rotating fiber at its end which irritates the inner lining of the damaged vein. After this mechanical ablation step is performed, a chemical solution is released into the vein. This solution causes fibrosis, which causes the vein to close.
What are the advantages of ClariVein?
ClariVein is fairly easy to use. This procedure usually takes about 30-minutes, and the patient can resume their daily activities almost immediately. It provides relief from symptoms such as pain, pressure, and swelling. Studies show that the venous clinical severity score (VCSS) that measures symptoms continues to improve for at least one year, and the quality of life improves as well.
Furthermore, since this procedure does not employ thermal energy (heat) to close the vein, it does not require the use of additional (tumescent) anesthesia during the procedure. Tumescent anesthesia is a weak solution of saline with lidocaine and sodium bicarbonate. This is typically injected around the treated vein in order to anesthetize the area during laser or radiofrequency ablation. This solution is not used with ClariVein
What are the disadvantages of ClariVein?
The main disadvantage of ClariVein is that long term data are still emerging. We know that the procedure works well for the first year or two. However, longer term studies are needed to show that it is at least as good as the current standard treatment which is radiofrequency ablation or laser ablation. So far, the early results are a bit inferior to vein ablation.
Futhermore, there is a limit to the amount of sclerosing agent that can be used in each person, and severe allergies to the sclerosing agent are rare, but possible. Tender lumps of trapped blood or discoloration may occur after the procedure. They will usually disappear after six weeks but occasionally may persist for several months.
Recurrence is possible as treated veins may reopen. This is especially true with larger veins. Since this technology is relatively new, its effects are studied for up to a year, and future studies will give us insights into beneficial effects beyond a year. Although this is a safe procedure, research suggests that it is less successful and less effective as compared to other options available today.
Here are some studies that found lower success rates with ClariVein:
- Mechanical Occlusion Chemically Assisted Ablation (MOCA) for GSV Insufficiency.
- RCT of mechanochemical and endovenous thermal ablation of varicose GSV.
- Three-year results of a RCT comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins.
What are the tried and true methods for vein ablation?
All methods of vein ablation can be effective. However, endovenous thermal ablation using laser (EVLT) and radiofrequency ablation (RFA) are the procedures most commonly used and with the highest rates of closure.
At the San Francisco Vein Center we offer laser ablation, radiofrequency ablation, and VenaSeal for treating varicose veins depending on symptoms, preferences, and priorities. We sometimes use laser (EVLT) for specific conditions that are better treated with laser. However, radiofrequency ablation is our preferred choice. This is because it is associated with slightly less discomfort of laser and no risk of allergic reaction of ClariVein or VenaSeal. Therefore, it usually offers the best balance of effectiveness, patient comfort, and risk.
At the San Francisco Vein Center, we recommend treatment plans suited for you. To discuss your symptoms, connect with us by either requesting an appointment or simply call us at 650-991-1122.