title: Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins.
abstract: Objective Mechanochemical ablation is a novel technique for ablation of varicose veins utilising a rotating catheter and liquid sclerosant. Mechanochemical ablation and radiofrequency ablation have no reported neurological side-effect but the rotating mechanism of mechanochemical ablation may produce microbubbles. Air emboli have been implicated as a cause of cerebrovascular events during ultrasound-guided foam sclerotherapy and microbubbles in the heart during ultrasound-guided foam sclerotherapy have been demonstrated. This study investigated the presence of microbubbles in the right heart during varicose vein ablation by mechanochemical abaltion and radiofrequency abaltion. Methods Patients undergoing great saphenous vein ablation by mechanochemical abaltion or radiofrequency ablation were recruited. During the ablative procedure, the presence of microbubbles was assessed using transthoracic echocardiogram. Offline blinded image quantification was performed using International Consensus Criteria grading guidelines. Results From 32 recruited patients, 28 data sets were analysed. Eleven underwent mechanochemical abaltion and 17 underwent radiofrequency abaltion. There were no neurological complications. In total, 39% (11/28) of patients had grade 1 or 2 microbubbles detected. Thirty-six percent (4/11) of mechanochemical abaltion patients and 29% (5/17) of radiofrequency ablation patients had microbubbles with no significant difference between the groups ( p=0.8065). Conclusion A comparable prevalence of microbubbles between mechanochemical abaltion and radiofrequency ablation both of which are lower than that previously reported for ultrasound-guided foam sclerotherapy suggests that mechanochemical abaltion may not confer the same risk of neurological events as ultrasound-guided foam sclerotherapy for treatment of varicose veins.
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: K H
authors: KH
authors: Moon
authors: 2 Academic Section of Vascular Surgery & Division of Experimental Medicine, Imperial College London, UK.
authors: B
authors: B
authors: Dharmarajah
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: R
authors: R
authors: Bootun
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: C S
authors: CS
authors: Lim
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: Tra
authors: T
authors: Lane
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: H M
authors: HM
authors: Moore
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: K
authors: K
authors: Sritharan
authors: 1 Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK.
authors: A H
authors: AH
authors: Davies
mesh_terms: D017115:Catheter Ablation; D004452:Echocardiography; D057510:Endovascular Procedures; D005260:Female; D005268:Femoral Vein / Q000601:surgery; D006321:Heart / Q000502:physiology*; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D011446:Prospective Studies; D011846:Radio Waves; D012501:Saphenous Vein / Q000601:surgery*; D012597:Sclerosing Solutions; D015911:Sclerotherapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014648:Varicose Veins / Q000601:surgery* / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions
keywords: Microbubbles; ablation; mechanochemical; radiofrequency; varicose veins