title: A multi-centre randomised controlled trial comparing radiofrequency and mechanical occlusion chemically assisted ablation of varicose veins - Final results of the Venefit versus Clarivein for varicose veins trial.
abstract: Background Endovenous thermal ablation has revolutionised varicose vein treatment. New non-thermal techniques such as mechanical occlusion chemically assisted endovenous ablation (MOCA) allow treatment of entire trunks with single anaesthetic injections. Previous non-randomised work has shown reduced pain post-operatively with MOCA. This study presents a multi-centre randomised controlled trial assessing the difference in pain during truncal ablation using MOCA and radiofrequency endovenous ablation (RFA) with six months' follow-up. Methods Patients undergoing local anaesthetic endovenous ablation for primary varicose veins were randomised to either MOCA or RFA. Pain scores using Visual Analogue Scale and number scale (0-10) during truncal ablation were recorded. Adjunctive procedures were completed subsequently. Pain after phlebectomy was not assessed. Patients were reviewed at one and six months with clinical scores, quality of life scores and duplex ultrasound assessment of the treated leg. Results A total of 170 patients were recruited over a 21-month period from 240 screened. Patients in the MOCA group experienced significantly less maximum pain during the procedure by Visual Analogue Scale (MOCA median 15 mm (interquartile range 7-36 mm) versus RFA 34 mm (interquartile range 16-53 mm), p = 0.003) and number scale (MOCA median 3 (interquartile range 1-5) versus RFA 4 mm (interquartile range 3-6.5), p = 0.002). ' Average' pain scores were also significantly less in the MOCA group; 74% underwent simultaneous phlebectomy. Occlusion rates, clinical severity scores, disease specific and generic quality of life scores were similar between groups at one and six months. There were two deep vein thromboses, one in each group. Conclusion Pain secondary to truncal ablation is less painful with MOCA than RFA with similar short-term technical, quality of life and safety outcomes.
authors.affiliation: 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.|3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK.
authors.forename: Tristan
authors.initials: T
authors.lastname: Lane
authors.affiliation: 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Roshan
authors.initials: R
authors.lastname: Bootun
authors.affiliation: 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.|3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK.
authors.forename: Brahman
authors.initials: B
authors.lastname: Dharmarajah
authors.affiliation: 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.|3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK.
authors.forename: Chung S
authors.initials: CS
authors.lastname: Lim
authors.affiliation: 3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK.
authors.forename: Mojahid
authors.initials: M
authors.lastname: Najem
authors.affiliation: 3 Department of Vascular Surgery, London North West Hospitals NHS Trust, London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Renton
authors.affiliation: 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Kaji
authors.initials: K
authors.lastname: Sritharan
authors.affiliation: 1 Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.|2 Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D014648:Varicose Veins / Q000503:physiopathology / Q000601:surgery*
keywords: Varicose veins; endovenous ablation; mechanical occlusion chemically assisted ablation; pain; radiofrequency ablation; randomised controlled trial