Outcomes After Mechanochemical Ablation Versus Endovenous Laser Ablation For Treatment Of Superficial Venous Insufficiency In A Safety Net Hospital
Joshua Hyunkee Kim, BS, BA, Ravi R. Rajani, MD, Christopher R. Ramos, MD, Jaime Benarroch-Gampel, MD, MS.
Emory University, Atlanta, GA, USA.
OBJECTIVES: While there is some data showing mechanochemical ablation (MOCA) has worse recanalization outcomes compared to endovenous laser ablation (EVLA) when treating chronic venous insufficiency, there is limited data regarding these differences in patients at safety net hospitals (SNH). Given differences in patient characteristics at SNHs, we wanted to examine the efficacy of EVLA versus MOCA in this population.
METHODS: This is a retrospective single-center study evaluating outcomes. Patients who had undergone either EVLA or MOCA at an urban safety net hospital from 5/1/2014 to 5/31/2020 were included. In 2017, there was a transition from EVLA to MOCA. Patients without postoperative ultrasounds were excluded. The primary outcome was freedom from recanalization of the treated vein after 2 years. Secondary outcomes included rates of post-operative local complications (including local pain, paresthesia, phlebitis, hematoma, access site infection, hyperpigmentation, endothermal heat-induced thrombosis), 2-years reintervention rate and 2-years patient-reported symptom recurrence. Data analysis was done using chi-square, T-test, Kaplan-Meier survival analyses.
RESULTS: 280 patients were analyzed. 186 (66.4%) patients underwent MOCA and 94 (33.6%) patients underwent EVLA. When compared to EVLA, patients who underwent MOCA were more likely to be performed in the outpatient clinic setting (49% vs 0%;P<.0001) and had larger treated segments (42.8cm vs 37.3cm;P=.0018). No significant differences were seen in age, sex, or presence of stasis ulcers. Postoperatively, patients who underwent MOCA had lower rates of local postoperative complications (10.5% vs 19.4%;P=.04). At 2 years, there was no difference in recanalization (9.7% vs 17%;P=.08, Figure 1a), reintervention (2.7% vs 7.5%;P=.06, Figure 1b) or symptom recurrence (22.7% vs 19.8%;P=.59) between patients who underwent MOCA compared to EVLA.
CONCLUSIONS: While there was a lower rate of overall complications in patients who underwent MOCA compared to EVLA, there were no significant differences in outcomes after 2 years. MOCA should be considered a non-inferior alternative for venous ablation when compared to EVLA. 
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