VENOUS INSUFFICIENCY
CLARIVEIN
Introduction
Last updated: apr 5, 2023
- Prevalence > 20% in Western population
- 5% suffer from venous edema, skin changes or ulcerations
- 0.5% active ulcers : 1.4% healed ulcers
Indications
- Clinical symptoms
- Aching
- Throbbing
- Heaviness
- Fatigue
- Pruritus
- Night cramps
- Restlessness
- Generalized pain
- Swelling
- Objective reflux
- 1 s reversed flow femoral or popliteal vein
- Deep femoral and perforating veins
- Perforators with a diameter > 3.5 mm
- Perforators located underneath an ulcer
- Refluxtijd ≥ 500ms (perforatoren ≥ 350ms)
Contra indications
Absolute
- Deep vein thrombosis (DVT) in the past six months (caution for deep venous obstruction with secondary varices essential for venous drainage)
- Acute superficial thrombophlebitis and migratory phlebitis
- Allergy to acrylate (type 4 hypersensitivity)
- Arterial insufficiency in Fontaine stages III and IV (Stage III marked by rest and nighttime pain; Stage IV with continuous pain and acral ulcerations). For arterial issues, adequate compression—crucial in sclerotherapy—cannot be used.
- Severe systemic illnesses, especially those involving bed confinement (acute infections, liver or kidney dysfunctions, neoplasms, severe chronic cardiac or respiratory diseases)
- Immobility due to musculoskeletal issues (typically accompanied by edema, intolerance to adequate compression, increased risk of thrombosis)
- Pregnancy and breastfeeding: Varices are typically not sclerosed during pregnancy as aethoxysclerol lacks a "safe during pregnancy" label. Veins often revert to normal size 8–10 weeks postpartum. If symptomatic, treatment is better scheduled prior to a subsequent pregnancy to prevent progression.
Relative
- History of recurrent DVT
- Clotting disorders with hypercoagulability
- Anticoagulant use
- Severe edema
- Complicating arteriosclerosis with risk of pressure necrosis
- Angiodysplasia, such as varices associated with Klippel-Trénaunay syndrome, where Duplex ultrasound should exclude deep vein anomalies
- Patient unable or unwilling to wear compression stockings
- **Clarivein-Specific**
- Bilateral GSV: Due to aethoxysclerol’s maximum dosage, treatment for 2 GSVs should be split into two sessions, or alternatively, consider VNUS instead of Clarivein for a single session. Bilateral SSV or accessory veins can be treated in one session with Clarivein.
- Small-caliber vein (<2mm) and short segment (<10 cm) require specific approaches.
The procedure in steps
- TOP
- Disinfect and drape skin
- Ultrasound-guided venous puncture and placement of 5Fr sheath
- Insert Clarivein catheter 1.5–2 cm distal to the junction
- Remove the plastic battery protection from the device
- Connect the device to the sheath (secure connection by right rotation)
- Aspirate 0.1 ml Aethoxyskerol for every cm
- Insert syringe in the device
- Treat vein by retracting catheter 1cm every 7 seconds while infusing 2% aethoxysclerol
- There is a white marker on the catheter indicating that you've reached the sheath
- Apply compression, bandage, and stocking
- SOP
Report
TOP. Huiddesinfectie en steriel afdekken. Echogeleide punctie van de VSM rechts en plaatsen 5Fr sheath. Inbrengen Clarivein catheter tot 1,5 cm distaal van de crosse. Roterend terugtrekken catheter (1cm / 7 sec) met gelijktijdige infusie van 2% aethoxysclerol. Hemostase. Aanbrengen steunkous. SOP.
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